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Werekuu A, Ayisi-Boateng NK, Tagoe N, Opoku DA, Barnie B, Twumasi GK, Boadu YT, So-Armah K, Tawiah P. KNUST aging and human immunodeficiency virus outcomes-Study protocol. PLoS One 2024; 19:e0307719. [PMID: 39150927 PMCID: PMC11329140 DOI: 10.1371/journal.pone.0307719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 08/18/2024] Open
Abstract
INTRODUCTION Globally, 7 million people with HIV (PWH) aged over 50 years exist. 5 million of them live in sub-Saharan Africa, the epicenter of the HIV epidemic. In Ghana, every 1 in 6 PWH is aged over 50 years. However, access to geriatric health care is grossly limited in Ghana and the sub-Saharan Africa region. This has resulted in a lack of focus on geriatric syndromes, a multi-factorial clinical condition common in older PWH, that do not fit discrete disease categories. Consequently, this gap threatens the life expectancy for aging PWH, necessitating the need to promptly fill it. The KNUST Aging and HIV Outcomes (KAHO) study will help identify priorities and opportunities for developing an effective integrated model of HIV and geriatric healthcare in Ghana. METHODS AND ANALYSIS The KAHO study will recruit 151 PWH aged 50 years and older at the Infectious Disease Unit (IDU) of the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST). The study will be conducted over a 2-year period and participants will be seen at months 0, 6 and 12. Participants at each visit will be taken through assessments and questionnaires on geriatric health, cognition, social vulnerability, HIV-related conditions and they will provide biospecimens for laboratory testing. We will also conduct semi-structured qualitative interviews of PWH, healthcare providers, policy makers and study research assistants. Quantitative data will be analyzed using one sample proportion test and linear regression models appropriately. The Levesque's framework will be used as a guide to analyze qualitative data.
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Affiliation(s)
- Alex Werekuu
- Department of General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Nana Kwame Ayisi-Boateng
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nadia Tagoe
- Office of Grants and Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Douglas Aninng Opoku
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernard Barnie
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Kaku So-Armah
- Department of General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Phyllis Tawiah
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Osman M, Cooper R, Sayer AA, Witham MD. The use of natural language processing for the identification of ageing syndromes including sarcopenia, frailty and falls in electronic healthcare records: a systematic review. Age Ageing 2024; 53:afae135. [PMID: 38970549 PMCID: PMC11227113 DOI: 10.1093/ageing/afae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Recording and coding of ageing syndromes in hospital records is known to be suboptimal. Natural Language Processing algorithms may be useful to identify diagnoses in electronic healthcare records to improve the recording and coding of these ageing syndromes, but the feasibility and diagnostic accuracy of such algorithms are unclear. METHODS We conducted a systematic review according to a predefined protocol and in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Searches were run from the inception of each database to the end of September 2023 in PubMed, Medline, Embase, CINAHL, ACM digital library, IEEE Xplore and Scopus. Eligible studies were identified via independent review of search results by two coauthors and data extracted from each study to identify the computational method, source of text, testing strategy and performance metrics. Data were synthesised narratively by ageing syndrome and computational method in line with the Studies Without Meta-analysis guidelines. RESULTS From 1030 titles screened, 22 studies were eligible for inclusion. One study focussed on identifying sarcopenia, one frailty, twelve falls, five delirium, five dementia and four incontinence. Sensitivity (57.1%-100%) of algorithms compared with a reference standard was reported in 20 studies, and specificity (84.0%-100%) was reported in only 12 studies. Study design quality was variable with results relevant to diagnostic accuracy not always reported, and few studies undertaking external validation of algorithms. CONCLUSIONS Current evidence suggests that Natural Language Processing algorithms can identify ageing syndromes in electronic health records. However, algorithms require testing in rigorously designed diagnostic accuracy studies with appropriate metrics reported.
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Affiliation(s)
- Mo Osman
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Miles D Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
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Ng RQM, Yip KF, Teh YE. An overview of neurocognitive impairment in older people living with HIV. PROCEEDINGS OF SINGAPORE HEALTHCARE 2023. [DOI: 10.1177/20101058231160605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Background With improved survival among People Living with HIV (PLHIV), many are confronted with age associated comorbidities and geriatric syndromes. Neurocognitive impairment is one of the three most frequent conditions that affects quality of life of PLHIV despite achieving viral suppression. Healthcare providers face challenges in early identification of neurocognitive impairment, performing comprehensive assessment and managing older PLHIV. Objectives This paper aims to review available evidence regarding aetiology and management of older PLHIV who develop neurocognitive impairment, suggest improvements on current management and postulate future study direction. Methods A PubMed search for original articles and Clinical Guidelines was conducted from September 2021 to August 2022 using a combination of keywords related to neurocognitive impairment in PLHIV. The citations from all selected articles were reviewed for additional studies. Results Older PLHIV tend to be frailer than their uninfected counterparts, are plagued with multi-morbidity and are at increased risk of cognitive impairment. The aetiologies for neurocognitive impairment are multifactorial, multi-dimensional and complex. The management of neurocognitive impairment in older PLHIV involves identifying and optimizing predisposing factors, physical function, social and psychological health with appropriate care navigation. Conclusion Identification and management of neurocognitive impairment in older PLHIV through interdisciplinary collaboration among stakeholders is important. This exemplifies an integrated model of care for older PLHIV and promotes the notion of living well beyond viral suppression.
