Clinical Scorecard: Insights Gained from a Geriatric Referral Approach for Individuals Living with HIV
At a Glance
Category
Detail
Condition
Aging-related geriatric syndromes in people with HIV
Key Mechanisms
HIV-associated inflammation, long-term antiretroviral therapy side effects, socioeconomic factors leading to accentuated and accelerated aging
Target Population
People with HIV aged 50 years or older, especially high-risk individuals with geriatric syndromes or polypharmacy
Care Setting
Outpatient infectious disease clinic with referral to a geriatric primary care clinic
Key Highlights
People with HIV experience earlier and higher prevalence of geriatric syndromes such as falls, dementia, frailty, and cardiovascular disease.
A referral-based geriatric consultation model was implemented to improve access to geriatric care for people with HIV aged ≥50 years.
Barriers to program uptake included lack of provider and patient consensus on geriatric care utility, geriatrician shortages, polypharmacy challenges, and financial constraints.
Guideline-Based Recommendations
Diagnosis
Screen patients for functional status, preventative care needs, socioenvironmental factors, and cognitive/mental health concerns during geriatric consultation.
Identify high-risk patients with geriatric syndromes, hyper-polypharmacy (≥10 medications), multimorbidity (≥2 chronic conditions), or need for advance care planning.
Management
Geriatricians provide recommendations on referrals to health or community services, medication adjustments, osteoporosis screening, and memory problem management.
Discuss advance directives with all patients during geriatric visits.
Monitoring & Follow-up
Communicate geriatric assessment findings and recommendations to primary HIV providers for ongoing care coordination.
Risks
Polypharmacy and multimorbidity increase complexity of care and risk of adverse outcomes.
Limited geriatric care access may delay identification and management of geriatric syndromes.
Patient & Prescribing Data
People with HIV aged ≥50 years, particularly those on ≥10 medications including antiretroviral therapy
Medication changes were recommended in 8 of 11 patients undergoing geriatric consultation, highlighting the importance of addressing polypharmacy.
Clinical Best Practices
Implement referral-based geriatric consultation for high-risk older adults with HIV to address complex aging-related needs.
Use standardized screening tools for functional, cognitive, and socioenvironmental assessments during geriatric visits.
Engage HIV providers in identifying and referring appropriate patients to geriatric care.
Discuss advance care planning routinely with aging patients living with HIV.
Address barriers such as provider and patient perceptions, co-location of services, and resource limitations to improve program uptake.
