Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA.
San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
Age Ageing. 2022 May 1;51(5). doi: 10.1093/ageing/afac093.
older HIV-positive adults experience a significant burden of geriatric conditions. However, little is known about the association between geriatric conditions and healthcare utilisation in this population.
outpatient safety-net HIV clinic in San Francisco.
in 2013, HIV-positive adults ≥50 years of age underwent geriatric assessment including functional impairment, fall(s)in past year, cognitive impairment (MOCA <26) and low social support (Lubben social network scale ≤12). We reviewed medical records from 2013 through 2017 to capture healthcare utilisation (emergency room (ER) visits and hospitalisations) and used Poisson models to examine the association between geriatric conditions and utilisation events over 4 years.
among 192 participants, 81% were male, 51% were white, the median age was 56 (range 50-74), and the median CD4 count was 508 (IQR 338-688) cells/mm3. Sixteen percent of participants had ≥1 activities of daily living (ADL) dependency, 58% had ≥1 instrumental activities of daily living IADL dependency, 43% reported ≥1 falls, 31% had cognitive impairment, and 58% had low social support. Over 4 years, 90 participants (46%) had ≥1 ER visit (total of 289 ER visits), 39 (20%) had ≥1 hospitalisation (total of 68 hospitalisations), and 15 (8%) died. In unadjusted and adjusted analyses, IADL dependency and falls were associated with healthcare utilisation (adjusted incidence rate ratios IADL (95%CI): 1.73 (1.33-2.25); falls: 1.51 (1.21-1.87)).
IADL dependency and history of falls were associated with healthcare utilisation among older HIV-positive adults. Although our results are limited by sample size, improved understanding of the association between geriatric conditions and healthcare utilisation could build support for geriatric HIV care models.
老年 HIV 阳性患者存在大量老年病负担。然而，对于这一人群中老年病与医疗保健利用之间的关系知之甚少。
旧金山门诊安全网 HIV 诊所。
2013 年，≥50 岁的 HIV 阳性成年人接受了老年评估，包括功能障碍、过去一年的跌倒、认知障碍（MOCA<26）和低社会支持（Lubben 社会网络量表≤12）。我们回顾了 2013 年至 2017 年的病历，以记录医疗保健的利用情况（急诊就诊和住院），并使用泊松模型检查了 4 年内老年病与利用事件之间的关系。
在 192 名参与者中，81%为男性，51%为白人，中位年龄为 56（范围 50-74），中位 CD4 计数为 508（IQR 338-688）细胞/mm3。16%的参与者有≥1 项日常生活活动（ADL）依赖，58%有≥1 项工具性日常生活活动（IADL）依赖，43%报告有≥1 次跌倒，31%有认知障碍，58%有低社会支持。在 4 年内，90 名参与者（46%）有≥1 次急诊就诊（共 289 次急诊就诊），39 名（20%）有≥1 次住院（共 68 次住院），15 名（8%）死亡。在未调整和调整分析中，IADL 依赖和跌倒与医疗保健利用相关（调整后的发病率比 IADL（95%CI）：1.73（1.33-2.25）；跌倒：1.51（1.21-1.87））。
IADL 依赖和跌倒史与老年 HIV 阳性成年人的医疗保健利用相关。尽管我们的结果受到样本量的限制，但更好地了解老年病与医疗保健利用之间的关系可以为老年 HIV 护理模式提供支持。