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Affiliation(s)
- Rachel QM Ng
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
| | - KF Yip
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
| | - YE Teh
- Department of Infectious Disease, Singapore General Hospital, Singapore, Singapore
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Wiechmann SL, Tejo AM, Inácio MVS, Mesas AE, Martínez-Vizcaíno V, Cabrera MAS. Frailty in people 50 years or older living with HIV: A sex perspective. HIV Med 2023; 24:1222-1232. [PMID: 37759412 DOI: 10.1111/hiv.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To estimate prefrailty and frailty prevalence and associated factors in people living with HIV (PLHIV) from a sex perspective. METHODS Cross-sectional study on PLHIV at specialized public health centres in Brazil. Data were obtained from individuals aged ≥50 years using antiretroviral therapy (ART) and with an undetectable viral load through personal interviews, clinical evaluations and medical records. Frailty and prefrailty were characterized using the Fried Frailty Phenotype tool. Multinomial regression models were performed, and the associated factors were selected through the backward stepwise method. RESULTS Among 670 patients, 373 men and 297 women were included. The prevalence of frailty and prefrailty was significantly higher for women (16.2% and 56.2%, respectively) than for men (11.5% and 46.4%, respectively). Low socioeconomic and educational level, multimorbidity, depression, subjective cognitive complaints, and low scores on the Mini-Mental State Exam (MMSE) were associated (P < 0.05) with frailty for both sexes. However, in the sex-specific analysis, while smoking (OR = 3.66, 95% CI: 1.58-8.48) and a history of low adherence to ART (OR = 3.10, 95% CI: 1.33-7.23) were associated with frailty in men, depression (OR = 3.39, 95% CI: 1.36- 8.44) and the absence of functional dentition (OR = 3.77, 95% CI: 1.36- 10.43) were associated with frailty in women. CONCLUSIONS This study adds self-reported cognitive complaints as a potential predictor of frailty in both sexes and supports the known deleterious effect of multimorbidity on frailty in adults living with HIV. Furthermore, it suggests that other possible predictors, such as depression, oral health status and adherence to ART, may be sex-specific.
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Affiliation(s)
- Susana Lilian Wiechmann
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
| | - Alexandre Mestre Tejo
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
| | - Manuel Victor Silva Inácio
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
| | - Arthur Eumann Mesas
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Mulligan R, Suarez Durall P. Geriatric Phenotypes and Their Impact on Oral Health. Clin Geriatr Med 2023; 39:235-255. [PMID: 37045531 DOI: 10.1016/j.cger.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Older adults have multiple morbidities that can impact oral, systemic, and psychological health. Although each disorder requires consideration from the provider before treatment, by assessing the common phenotypic presentations of older adults, we can better understand, select, and coordinate treatment modifications that would need to be considered and implemented for dental care.
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Affiliation(s)
- Roseann Mulligan
- Herman Ostrow School of Dentistry of the University of Southern California, DEN 4338, Mail Code: 0641, Los Angeles, CA 90089, USA.
