Understanding geriatric models of care for older adults living with HIV: a scoping review and qualitative analysis

Abstract

Background Advances in Human Immunodeficiency Virus (HIV) treatment have reduced mortality rates and consequently increased the number of individuals with HIV living into older age. Despite this, people aged 50 years and older have been left behind in recent HIV treatment and prevention campaigns, and a gold-standard model of care for this population has not yet been defined. Developing evidence-based geriatric HIV models of care can support an accessible, equitable, and sustainable HIV health care system that ensures older adults have access to care that meets their needs now and in the future. Methods Guided by Arksey & O’Malley (2005)’s methodological framework, a scoping review was conducted to determine the key components of, identify gaps in the literature about, and provide recommendations for future research into geriatric models of care for individuals with HIV. Five databases and the grey literature were systematically searched. The titles, abstracts and full texts of the search results were screened independently in duplicate. Data were analyzed using a qualitative case study and key component analysis approach to identify necessary model components. Results 5702 studies underwent title and abstract screening, with 154 entering full-text review. 13 peer-reviewed and 0 grey literature sources were included. Most articles were from North America. We identified three primary model of care components that may improve the successful delivery of geriatric care to people living with HIV: Collaboration and Integration; Organization of Geriatric Care; and Support for Holistic Care. Most articles included some aspects of all three components. Conclusion To provide effective geriatric care to older persons living with HIV, health services and systems are encouraged to use an evidence-based framework and should consider incorporating the distinct model of care characteristics that we have identified in the literature. However, there is limited data about models in developing countries and long-term care settings, and limited knowledge of the role of family, friends and peers in supporting the geriatric care of individuals living with HIV. Future evaluative research is encouraged to determine the impact of optimal components of geriatric models of care on patient outcomes.

Systematic Review: HIV, Aging, and Housing—A North American Perspective, 2012–2023

“…People with HIV experience delays in treatment in general due to fear of disclosure, loneliness, social isolation, and depression brought on by the stigma attached to the virus, and they may also perceive discrimination from healthcare professionals, which makes them reluctant or unwilling to seek medical attention [44]. An ideal care model [45] identified three core care components: collaboration and integration, organization of geriatric care, and support for holistic care that may enhance the adequate provision of geriatric care to individuals living with HIV. A holistic person-centered care approach for older adults with HIV needs to incorporate financial, social, emotional/spiritual, and physiological aspects.…”

“…These issues could have significantly impacted the living experiences of older PLWHA. There were contributing observations of ageism, sexism [18,33], and HIV-related stigma [17,19,22,23,26,28,29,33,37,[41][42][43][44][45]47].…”

Co-Creating Socio-Culturally-Appropriate Virtual Geriatric Care for Older Adults Living With HIV: A Community-Based Participatory, Intersectional Protocol

“…As older persons with HIV age, specialized care provided by, or in consultation with, geriatric care specialists, including geriatricians and geriatric clinical nurse specialists) are healthcare professionals who specialize in providing comprehensive medical care and chronic illness management for older adults (Brañas et al, 2019), can address geriatric syndromes commonly present in older persons with HIV (Greene et al, 2015). Geriatric care specialists manage geriatric syndromes, provide comprehensive medication management, optimize quality of life, and promote healthy aging (Kokorelias et al, 2023). Through the development of tailored care plans and interdisciplinary collaboration, they can provide specialized expertise to enhance the overall well-being and outcomes of persons aging with HIV (Guaraldi et al, 2019).…”

“…Investigations into impactful and appropriate models of care for older persons living with HIV are limited. We conducted a systematic synthesis of existing models of geriatric HIV care to identify the key components and inform novel geriatric-HIV models of care within Canada (Kokorelias et al, 2023). Our review found that, while numerous models have been implemented with geriatricians taking on responsibilities ranging from consultation to leadership roles, no model considered the role of culturally-appropriate care.…”

“…Our review found that, while numerous models have been implemented with geriatricians taking on responsibilities ranging from consultation to leadership roles, no model considered the role of culturally-appropriate care. Moreover, none of the existing models were from Canada or delivered care in rural and remote communities (Kokorelias et al, 2023), despite people living in this setting being disproportionately impacted by HIV with increased frailty outcomes, and less treatment uptake and viral suppression (PHAC, 2020). A similar review explored the confidence of geriatricians in managing the care of older persons living with HIV and concluded their lack of comfort in dealing with intersecting identities (Jones & Barber, 2022).…”