AND ABSTRACT Due in large part to the successful development of antiretroviral therapy, adults with HIV infection are living longer; in the developed world, including the United States, over one-third of people living with HIV are age 50 or older. This aging population increasingly experiences geriatric conditions such as multimorbidity, polypharmacy and frailty. Comprehensive geriatric assessment (CGA), which includes assessment and management of conditions such as functional impairment, cognitive and mental health, could help improve care for older adults with HIV infection, but how to optimally integrate CGA into HIV care is unknown. Specifically, little is known about outcomes associated with care interventions incorporating CGA for this population or acceptability of such interventions by patients and providers. This proposal will build on a prior care intervention known as the ?Silver Project? which incorporated elements of CGA in an urban HIV clinic, Ward 86 at San Francisco General Hospital, to address these gaps. Specifically we will first evaluate the value and impact of CGA on clinical care for older HIV-positive adults by a) examining how providers utilized Silver Project results and recommendations and b) examining if geriatric conditions identified are associated with healthcare utilization. This will be accomplished by electronic medical record review for how providers utilized the information as well as data on healthcare utilization. Next we will incorporate this data to refine the Silver Project intervention and assess the refined strategy for feasibility, acceptability by patients and providers, and association with improvement in quality of life and other patient reported outcomes. Improvement in patient reported outcomes will be assessed by conducting a pre-post analysis of participant results and a comparison to other patients who have patient reported outcomes collected as part of usual care. The data from this proposal will contribute towards the PI's goal of developing a clinical care intervention that incorporates geriatric assessments to improve the quality of life for older adults living with HIV. This proposal aligns with the NIA GEMSSTAR program's goal of supporting a young investigator in geriatrics to bridge the fields of geriatrics and HIV medicine to improve clinical care for older adults living with HIV infection.
The number of adults age 50 or older living with HIV is dramatically increasing in the United States and they are now facing unique health needs. To address these health needs, this project will first examine the impact of a prior HIV and aging care model and then use what is learned to improve the care model and re-evaluate it. Ultimately, the information learned from this project will lead to the development of healthcare models to improve quality of life and overall care for the aging HIV population.