| | - Piedad Suarez Durall
- Herman Ostrow School of Dentistry of the University of Southern California, University Park Campus, DEN 4338, Mail Code: 0641, Los Angeles, CA 90089, USA
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Ates AC, Bachnak A, Murateva Y, Toiber Kent Y, Blackburn S, Boffito M, Milinkovic A, Tong T, Varadarajan M. Results of a Multi-Disciplinary Approach Involving Geriatricians of a Clinic for Older People Living with HIV. AIDS Patient Care STDS 2023; 37:213-214. [PMID: 37083444 DOI: 10.1089/apc.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Affiliation(s)
- Aylin Cansu Ates
- Imperial College London Faculty of Medicine, London, United Kingdom
| | - Andrei Bachnak
- Imperial College London Faculty of Medicine, London, United Kingdom
| | - Yana Murateva
- Imperial College London Faculty of Medicine, London, United Kingdom
| | | | - Sophie Blackburn
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| | - Marta Boffito
- Imperial College London Faculty of Medicine, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| | - Ana Milinkovic
- Imperial College London Faculty of Medicine, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| | - Tim Tong
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
| | - Maithili Varadarajan
- Chelsea and Westminster Hospital NHS Foundation Trust, HIV Department and Older Adults Team, London, United Kingdom
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do Nascimento LM, da Cruz TGC, Silva JFDLE, Silva LP, Inácio BB, Sadamitsu CMO, Scheicher ME. Use of Intrinsic Capacity Domains as a Screening Tool in Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4227. [PMID: 36901237 PMCID: PMC10002144 DOI: 10.3390/ijerph20054227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
The World Health Organization (WHO) created the concept of Integrated Care for Older People and one of its constructs is intrinsic capacity (IC). The study aimed to carry out a screening with the tools designated by the WHO to assess the IC domains and whether they can be used as indicators for decision-making on integrated care for older people based on risk categorization. The interaction between the risk category and the domain scores was verified. One hundred and sixty three (163) community-dwelling older people of both genders were evaluated. Domains assessed: cognitive, psychological, vitality, locomotion, and sensory. Scores indicating a low, moderate and high risk were assigned to each domain. For all domains, there were individuals in all risk groups. Effect of risk on the domains: cognitive [χ2(2) = 134.042; p < 0.001], psychological [χ2(2) = 92.865; p < 0.001], vitality [χ2(2) = 129.564; p < 0.001], locomotion [χ2(2) = 144.101; p < 0.001], and sensory [χ2(2) = 129.037; p < 0.001]. Scores of the CI domains were affected by the risk category. There were individuals in all risk groups, demonstrating the importance of screening as a public health strategy, making it possible to know which risk category each elderly person belongs to and thus develop strategies in the short-, medium- and long-term.
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Affiliation(s)
- Livia Maria do Nascimento
- Graduate Program in Human Development and Technologies, Institute of Biosciences, Paulista State University—UNESP, Rio Claro 13506-900, SP, Brazil
| | - Thainá Gabriele Camargo da Cruz
- Graduate Program in Human Development and Technologies, Institute of Biosciences, Paulista State University—UNESP, Rio Claro 13506-900, SP, Brazil
| | | | - Letícia Prado Silva
- Department of Physical Therapy and Occupational Therapy, Paulista State University—UNESP, Marília1 7525-900, SP, Brazil
| | - Beatriz Bigatão Inácio
- Department of Physical Therapy and Occupational Therapy, Paulista State University—UNESP, Marília1 7525-900, SP, Brazil
| | - Carolina Masumi Oki Sadamitsu
- Department of Physical Therapy and Occupational Therapy, Paulista State University—UNESP, Marília1 7525-900, SP, Brazil
| | - Marcos Eduardo Scheicher
- Graduate Program in Human Development and Technologies, Institute of Biosciences, Paulista State University—UNESP, Rio Claro 13506-900, SP, Brazil
- Department of Physical Therapy and Occupational Therapy, Paulista State University—UNESP, Marília1 7525-900, SP, Brazil
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Tari Selcuk K, Atan RM, Arslan S, Sahin N. Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey. Exp Gerontol 2023; 172:112054. [PMID: 36513213 DOI: 10.1016/j.exger.2022.112054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
AIMS In this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition. METHODS The study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis. RESULTS In the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21-3.51, p:0.007). CONCLUSION While food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation.
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Affiliation(s)
- Kevser Tari Selcuk
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
| | - Ramazan Mert Atan
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Sedat Arslan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
| | - Nursel Sahin
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
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De Cock AM, Strens D, Van Osta P, Standaert B. Infections and hospital bed-days among aging adults: A five-year retrospective study in a Belgian general hospital. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:912469. [PMID: 36340588 PMCID: PMC9632861 DOI: 10.3389/fmedt.2022.912469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Infectious disease in aging adults (≥61 years) often occurs in combination with other health conditions leading to long hospital stays. Detailed studies on infection in aging adults investigating this problem are sparse. Aim To quantify the effect of primary and secondary diagnosed infections on hospitalization bed-days among aging adult patients. Design Retrospective patient-file study. Setting Ziekenhuis Netwerk Antwerpen (ZNA) Hospital, a 1,858-bed general hospital in Belgium, with 364 beds allocated to geriatric patients. Data source Database of hospitalized adult patients aged ≥61 years. Methods All adult patients aged ≥61 years hospitalized on two wards, Geriatrics and Pulmonology, from 2010 to 2014 were included. Primary diagnosed infections were defined as infections known at entry to be treated first. Secondary diagnosed infections included infections known at entry but treated in parallel to primary non-infectious causes of entry, infections unknown at entry, and hospital-acquired (nosocomial) infections. Data were analyzed by patient age, gender, year, ward type, bed-days of hospitalization, infection rates, and seasonality. Results There were 3,306 primary diagnosed infections (18%) and 14,758 secondary infections (82%) identified in the two wards combined (54.7% of all hospital stays at those 2 wards). Secondary diagnosed infections accounted for a significantly higher proportion of hospitalizations in both wards (+40% for Geriatric ward; +20% for Pulmonology ward; p < 0.001) and were associated with a significantly longer average hospital stay (+4 days for Geriatric ward; +5 days for Pulmonology ward; p < 0.001). Nosocomial infections (12% for Geriatric ward; 7% for Pulmonology ward) were associated with particularly high bed-days of hospitalization, at approximately +15 days and +12 days on Geriatric and Pulmonology wards, respectively. Both wards showed marked seasonality for respiratory infections with winter peaks. Conclusion Real-world data showed that secondary diagnosed infections in aging adults imposed a high burden on hospital care along with longer hospital stays. This hampered bed availability during peak seasons.
