Clinical Report: Geriatric Referral Model for Older Adults with HIV
Overview
A referral-based geriatric consultation program for people with HIV aged 50 and older was implemented at the University of Colorado. Despite identifying 903 eligible patients, only 11 underwent consultation, revealing barriers to uptake despite positive provider feedback and meaningful geriatric recommendations.
Background
People with HIV experience geriatric syndromes at higher rates and earlier ages compared to the general population, due to factors like HIV-associated inflammation and antiretroviral therapy side effects. Geriatricians can provide specialized care addressing functional status, cognitive health, and polypharmacy. Various clinical models exist to integrate geriatric care into HIV management, but optimal strategies remain unclear. The University of Colorado implemented a referral model to connect high-risk older adults with HIV to geriatric care.
Data Highlights
Metric
Value
Eligible patients ≥50 years
903
Patients receiving geriatric consultation
11
Average age of consulted patients
69 years (SD 7.4; range 59–80)
Recommendations for referral to other services
9 patients
Medication changes recommended
8 patients
Osteoporosis screening recommended
6 patients
Management of memory problems
5 patients
Advanced directives discussed
All visits (11/11)
Key Findings
Only 11 out of 903 eligible patients underwent geriatric consultation despite active recruitment efforts.
Geriatricians provided recommendations on referrals, medication adjustments, osteoporosis screening, and memory management.
Advanced care planning was addressed in every geriatric consultation visit.
Most primary HIV providers expressed willingness to refer future patients to the program.
Barriers to program uptake included lack of consensus on geriatric care utility, non-co-located clinics, polypharmacy challenges, geriatrician shortages, and financial constraints.
Clinical Implications
Referral-based geriatric consultation can identify and address complex needs in older adults with HIV, including medication management and advance care planning. However, integration challenges such as clinic location, provider and patient perceptions, and resource limitations must be addressed to improve access and utilization. Collaborative models and education may enhance uptake and optimize care for this population.
Conclusion
The geriatric referral model improved access to specialized care for older adults with HIV but faced significant barriers limiting participation. Addressing these challenges is essential to better serve the aging HIV population with comprehensive geriatric assessment and management.
References
University of Colorado Study 2018-2019 -- Insights from a Geriatric Referral Approach for Individuals Living with HIV
