Comprehensive Geriatric Assessment in Older Persons With HIV

Sangarlangkarn, Aroonsiri; Appelbaum, Jonathan

doi:10.1093/ofid/ofaa485

Cited by 15 publications

(10 citation statements)

References 65 publications

(66 reference statements)

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“…We included 56 participants in this study (34 OALWH,11 healthcare providers and 11 primary caregivers) after reaching data saturation. All approached participants agreed to participate.…”

Section: Summary Of Participant Characteristicsmentioning

confidence: 99%

“…Despite limited research on ageing with HIV, especially in SSA 5,6 , existing evidence suggests that apart from physical health challenges, OALWH face unique mental health burdens and challenges to their social well-being that may differ from their uninfected peers and younger counterparts, e.g. elevated comorbidity and early-onset geriatric conditions [6][7][8][9][10][11] . Despite the observed challenges, intervention research designed to address the unique needs of OALWH is insufficient 12 , and it is unclear how these adults cope and age with HIV, especially in SSA, where the health system is largely unprepared to meet their complex healthcare needs.…”

Section: Introductionmentioning

confidence: 99%

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Strategies for improving mental health and wellbeing used by adults ageing with HIV: a qualitative exploration

Mwangala¹,

Wagner²,

Newton³

et al. 2022

Wellcome Open Res

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Background: Physical and mental health problems are common among older adults living with HIV (OALWH). Adaptive coping strategies play a vital role in improving these adults' mental health and well-being despite the deleterious effects of HIV and ageing. However, in sub-Saharan Africa, limited evidence exists on the commonly utilized coping strategies in this population. We explore the coping strategies used by Kenyan OALWH to improve their mental health and wellbeing. Methods: Semi-structured in-depth interviews were conducted between October and December 2019 with 56 participants: 34 OALWH (53% female), 11 healthcare providers (63% female) and 11 primary caregivers (73% female) in Kilifi County. All interviews were audio-recorded and transcribed verbatim. We used the framework approach to synthesize the qualitative data. Results: Five major themes emerged from the analysis of participants’ narratives, including self-care practices, religion and spirituality, relational living (social connectedness), generativity, identity, and mastery. Our study further revealed maladaptive coping strategies, including reliance on over-the-counter medications, self-isolation, waiting to see if symptoms would subside despite doing nothing, and HIV treatment interruptions during prolonged periods of prayer and fasting. Conclusions: Our findings provide an initial understanding of the coping strategies used by OALWH to confront HIV and ageing challenges in a low-literacy, low socio-economic Kenyan setting. Our results suggest that interventions designed to enhance personal capacity, social support, positive religiosity and spirituality, and intergenerational connections may be beneficial in improving the mental health and well-being of OALWH.

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“…We included 56 participants in this study (34 OALWH,11 healthcare providers and 11 primary caregivers) after reaching data saturation. All approached participants agreed to participate.…”

Section: Summary Of Participant Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Strategies for improving mental health and wellbeing used by adults ageing with HIV: a qualitative exploration

Mwangala¹,

Wagner²,

Newton³

et al. 2022

Wellcome Open Res

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“…Prior studies have recommended quick, simple tools for use by HIV clinicians to assess function and cognition [ 22 ], including the mini-cog or Montreal Cognitive Assessment (MoCA) for cognition, and the Timed Get-Up-and-Go (TUG) test or ADL/IADL for function. An article by Sangarlangkarn et al provided guidance on how best to implement such screenings in a busy HIV practice [ 22 ].…”

Section: Strategies On Applying Existing Guidelines To Older Pwhmentioning

confidence: 99%

HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV

Sangarlangkarn

Yamada

2021

Pathogens

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With advances in antiretroviral therapy and subsequent increase in life expectancy, People with HIV (PWH) now experience multiple geriatric syndromes in the setting of advanced aging and increased multimorbidity. HIV clinicians bear the responsibility of delivering geriatric care to this vulnerable population, despite limited geriatric medicine training and limited support from HIV service networks that were not traditionally designed to care for an aging population. Although HIV clinicians reported formal guidelines specific to older PWH to be among the most helpful interventions, current HIV guidelines present multiple issues in their applicability to the care of older PWH, including multifactorial nature of conditions in older adults, difficulty measuring patient-centered outcomes, lack of representation of older PWH in clinical trials, limited guidelines addressing geriatric syndromes, and the use of chronological age as criteria for inclusion despite advanced aging in PWH. Understanding that updated guidelines addressing above challenges may take many years to develop, we offer strategies on the application of current guidelines, including using baseline attributes, time to benefit, and the Geriatrics 5M model to aid in shared decision making and improve outcomes among older PWH.

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“…Antiretroviral treatment of human immunodeficiency virus (HIV) infection has afforded people with HIV (PWH) near-normal longevity [1,2]. Accompanying the extended life span is the potential of age-related declines in motor functions [3][4][5], including instability of standing balance [6].…”

Section: Introductionmentioning

confidence: 99%

Postural instability in HIV infection: relation to central and peripheral nervous system markers

Sullivan

Zahr

Sassoon

et al. 2023

Aids

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Objectives: Determine the independent contributions of central nervous system (CNS) and peripheral nervous system (PNS) metrics to balance instability in people with HIV (PWH) compared with people without HIV (PWoH).Methods: Volumetric MRI (CNS) and two-point pedal discrimination (PNS) were tested as substrates of stance instability measured with balance platform posturography.Design: 125 PWH and 88 PWoH underwent balance testing and brain MRI. Results:The PWH exhibited stability deficits that were disproportionately greater with eyes closed than eyes open compared with PWoH. Further analyses revealed that greater postural imbalance measured as longer sway paths correlated with smaller cortical and cerebellar lobular brain volumes known to serve sensory integration; identified brain/ sway path relations endured after accounting for contributions from physiological and disease factors as potential moderators; and multiple regression identified PNS and CNS metrics as independent predictors of postural instability in PWH that differed with the use of visual information to stabilize balance. With eyes closed, temporal volumes and twopoint pedal discrimination were significant independent predictors of sway; with eyes open, occipital volume was an additional predictor of sway. These relations were selective to PWH and were not detected in PWoH. Conclusion:CNS and PNS factors were independent contributors to postural instability in PWH. Recognizing that myriad inputs must be detected by peripheral systems and brain networks to integrate sensory and musculoskeletal information for maintenance of postural stability, age-or disease-related degradation of either or both nervous systems may contribute to imbalance and liability for falls.

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Comprehensive Geriatric Assessment in Older Persons With HIV

Cited by 15 publications

References 65 publications

Strategies for improving mental health and wellbeing used by adults ageing with HIV: a qualitative exploration

Strategies for improving mental health and wellbeing used by adults ageing with HIV: a qualitative exploration

HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV

Postural instability in HIV infection: relation to central and peripheral nervous system markers

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