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Affiliation(s)
- Anne-Marie De Cock
- University Centre of Geriatrics, General Hospital ZNA Middelheim, Antwerpen, Belgium
| | | | - Peter Van Osta
- University Centre of Geriatrics, General Hospital ZNA Middelheim, Antwerpen, Belgium
| | - Baudouin Standaert
- HEBO, Antwerpen, Belgium
- Research Unit Ethics / Patient Care, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
- Correspondence: Baudouin Standaert
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Olivieri-Mui B, Wilson I, Shi S, Montano M, McCarthy EP, Oh G, Kim DH. Geriatric Conditions Associated with Nonadherence to Antiretroviral Therapy Among Older People with HIV: The Importance of Frailty. AIDS Patient Care STDS 2022; 36:226-235. [PMID: 35687816 PMCID: PMC9242718 DOI: 10.1089/apc.2022.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Poor compliance with medications is a growing concern in geriatric care and is increasingly more relevant among people living with HIV (PLWH) as they age. Our goal was to understand geriatric conditions associated with antiretroviral therapy (ART) nonadherence in a Medicare population of older PLWH. We analyzed Medicare data from PLWH aged 50 years or older who were continuously enrolled in fee-for-service Medicare from January 1, 2014 to June 30, 2015. Prevalent geriatric conditions (dementia, depression, falls, hip fracture, sensory deficits, osteoporosis, orthostatic hypotension, urinary incontinence, frailty) were identified in January 1, 2014-December 31, 2014. ART nonadherence was defined as <80% proportion of days covered (PDC) by at least two ART medications in January 1, 2015-June 30, 2015. We examined geriatric condition association with nonadherence using lowest Akaike Information Criterion multi-variate logistic models, controlling for age, sex, race, census region, substance use, Medicaid eligibility, and polypharmacy. Of 8778 PLWH, 23% (n = 2042) had <80% PDC. The average age was 60 years (standard deviation ±8), and >70% were males. In adjusted models, age was not associated with nonadherence, frailty status was the only geriatric condition associated with nonadherence [robust: reference, prefrail odds ratio (OR): 0.97, confidence interval (95% CI) 0.86-1.10, frail OR: 1.34 95% CI 1.11-1.61], and odds of nonadherence were lower for polypharmacy [OR: 0.48 (0.43-0.54)]. Our findings suggest that patient-centered care plans aimed at improving ART adherence among older PLWH would benefit from long-term surveillance; a deeper understanding of the role of frailty and polypharmacy, even at chronologically younger ages in PLWH.
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Affiliation(s)
- Brianne Olivieri-Mui
- The Roux Inst and Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA.,The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.,Address correspondence to: Brianne Olivieri-Mui, MPH, PhD, The Roux Inst and Department of Health Sciences, Northeastern University, 360 Huntington Avenue, 316a Robinson Hall, Boston, MA 02115, USA
| | - Ira Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sandra Shi
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Monty Montano
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen P. McCarthy
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Gahee Oh
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Dae Hyun Kim
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
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Titon JP, Titon OJ, Júnior VS, Wendt GW, Follador FAC, Vieira AP, Ferreto LED. Sociodemographic, behavioral, and geriatric characteristics in older adults with and without HIV: A case-control study. Medicine (Baltimore) 2021; 100:e26734. [PMID: 34397711 PMCID: PMC8322525 DOI: 10.1097/md.0000000000026734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
Older adults with human immunodeficiency virus (HIV) have higher risks for early manifestations of age-related disabilities. The objective of this study was to compare HIV-positive and HIV-negative adults aged ≥50 years in relation to sociodemographic, behavioral, and geriatric characteristics. A case-control study was conducted with a >90% estimated statistical power. A total of 52 individuals living with HIV were matched by age, sex, and neighborhood of residence with 104 community controls. Age-related disabilities were assessed throughout a comprehensive geriatric assessment. Review of medical records and interviews were used to obtain behavioral and clinical covariates. No statistical differences on clinically significant age-related disabilities were found. However, multivariate regression analyses, controlling for education and income, revealed that behavioral (use of condom [odds ratio {OR}: 7.03; 95% confidence intervals {CI}: 2.80-7.65] and number of medical visits [OR: 1.25; 95%CI: 1.09-1.43]), along with faster gait speed (OR: 17.68; 95%CI: 2.55-122.85) and lower body and muscle mass indexes were independently associated with HIV (OR: .88; 95%CI: .79-.98 and OR: .72; 95%CI: .54-.97, respectively). In summary, results on age-related disabilities between groups could mean that public policies on HIV might be contributing to patients' positive outcomes regardless of the effects of aging, albeit gait speed, body and muscle mass indexes were independently associated with HIV. Screenings for age-related disabilities in specialized HIV services are recommended.
