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Frailty Accelerates Aging/Mortality: INTEGRATE Care for Older PWH
Integrating [differential] approaches to older people living with HIV
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Fatima Branas
Download the PDF
EACS 2023 Oct 18-21
Dr Banas draws attention to that we should differentiate patients - some - 35% had no geriatric syndromes in her cohort and 29% who are frail or suffering from 1 or more geriatric syndromes - from those that are frail & have comoebidities and thus need attention, that we must provide differentiated care for those that do or don't need it.
"challenge is now....we cannot wait...
......long term survivors with a very heavy back-pack because history of IV drug use for years, taking HIV mediations for more than 20 years - toxicity of medications in early years, MSM with healthy aging-active life, women diagnosed in old age, high volume with psychiatric illness - most have never worked, PWH who need basic care because their disabilities - DO YOU REALLY THINK WE ARE CONSIDERING ALL THESE DIFFERENCES in the Clinical MGT of older PWH ? Its mandatory we establish clinical profiles of patients with common needs and then we can design approaches specific for each group" Dr Branas
"any tool is better than no tool, otherwise we will be waiting for the perfect tool, and it will take years. When you have a positive screening tool result you have to make a more positive evaluation of the patient. If you have access to a geriatrician you have to involve them, but if you dont you have to define 4 points to evaluate:
1 - make sure patient does not have an untreated disease like hypothyroidism or cancer,
2 - assess polypharmacy & DDIs & timing of dosing of medications during the day,
3 - physical exercise for all frail patients - physical exercise is the only intervention that's been demonstrated for reversing frailty,
4 - ensure patient is eating enough proteins because muscles are absolutely important for reversing frailty so without proteins its not possible". Dr Branas
in her cohort study
35% have no geriatric syndromes, no comorbidity, no frailty. But 29% who are frail or are suffering with 1 or more geriatric syndromes.
Funcrail published study pdf attached.
WHAT IS A GERIATRIC SYNDROME? Inability or challenges to perform many normal activities of daily living: like shopping, cooking, showering, taking public transportation, not communicating easily with others, fatigue, inability to focus clearly mentally, challenges in maintain relationships.
The term "geriatric syndrome" is a commonly used but ill-defined concept among internists and geriatricians alike. Many conditions have been called "geriatric syndromes" including delirium,1 dementia,1 depression,2 dizziness,3 emesis,4 falls,1 gait disorders,1 hearing loss,1 insomnia,1 urinary incontinence,1 language disorders,1 functional dependence,5 lower extremity problems,6 oral and dental problems,6 malnutrition,1 osteoporosis,1 pain,1 pressure ulcers,1 silent angina pectoris,7 sexual dysfunction,6 syncope,6 and vision loss.1 This leaves the impression that any commonly encountered condition in older persons is a geriatric syndrome. Can this be possible? What specifically is a geriatric syndrome anyway?
https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1046/j.1532-5415.2003.51174.x
Geriatric Syndromes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732407/
"challenge is now.
long term survivors with a very heavy back-pack because history of IV drug use for years, taking HIV mediations for more than 20 years - toxicity of medications in early years, MSM with healthy aging-active life, women diagnosed in old age, high volume with psychiatric illness - most have never worked, PWH who need basic care because their disabilities - DO YOU REALLY THINK WE ARE CONSIDERING ALL THESE DIFFERENCES in the Clinical MGT of older PWH ? Its mandatory we establish clinical profiles of patients with common needs and then we can design approaches specific for each group" Dr Branas
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