How do geriatricians feel about managing older people living with HIV? A scoping review

Abstract

Purpose The proportion of people living with HIV being older adults is increasing and due to high rates of multimorbidity and frailty within this group geriatricians are well placed to contribute to their care. However, little is known about how geriatricians feel about this new opportunity. Methods A scoping review was performed following the Arksey & O’Malley’s methodological framework with nine databases searched in December 2021 for studies reporting the experiences or views of geriatricians on caring for people living with HIV. Study inclusion was not limited by language or year of publication. Narrative reviews were excluded. Two reviewers independently performed the extraction using predetermined criteria. A descriptive analysis of extracted information was performed. Results Six publications reporting four studies, all conducted in the USA, were identified. The current barriers to geriatricians being involved in the care of older people living with HIV are: their current experience in managing people living with HIV, their knowledge of HIV, specific issues related to older people living with HIV and screening for HIV in older people as well as their attitudes to people living with HIV and experience of managing older LGBTQ + people. Conclusion Prior to geriatricians being routinely involved in the care of older people living with HIV further research outside of the USA is required. Geriatricians will also require specific training which should be incorporated into geriatric medicine training curricula as well as the creation of learning tools and quality clinical practice guidelines ideally created in collaboration with HIV organisations.

Frailty and frailty screening: A qualitative study to elicit perspectives of people living with HIV and their healthcare professionals

“…However, HIV professionals reported feeling that they were perhaps not best placed to provide frailty care, as they are not experts in geriatric care. These results reflect those of Siegler et al [41], that healthcare providers do not feel comfortable caring for issues that they do not usually treat, with a recent study also showing that 46% of geriatricians were not comfortable providing care to people living with HIV [42]. How to maximize healthy ageing in people living with HIV remains unclear [43], but dedicated ageing services for people living with HIV and the use of the CGA within a dual consultation of an elderly medicine and HIV physician is gaining traction [44].…”

Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough?

“…The geriatric workforce is not adequate to meet the needs of the general population globally 67–69 and lacks training in HIV care. 70 As with many of the proposed interventions, opportunities for connecting patients with geriatricians often occur in HIC in large cities with academic institutions, limiting the generalizability of such interventions and calling attention to the importance of equity in designing programs. Lack of consensus about who should be referred to geriatricians and when.…”

A new era of HIV care for age-associated multimorbidity

“…A less resource intensive approach, at least for those with geriatric needs, might be to integrate PWH within existing geriatric services. However, there are barriers to developing HIV care by geriatricians which will need to be overcome, in particular the lack of experience and knowledge about HIV in older adults as it is an evolving area of expertise [46]. Thus, although this model provides a fully integrated service for PWH with multimorbidity, it's unlikely to provide a major part of an integrated health system outside secondary care.…”