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Affiliation(s)
- Joana Perotta Titon
- Western Paraná State University, Department of Health Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, Paraná, Brazil
- Western Paraná State University, Department of Health Sciences, Francisco Beltrão, Paraná, Brazil
| | - Odirlei João Titon
- Western Paraná State University, Department of Health Sciences, Francisco Beltrão, Paraná, Brazil
| | - Valdir Spada Júnior
- Western Paraná State University, Department of Health Sciences, Francisco Beltrão, Paraná, Brazil
| | - Guilherme Welter Wendt
- Western Paraná State University, Department of Health Sciences, Francisco Beltrão, Paraná, Brazil
| | - Franciele Aní Caovilla Follador
- Western Paraná State University, Department of Health Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, Paraná, Brazil
| | - Ana Paula Vieira
- Western Paraná State University, Department of Health Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, Paraná, Brazil
| | - Lirane Elize Defante Ferreto
- Western Paraná State University, Department of Health Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, Paraná, Brazil
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Siew AL, Wong JW, Chan EY. Effectiveness of simulated patients in geriatric education: A scoping review. NURSE EDUCATION TODAY 2021; 100:104856. [PMID: 33740706 DOI: 10.1016/j.nedt.2021.104856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Global healthcare systems are adapting to meet the demands of an aging population. It is essential to prepare our healthcare workers on complex and unique issues in the treatment of older adults. Past studies have shown that simulated patients are a valuable teaching tool in training current and prospective healthcare professionals. Few studies have examined its use in the geriatric context. OBJECTIVES This scoping review presents the effectiveness of simulated patients in healthcare education for geriatric care and eldercare purposes among current and prospective healthcare professionals. DATA SOURCES Search on CINAHL, Cochrane, ScienceDirect and Medline were completed on studies published between January 2009 to January 2020. A manual hand searching of reference lists for relevant articles was also conducted. REVIEW METHODS This scoping review follows the methods of Arksey and O-Malley to synthesize the literature on simulated patients in the teaching of geriatric care to current and prospective healthcare professionals. Inclusion criteria were, primary studies, with full-text articles, and in English. RESULTS Fifteen articles were included in this review. These articles were of wide variation by study design, settings, populations. Four broad themes were identified from existing literature: (i) improvement in geriatric knowledge, (ii) improvement in technical and non-technical skills, (iii) greater confidence in clinical and non-clinical skills, and (iv) learners' perception towards simulation as a learning pedagogy. CONCLUSION Simulated patients may have potential in improving geriatric education. Students generally enjoyed the learning methodology, finding it engaging and easy to learn by practising. Future studies could consider engaging simulated patients in the teaching pedagogy of geriatric teaching for current or prospective healthcare professionals.
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Affiliation(s)
- An Ling Siew
- Department of Nursing, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore.
| | - Jing Wen Wong
- Faculty of Arts and Social Science, National University of Singapore, Singapore, Singapore
| | - Ee-Yuee Chan
- Department of Nursing Service, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore; Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Abstract
Older adults have multiple morbidities that can impact oral, systemic, and psychological health. Although each disorder requires consideration from the provider before treatment, by assessing the common phenotypic presentations of older adults, we can better understand, select, and coordinate treatment modifications that would need to be considered and implemented for dental care.
