Baseline Characteristics and Outcomes for the 4F Pilot for Persons Aging with HIV

TL;DR

This study examines baseline characteristics and outcomes of older adults with HIV to address aging-related health risks like polypharmacy and falls.

Contribution

The study introduces a pilot program training clinicians to assess and manage aging-related conditions in older HIV patients.

Findings

25% of patients experienced hyperpolypharmacy (15+ medications), and 66% were prescribed potentially inappropriate medications.

27% of women and 24% of men were at high risk for a serious fall within 6 months.

Only 18% of clinicians had assessed their patients' fracture risk.

Abstract

More than half of people living with HIV in the US are 50+ years of age. HIV clinicians must be comfortable assessing for and managing conditions associated with aging.

We trained 11 clinicians at an academic HIV ambulatory care center to assess and prevent the 4F’s (polypharmacy, fragility fractures, falls) among their patients 50+ years old. We share baseline patient data and results from the HIV clinicians’ knowledge, attitudes, and practices baseline assessment.

125 patients were enrolled. Mean age was 63±6 years, 49% were women, 48% identified as Black. 30% were current smokers, and 30% reported ongoing marijuana use. The mean number of medications prescribed was 10±5. However, 25% experienced hyperpolypharmacy (taking 15+ medications), and 66% were prescribed potentially inappropriate medications (PIMs). Mean FRAX scores indicated low 10-year risk for fragility fractures (major osteoporotic fracture: 8.71%±6.95%; hip fracture 2.11%±3.58%). Using our serious fall risk assessment tool, we found that 27% of women and 24% of men were at high risk for a serious fall within the next 6 months. Among the clinicians participating in the study, 73% performed medication reconciliation at least once a year. 55% reported asking about falls only if the patient brought it up, and 36% had only asked their patients once about falls. 18% had never assessed their patients’ fracture risk.

Polypharmacy, high medication count, and PIMs are key risk factors for adverse outcomes among older adults. Deprescribing and fall and fracture prevention are key foci for future interventions.