This study (John 2016) looked comprehensively across physical, mental and social health domains to examine health related needs of older adults living with HIV. The study showed that among 359 people living with HIV in San Francisco: 39% reported dependence with ≥1 IADL, 40% reported falls in the previous year, 58% experienced loneliness, 55% depression, and 12% PTSD. The study included two different clinics, both of which receive Ryan White funding but based within two different healthcare systems- a university clinic and a county (public hospital) based clinic. Although the majority of participants were men (85%) and had been infected with HIV for more than 10 years (85%), so the results may not extend to women or older adults newly diagnosed with HIV, this study adds to the growing body of evidence about the aging related health needs for older adults living with HIV.

A few practical considerations:

• Some assessments are easy to incorporate into clinical practice- such as once a year screening questions for falls and balance problems which could be done by any member of an office team.
  • Example screening tools which guide the fall evaluation based on overall fall risk are available on the CDC and American Geriatrics Society website: http://www.cdc.gov/steadi/, http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/prevention_of_falls_summary_of_recommendations
• Healthcare providers have to consider the social context of care and address mental health concerns in order to support the health of older adults living with HIV. Finding ways to incorporate routine mental health screening (even an annual PHQ-2) and ways to link patients to community resources will be critical.
  • Ryan White wrap around services often help address these needs
  • Have to consider overlap or how to combine HIV specific services and aging specific services