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Affiliation(s)
- Roseann Mulligan
- Herman Ostrow School of Dentistry of the University of Southern California, DEN 4338, Mail Code: 0641, Los Angeles, CA 90089, USA.
| | - Piedad Suarez Durall
- Herman Ostrow School of Dentistry of the University of Southern California, University Park Campus, DEN 4338, Mail Code: 0641, Los Angeles, CA 90089, USA
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Agustina D, Chrismawaty B, Hanindriyo L. Hyposalivation is the main risk factor for poor oral health status in Indonesian elderly. J Int Oral Health 2021. [DOI: 10.4103/jioh.jioh_255_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Picca A, Guerra F, Calvani R, Coelho-Junior HJ, Bossola M, Landi F, Bernabei R, Bucci C, Marzetti E. Generation and Release of Mitochondrial-Derived Vesicles in Health, Aging and Disease. J Clin Med 2020; 9:jcm9051440. [PMID: 32408624 PMCID: PMC7290979 DOI: 10.3390/jcm9051440] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 02/06/2023] Open
Abstract
Mitochondria are intracellular organelles involved in a myriad of activities. To safeguard their vital functions, mitochondrial quality control (MQC) systems are in place to support organelle plasticity as well as physical and functional connections with other cellular compartments. In particular, mitochondrial interactions with the endosomal compartment support the shuttle of ions and metabolites across organelles, while those with lysosomes ensure the recycling of obsolete materials. The extrusion of mitochondrial components via the generation and release of mitochondrial-derived vesicles (MDVs) has recently been described. MDV trafficking is now included among MQC pathways, possibly operating via mitochondrial-lysosomal contacts. Since mitochondrial dysfunction is acknowledged as a hallmark of aging and a major pathogenic factor of multiple age-associated conditions, the analysis of MDVs and, more generally, of extracellular vesicles (EVs) is recognized as a valuable research tool. The dissection of EV trafficking may help unravel new pathophysiological pathways of aging and diseases as well as novel biomarkers to be used in research and clinical settings. Here, we discuss (1) MQC pathways with a focus on mitophagy and MDV generation; (2) changes of MQC pathways during aging and their contribution to inflamm-aging and progeroid conditions; and (3) the relevance of MQC failure to several disorders, including neurodegenerative conditions (i.e., Parkinson's disease, Alzheimer's disease) and cardiovascular disease.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (M.B.); (F.L.); (R.B.); (E.M.)
| | - Flora Guerra
- Department of Biological and Environmental Sciences and Technologies, Università del Salento, 73100 Lecce, Italy;
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (M.B.); (F.L.); (R.B.); (E.M.)
- Correspondence: (R.C.); (C.B.); Tel.: +39-06-3015-5559 (R.C.); +39-0832-29-8900 (C.B.); Fax: +39-06-305-1911 (R.C.); +39-0832-29-8941 (C.B.)
| | - Hélio José Coelho-Junior
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Maurizio Bossola
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (M.B.); (F.L.); (R.B.); (E.M.)
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Francesco Landi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (M.B.); (F.L.); (R.B.); (E.M.)
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Roberto Bernabei
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (M.B.); (F.L.); (R.B.); (E.M.)
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Cecilia Bucci
- Department of Biological and Environmental Sciences and Technologies, Università del Salento, 73100 Lecce, Italy;
- Correspondence: (R.C.); (C.B.); Tel.: +39-06-3015-5559 (R.C.); +39-0832-29-8900 (C.B.); Fax: +39-06-305-1911 (R.C.); +39-0832-29-8941 (C.B.)
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (M.B.); (F.L.); (R.B.); (E.M.)
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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Older Adults with Physical Frailty and Sarcopenia Show Increased Levels of Circulating Small Extracellular Vesicles with a Specific Mitochondrial Signature. Cells 2020; 9:cells9040973. [PMID: 32326435 PMCID: PMC7227017 DOI: 10.3390/cells9040973] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 01/23/2023] Open
Abstract
Mitochondrial dysfunction and systemic inflammation are major factors in the development of sarcopenia, but the molecular determinants linking the two mechanisms are only partially understood. The study of extracellular vesicle (EV) trafficking may provide insights into this relationship. Circulating small EVs (sEVs) from serum of 11 older adults with physical frailty and sarcopenia (PF&S) and 10 controls were purified and characterized. Protein levels of three tetraspanins (CD9, CD63, and CD81) and selected mitochondrial markers, including adenosine triphosphate 5A (ATP5A), mitochondrial cytochrome C oxidase subunit I (MTCOI), nicotinamide adenine dinucleotide reduced form (NADH):ubiquinone oxidoreductase subunit B8 (NDUFB8), NADH:ubiquinone oxidoreductase subunit S3 (NDUFS3), succinate dehydrogenase complex iron sulfur subunit B (SDHB), and ubiquinol-cytochrome C reductase core protein 2 (UQCRC2) were quantified by Western immunoblotting. Participants with PF&S showed higher levels of circulating sEVs relative to controls. Protein levels of CD9 and CD63 were lower in the sEV fraction of PF&S older adults, while CD81 was unvaried between groups. In addition, circulating sEVs from PF&S participants had lower amounts of ATP5A, NDUFS3, and SDHB. No signal was detected for MTCOI, NDUFB8, or UQCRC2 in either participant group. Our findings indicate that, in spite of increased sEV secretion, lower amounts of mitochondrial components are discarded through EV in older adults with PF&S. In-depth analysis of EV trafficking might open new venues for biomarker discovery and treatment development for PF&S.
