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Three Quarters of Spanish Geriatricians
Uncomfortable With HIV Patients
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International Workshop on HIV and Aging, October 13-14, 2022
By Mark Mascolini for NATAP and Virology Education
Nearly three quarters of geriatricians in a national survey in Spain said they feel uncomfortable evaluating a person with HIV, and they rarely saw an HIV patient in the past year [1]. But surveyed geriatricians and HIV specialists agreed management of older people with HIV should be multidisciplinary.
As HIV populations around the world age into the later decades of life, questions arise about whether and how geriatricians should become involved in their care. To address these issues, Spanish researchers developed 12 questions for geriatricians and HIV specialists and distributed surveys during 1 week in March 2022 through national scientific societies. Ninety-four geriatricians and 63 HIV specialists responded anonymously,
Almost three quarters of geriatricians, 71%, said they feel "uncomfortable" evaluating people with HIV, while another 3% feel "out of place." Those responses make sense when one learns that 86% of geriatricians saw 1 or no HIV patients in the last year, while another 12% saw 5 to 10 and only 2% saw more than 10. About half of geriatricians considered an HIV patient "older" when they turn 65, while one quarter believed "older" means at least 75 year and another quarter gave the cutoff at age 50 (the age often cited in HIV literature). Only 6% of geriatricians thought "older" people with HIV made up half of the global HIV population (the correct answer), while the rest thought "older" patients made up 10% to 30% of the global HIV population.
In a question for HIV specialists, 92% agreed with the European AIDS Clinical Society that everyone older than 50 with HIV should be screened yearly for frailty, but three quarters did not screen because they did not have time, did not know how to screen, or would not know what to do if a person screened positive.
When asked if they thought the model of care for older people with HIV should change, 79% of HIV specialists and 91% of geriatricians agreed the model should change by becoming multidisciplinary. While 71% of HIV specialists believe geriatricians should collaborate in a multidisciplinary team in selected cases of older people with HIV, 55% of geriatricians agreed. Among geriatricians, 41% said geriatricians should collaborate in all cases of older HIV patients, while 8% of HIV specialists saw a need for geriatricians in all cases.
The survey found close agreement between geriatricians (83%) and HIV specialists (87%) on the belief that presence of geriatric syndromes like frailty-not chronological age-should be the reason for referring an older person with HIV to a geriatrician. Almost all geriatricians (98%) think they need special training to care for older people with HIV, and 81% of HIV specialists believe all professionals working with HIV patients need special training to detect geriatric syndrome. Another 17% of HIV specialists think all professionals would need special training only for certain syndromes.
The researchers concluded that (1) geriatricians lack knowledge about older people with HIV and are not yet involved in their care, (2) HIV specialists are open to multidisciplinary care of older HIV patients, and (3) geriatricians need specific training to ensure the best care of this older cohort.
Reference
1. Brañas F, Martínez S, Polo R, Sánchez-Conde M. Needs and involvement of HIV specialists and geriatricians in the care of older adults with HIV. A national survey. International Workshop on HIV and Aging, October 13-14, 2022. Abstract 9.
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