# Lessons Learned From A Geriatric Referral Model in People With HIV

## TL;DR

A geriatric consultation model for older adults with HIV was implemented but faced challenges in adoption due to structural and financial barriers.

## Contribution

This paper presents a novel geriatric referral model for people with HIV and identifies barriers to its implementation.

## Key findings

- Geriatricians made recommendations on referrals, medication changes, and osteoporosis screening.
- Most HIV providers expressed willingness to refer future patients to the program.
- Limited uptake of the program was observed despite positive outcomes.

## Abstract

People with HIV experience geriatric syndromes commonly found in much older populations and may benefit from geriatrician consultation. Multiple clinical models have emerged to address this need. We describe a model at the University of Colorado and the barriers to its robust implementation. The UCHealth Infectious Disease clinic implemented a referral-based model to connect high-risk people with HIV ≥50 years old with the UCHealth Seniors clinic. During geriatric consultation, patients were screened for functional status, preventative care, socioenvironmental factors, and cognitive/mental health concerns. Geriatricians communicated recommendations to the primary HIV provider. HIV providers completed a survey about the program. From January 2018 to July 2019, 11 patients underwent geriatric consultation. The average age was 69 years old (SD = 7.4; range 59–80). Geriatricians made recommendations regarding referral to other health or community-based services (n = 9), medication changes (n = 8), osteoporosis screening (n = 6), and management of memory problems (n = 5). Advanced directives were discussed in all visits. Almost all primary HIV providers said they would refer future patients to the program. The geriatric consultation program improved access to geriatric care but with limited uptake. We posit that lack of provider and patient consensus on the utility of geriatric care, the lack of a co-located clinical model, challenges in addressing polypharmacy, geriatrician shortages, and financial constraints all act as barriers to implementation of models of HIV geriatric care.

We describe a geriatric consultation model for older adults with HIV and its limited uptake in a US clinic. Despite several positive outcomes, implementation barriers—including structural, financial, and workforce challenges—highlight the need for integrated, scalable models of HIV-geriatrics care.