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Guaraldi G, Franconi I, Milic J, Besutti G, Pintassilgo I, Scaglioni R, Ligabue G, Riva N, Raimondi A, Menozzi M, Carli F, Zona S, Santoro A, Malagoli A, Borghi V, Torricelli P, Cossarizza A, Mussini C. Thymus Imaging Detection and Size Is Inversely Associated With Metabolic Syndrome and Frailty in People With HIV. Open Forum Infect Dis 2019; 6:ofz435. [PMID: 31660382 PMCID: PMC6809752 DOI: 10.1093/ofid/ofz435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND People with HIV (PWH) may experience accentuating aging in relation to immuno-activation. Little is known regarding thymus (THY) involution in this process. We sought to investigate the relationship between THY imaging detection/size and clinically relevant aging outcomes such as metabolic syndrome (MetS), multimorbidity (MM), and frailty in PWH. METHODS This was a cross-sectional observational study including 665 HIV patients (81% males; median age, 53 years) attending Modena HIV Metabolic Clinic from 2014 to 2017. They underwent thoracic computed tomography scan as part of the medical assessment for cardiovascular disease, in which THY detection and size were reported using a semiquantitative score. Outcome measures were MetS, MM, and frailty. RESULTS THY was detected in 27.0% of subjects; 71.1% showed THY size of grade 1-2, and 28.9% exhibited grade ≥3. Covariates that inversely correlated with THY detection were age, male gender, body mass index (BMI), and HIV duration. Covariates that inversely correlated with MetS were age, HIV duration, BMI, and THY grade 1-2. Covariates that inversely correlated with MM were age, HIV duration, and CD4 nadir. Covariates that inversely correlated with frailty were age, HIV duration, CD4 nadir, BMI, and THY detection. CONCLUSIONS THY is inversely associated with MetS and frailty in PWH.
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Affiliation(s)
- Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Iacopo Franconi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Jovana Milic
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Radiology Unit, University of Modena and Reggio Emilia, Italy
| | - Ines Pintassilgo
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Guido Ligabue
- Radiology Unit, University of Modena and Reggio Emilia, Italy
| | - Nicoletta Riva
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Alessandro Raimondi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Marianna Menozzi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Federica Carli
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Stefano Zona
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Antonella Santoro
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Andrea Malagoli
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Vanni Borghi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | | | - Andrea Cossarizza
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia, Italy
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
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18
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Guaraldi G, Francesco DD, Malagoli A, Zona S, Franconi I, Santoro A, Mussini C, Mussi C, Cesari M, Theou O, Rockwood K. Compression of frailty in adults living with HIV. BMC Geriatr 2019; 19:229. [PMID: 31438859 PMCID: PMC6706922 DOI: 10.1186/s12877-019-1247-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
Background Contemporary HIV care may reduce frailty in older adults living with HIV (OALWH). Objective of the study was to estimate prevalence of frailty at the age of 50 and 75 years, and build a model to quantify the burden of frailty in the year 2030. Methods This study included OALWH attending Modena HIV Metabolic Clinic between 2009 and 2015. Patients are referred from more than 120 HIV clinics well distributed across Italy, therefore being country representative. Our model forecasts the new entries on yearly basis up to 2030. Changes in frailty over a one-year period using a 37-variable frailty index (FI) and death rates were modelled using a validated mathematical algorithm with parameters adjusted to best represent the changes observed at the clinic. In this study, we assessed the number of frailest individuals (defined with a FI > 0.4) at the age of 50 and at the age 75 by calendar year. Results In the period 2015–2030 we model that frailest OALWH at age 50 will decrease from 26 to 7%, and at the age of 75 years will increase from 43 to 52%. This implies a shift of the frailty prevalence at an older age. Conclusion We have presented projections of how the burden of frailty in older adults, living with HIV will change. We project fewer people aged 50+ with severe frailty, most of whom will be older than now. These results suggest a compression of age-related frailty. Electronic supplementary material The online version of this article (10.1186/s12877-019-1247-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy.
