Ageing - polypharmacy & frailty

[Jim Allen]

It is not unexpected to see co-morbidities in people living with HIV, particularly those over a certain age, but with more of us living longer, it is something to keep an eye on, of course.

Good read, though.

Aidsmap article in full: https://www.aidsmap.com/news/nov-2023/doctors-alarmed-complex-needs-elderly-people-living-hiv

In Brief:

Dr Frederico Duarte at EACS 2023.

While HIV is often described as a chronic, manageable condition and the growing number of people ageing with HIV as a success, this does not describe the complete picture, Dr Frederico Duarte told the recent 19th European AIDS Conference (EACS 2023) in Warsaw. “The real scenario in clinical practice is much more complex and can be a bumpy road,” he said.

While people over the age of 70 make up only 5% of the patient cohort (65 people) in the town of Matosinhos, Portugal where Dr Duarte practices, their medical histories are complex. They have been on HIV treatment for an average of 10 years (but some have been treated for 25 years), most have several co-morbidities and as a result, need to take multiple medications. Four in ten of those over 70 are taking ten or more pills a day, with some taking as many as 18 pills.

A more comprehensive picture comes from a French cohort of people living with HIV aged over 70. With around 500 study participants, this may be the largest cohort of people living with HIV over 70 in the world, even if those taking part represent a fraction of the several thousand HIV-positive people in this age group in France.

As reported earlier this year, 60% have three or more co-morbidities, with the most common being high blood pressure (67%), dyslipidaemia (67%), cognitive impairment (58%), kidney disease (39%), depression (33%) and diabetes (21%).

But geriatrician Dr Fatima Brañas of the Hospital Universitario Infanta Leonor in Madrid said that clinicians need to broaden their focus from HIV and co-morbidities to consider frailty and functional impairment. This should prompt more attention to problems which affect people’s day to day lives and their quality of life.

[BKKKevin]

"As reported earlier this year, 60% have three or more co-morbidities, with the most common being high blood pressure (67%), dyslipidaemia (67%), cognitive impairment (58%), kidney disease (39%), depression (33%) and diabetes (21%)."

It would be interesting to know how these percentages compare with the over 70  general population?...

[leatherman]

Doing some quick research, I found that many of these issues were quite similar to the general population. The standout issues seems to be cognitive impairment and depression. Considering the discussion is about about PLHIV 70+ yr olds, there is a need to also consider factors like the percentage of MSM, since many  would have experienced greater stigma, loss, deaths, and medical issues which would increase depression.

consider frailty and functional impairment

considering that percentage of MSM (in the States and Europe), who are often single and alone in later years, and those PLHIV who have been on meds long term, early meds, and/or late treatment, frailty and functional impairment are quite an issue. Elder care is not plentiful, and is expensive. The gen pop elderly already have issues navigating elder care without multiple co-morbidities, multiple medications, and cognitive impairment, not to mention the stigma and discrimination against patients with HIV. Sadly, elder care is not something that doctors or medications can improve


high blood pressure (67%)
The Framingham Heart Study5 showed than more than 90% of the participants with a normal blood pressure (BP) at age 55 years eventually develop HTN. Approximately 60% of the population has HTN by 60 years of age and about 65% of men and 75% of women develop high BP by 70 years
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021657/

Dyslipidemia (67%)
>70–75 years   Females 41.3%, Males 58.7%
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497166/

cognitive impairment (58%)
In the USA, the estimated prevalence of Cognitive Impairment, No Dementia after 70 years of age was 22.2%, ranging from 16% (71–79 years) to 39% (≥90 years) [22]. In some reviews, this prevalence ranges from 5 to 29% [23]. Among African-Americans, the prevalence was 23.4% (increasing with age, from 19.2% to 38%) [24].
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197520/

kidney disease (39%)
The prevalence in the US elderly was much higher at about 39.4% of persons aged 60+ years have been noted to have CKD
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291282/

depression (33%)
The good news is that the majority of older adults are not depressed. Some estimates of major depression in older people living in the community range from less than 1% to about 5% but rise to 13.5% in those who require home healthcare and to 11.5% in older hospitalized patients
https://www.cdc.gov/aging/depression/index.html

diabetes (21%)
Prevalence in seniors: The percentage of Americans age 65 and older remains high, at 29.2%, or 15.9 million seniors (diagnosed and undiagnosed)
https://diabetes.org/about-diabetes/statistics/about-diabetes