Evaluation of a Combined HIV and Geriatrics Clinic for Older People Living with HIV: The Silver Clinic in Brighton, UK

Levett, Tom; Alford, Katie; Roberts, Jonathan C.; Adler, Zoe; Wright, Juliet; Vera, Jaime H.

doi:10.3390/geriatrics5040081

Cited by 22 publications

(51 citation statements)

References 48 publications

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“…Few integrated care programs for older people with HIV have been evaluated. The findings in this and in previous assessments of Golden Compass [ 15 ] are consistent with the limited literature demonstrating high patient and provider satisfaction with care models that incorporated geriatric medicine in HIV care [ 22 , 23 ]. Principles of geriatric medicine emphasize a comprehensive problem-solving approach to sustaining functional ability and improving quality of life [ 22 , 23 ].…”

Section: Discussionsupporting

confidence: 89%

“…The findings in this and in previous assessments of Golden Compass [ 15 ] are consistent with the limited literature demonstrating high patient and provider satisfaction with care models that incorporated geriatric medicine in HIV care [ 22 , 23 ]. Principles of geriatric medicine emphasize a comprehensive problem-solving approach to sustaining functional ability and improving quality of life [ 22 , 23 ]. Our findings illustrate that the Golden Compass multidisciplinary team embedded within an HIV clinic contributed to self-reported improved knowledge and confidence among providers in caring for patients, which aligns with other models of HIV care for older adults involving both a general practitioner and specialists [ 22 ].…”

Section: Discussionsupporting

confidence: 89%

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Examining the Impact of the Golden Compass Clinical Care Program for Older People with HIV: A Qualitative Study

et al. 2021

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The combined burden of geriatric conditions, comorbidities, and HIV requires a model of HIV care that offers a comprehensive clinical approach with people 50 years or older with HIV. Golden Compass is an outpatient, multidisciplinary HIV-geriatrics program with an onsite HIV geriatrician, cardiologist, pharmacist, and social worker, offering specialist referrals, care navigation, and classes on improving functional status and cognition. Participants (13 patients and 11 primary care providers) were recruited using a non-probability sampling method to participate in semi-structured interviews on the perceived impact of Golden Compass on care delivered to older people with HIV. Interviews were transcribed verbatim and framework analysis used to analyze the transcripts. The perceived impacts of Golden Compass by patients and providers were organized by the Compass points (Northern: Heart and Mind, Eastern: Bones and Strength, Southern: Navigation and Network, Western: Dental, Hearing, and Vision). Overall, patients valued the focus on functional health and whole-person care, leading to greater trust in the ability of providers. Providers gained new skills through the geriatrics, cardiology and/or pharmacist consultations. The HIV-geriatrics specialty approach of Golden Compass improved functional ability and quality of life for older adults with HIV. Few integrated care programs for older people with HIV have been evaluated. This study adds to the limited literature demonstrating high patient and provider satisfaction with a HIV-care model that incorporated principles of geriatric medicine emphasizing a comprehensive approach to sustaining functional ability and improving quality of life.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Examining the Impact of the Golden Compass Clinical Care Program for Older People with HIV: A Qualitative Study

et al. 2021

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“…Currently there is no gold standard model for managing people living with HIV as they age. Several models have been proposed internationally including joint HIV and geriatric medicine clinics such as the 'Silver Clinic' in Brighton, UK, and the 'Golden Compass Programme' in San Francisco, US [11,12]. As many HIV physicians may be unfamiliar with frailty, while geriatricians lack experience of HIV, joint services such as these may allow for more holistic care.…”

Section: Introductionmentioning

confidence: 99%

What problems associated with ageing are seen in a specialist service for older people living with HIV?

et al. 2021

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Objectives: By 2030 the majority of the people living with HIV in the United Kingdom will be over the age of 50. HIV services globally must adapt to manage people living with HIV as they age. Currently these services are often designed based on data from the wider population or from the experiences of HIV clinicians. This article aims to help clinicians designing inclusive HIV services by presenting the most common needs identified during the first year of a specialist clinic for older people living with HIV at the Ian Charleson Day Centre, Royal Free Hospital in London, United Kingdom. Methods:The records of all thirty-five patients attending the inaugural nine sessions were reviewed. Results:The median age of attendees was 69 (53-93) with 77% being male, 63% being White, 49% being heterosexual and 97% being virally suppressed respectively. The majority (83%) met the criteria for frailty using the Fried frailty phenotype. Eighteen issues linked to ageing were identified with the most common being affective symptoms (51%), memory loss (37%) and falls (29%). Conclusions:Whilst older people living with HIV are a heterogeneous group frailty is common and appears to present earlier. HIV services either need to adapt to meet these additional needs or must support users in transitioning to existing services. We feel that our multidisciplinary model is successful in identifying problems associated with ageing in people living with HIV and could be successfully replicated elsewhere.

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“… 17 Programs to meet needs of older people with HIV are being developed around the world. 18 Examples like the Silver Clinic in England 19 and Golden Compass in San Francisco 20 have described significant comorbidities, functional burdens, and geriatric syndromes. Functional deficits are not irreversible, and timely interventions may be able to improve quality of life.…”

Section: Introductionmentioning

confidence: 99%

Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation

Siegler¹,

Moxley²,

Glesby³

2021

HIV

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Purpose People with HIV (PWH) are living longer lives and likely experiencing accentuated aging. Comprehensive geriatric assessment (CGA) has been proposed as a way to identify and help meet each individual patient’s needs. Patients and Methods We performed a retrospective review of the results of CGA in an HIV clinic in New York City. CGA included assessment of basic and instrumental activities of daily living, screens for depression, anxiety, frailty, cognition, and quality of life, along with general discussion of concerns and goals. We compared the group of PWH referred for CGA to those of comparable age who were not referred to determine the factors that were associated with referral. We carried out a descriptive analysis of those undergoing CGA, along with regression to determine factors associated with poorer PHQ-2 depression scores and higher VACS score. Results A total of 105 patients underwent full CGA during the study period. Mean age of referred patients was 66.5 years, ranging from 50 to 84 years (SD 7.99). More than 92% were virally suppressed. Compared with their non-referred counterparts over 50, referred patients were older and had more functional comorbidities like cerebrovascular disease, neuropathy, and urinary incontinence. More than half complained of fatigue, and 2/3 noted poor memory. Almost 60% were frail or prefrail. Ninety patients were asked about their goals, and the most commonly cited were related to health or finances; fifteen patients were unable to articulate any goals. Having fewer goals and noting weight loss or fatigue were predictive of higher scores on the PHQ-2 depression screen. Conclusion Although most older PWH undergoing CGA can manage their ADL, many have concerns and deficits beyond their comorbidities. CGA offers an important window into the psychosocial concerns and needs of older PWH.

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Evaluation of a Combined HIV and Geriatrics Clinic for Older People Living with HIV: The Silver Clinic in Brighton, UK

Cited by 22 publications

References 48 publications

Examining the Impact of the Golden Compass Clinical Care Program for Older People with HIV: A Qualitative Study

Examining the Impact of the Golden Compass Clinical Care Program for Older People with HIV: A Qualitative Study

What problems associated with ageing are seen in a specialist service for older people living with HIV?

Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation

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