| | | | - Andrea Malagoli
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Stefano Zona
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Iacopo Franconi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Antonella Santoro
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Chiara Mussi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Olga Theou
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Walker VG. The Life Course Paradigm as a Lens for Holistic Nursing Research in Older Adults Diagnosed With Schizophrenia. J Holist Nurs 2019; 37:366-380. [DOI: 10.1177/0898010119867169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Older adults diagnosed with schizophrenia (OADWS) have unique needs for care and live longer today than their forebears who were diagnosed with schizophrenia. As a result, nurses need to be prepared for the specific care of individuals who live with schizophrenia as they age. Together, Life Course Theory and holistic nursing suggest a good fit in the quest for successful solutions and/or outcomes for the unique problems that OADWS face. Holistic nursing views the patient as a whole person, considering all aspects of the patient’s experiences within life’s broader environment. The life course paradigm offers an effective way for nurses to understand issues that patients face throughout their lives, thus enhancing holistic nursing with a historical perspective. This is especially important for the care of OADWS, who face unique disparities as well as physical and psychological comorbidities over their life course. This article is intended to initiate a discussion of OADWS, focused with Life Course Theory as a holistic lens. Literature pertinent to the life course of OADWS is reviewed, followed by an analysis of the life course paradigm in relation to OADWS’ unique experiences. Conclusions support the holistic use of Life Course Theory in research and interventions for OADWS.
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20
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Older HIV-infected adults: complex patients- geriatric syndromes (II). Eur Geriatr Med 2019; 10:213-218. [PMID: 34652755 DOI: 10.1007/s41999-019-00160-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/04/2019] [Indexed: 12/19/2022]
Abstract
With the widespread adoption of highly active antiretroviral therapy (HAART), HIV infection starts to be considered one of the many chronic illnesses of advanced age. A growing proportion of the affected patients is presently older than 50. It has been suggested that HIV infection may today represent a model of accelerated and accentuated ageing. The need for a closer collaboration between geriatricians and HIV physicians is being growingly recognised to better address the priorities and needs of HIV patients. The final aim behind the generation of such synergies resides in the design of personalised plans of interventions. These plans should stem from the results of a comprehensive assessment of the individual spanning clinical, environmental, and psychosocial domains. Through the early identification of stressors and risk factors potentially disrupting the homeostatic balance of frail patients (including those living with HIV), it might be possible to protect the "biologically old" (but not necessarily "chronologically old") HIV-infected people from developing detrimental geriatric syndromes. In this article, specific features making the ageing HIV population of special interest for geriatric medicine, and the importance of a multidisciplinary model of care are described. The final objective is to stress how the only way for adequately tackling the multifaceted frailty condition of people with HIV is to implement novel models of care based on the comprehensive geriatric assessment.
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Geriatric-HIV Medicine: the geriatrician’s role. Eur Geriatr Med 2018; 10:259-265. [DOI: 10.1007/s41999-018-0144-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/24/2018] [Indexed: 12/21/2022]
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22
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Guaraldi G, Pintassilgo I, Milic J, Mussini C. Managing antiretroviral therapy in the elderly HIV patient. Expert Rev Clin Pharmacol 2018; 11:1171-1181. [PMID: 30444968 DOI: 10.1080/17512433.2018.1549484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Owing to more effective and less toxic antiretroviral therapy (ART), people living with HIV (PLWH) live longer, a phenomenon expected to grow in the next decades. With advancing age, effectively treated PLWH experience not only a heightened risk for non-infective comorbidities and multimorbidity, but also for geriatric syndromes and frailty. In addition, older adults living with HIV (OALWH) have a higher prevalence of so-called iatrogenic triad described as polypharmacy (PP), potentially inappropriate medication use, and drug-drug interactions. Areas covered: This review will focus the management of ART in OALWH. We will discuss iatrogenic triad and best way to address PP. Special focus will be given to pharmacokinetic and pharmacodynamic aspects of ART in the elderly, evaluation of ART toxicities, and specific ART strategies commonly used in this population. Expert commentary: Research should be focused on recruiting more OALWH, frail individuals in particular, into the clinical trials and specific geriatric outcome need to be considered together with traditional viroimmunological outcomes.
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Affiliation(s)
- Giovanni Guaraldi
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Ines Pintassilgo
- c Internal Medicine Department , Hospital Garcia de Orta , Almada , Portugal
| | - Jovana Milic
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy.,d Clinical and Experimental Medicine PhD Program , University of Modena and Reggio Emilia , Modena , Italy
| | - Cristina Mussini
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
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23
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Guaraldi G, Cossarizza A. Geriatric-HIV medicine: A science in its infancy. Virulence 2017; 8:504-507. [PMID: 28350196 PMCID: PMC5538343 DOI: 10.1080/21505594.2017.1306622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Giovanni Guaraldi
- University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Andrea Cossarizza
- University of Modena and Reggio Emilia School of Medicine, Modena, Italy
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