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Accelerated or Premature Aging & Comorbidities
for PLWH & The Need To Fix Healthcare
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It is well recognized that PLWH are speedily aging as group, which many are calling the "Silver Tsunami". Right now its estimated 55% of PLWH in the USA are >50 but 250,000 are >60, and its predicted that by 2030 70% will be over 50 and 400,000 will be over 60. In NYC 80% are over 40 now & 30% are over 60, and by 2030 80% will be over 50 and 50% will be over 60. Similar numbers for SF are expected. However, not only are we unprepared for this "silver Tsunami" but currently elderly PLWH are not getting their care needs met and older PLWH are not getting screened for elder care needs like cognitive impairment, pre-frailty, and mobility.
Elderly PLWH over 65 suffer accelerated or premature aging - earlier onset of comorbidities (e.g. heart disease, kidney, bone disease, frailty, cancers, cognitive and physical function impairment) and at higher rates compared to the general population. Many studies show older PLWH experience 2-5 times higher rates of key comorbidities and earlier onset by 7-20 years. As well the well recognized large Kaiser Permanente Study reported 2 years ago 9 years shorter lifespan for PLWH compared to HIV-negatives. Studies also show African-Americans with HIV have shorter lifespan than Whites with HIV, and studies show PLWH with multimorbidities can have shorter lifespan. Studies in Medicare populations show HIV+ African-Americans & Latinos have 3-5 times higher rates of these comorbidities and higher mortality rates.
The point is - Elderly PLWH >65 are not getting their care needs met in HIV clinics. Doctor visits and specialists visits are 15-20 minutes, so there is so too little time to provide the care and attention they need. HIV Clinics are often understaffed & overwhelmed and unable to provide good care, and there is no care coordination for an elderly or older population with many challenges. This spells bad outcomes for our current elderly PLWH population and unless the system is fixed bad outcomes for PLWH in their 50s aging into elder years.
It is recommended that PLWH a age 50 get screened with Bone Mineral Density test, yet many clinics never do this test ever. As older PWH age into their 60s cardiovascular testing & monitoring should begin but all too often this does not happen. Many elderly PLWH have hard to manage diabetes yet support programs for them re non-existent, as well falls prevention programs are present in the non-HIV care setting but not in HIV clinical care setting. And cognitive impairment support or training programs are as well non-existent in HIV clinics.
The new IAS-USA HIV Guidelines just released say OPLWH >50 should receive elder screenings for cognitive impairment, mobility, physical function, frailty and Bone Mineral Density testing. So all HIV clinics should be providing this care. This is a new Standard of Care set by IAS, whose panel are leading HIV researchers and clinicians.
As well, prevention care and services are needed to try to prevent accelerated or premature aging in PLWH, which must include services and support around diet, exercise, physical therapy, mental health care, lifestyle changes to encourage a healthy living lifestyle that might help to slow aging and onset for comorbidities.
Funding to support these programs can be provided by HRSA for RWCare clinics or from other sources.
Jules Levin
NATAP
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