Current Reality: The New York Experience

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1 Current Reality: The New Yrk Experience Eugenia L. Siegler, MD 8th Internatinal Wrkshp n HIV & Aging Octber 3, 2017

2 Dr. Siegler is an investigatr n an investigatr-initiated research grant frm Gilead Sciences.

3 Divisin f Geriatrics and Palliative Medicine Center fr Special Studies Divisin f Infectius Diseases Weill Crnell/NYPH Clleagues and Cllabratrs Christiana Bitas Chelsie Burchett Tessa Del Carmen Marshall Glesby Sian Jnes Harjt Singh Objectives Recgnize aging-related cncerns f PWHA Understand challenges t establishing geriatric HIV prgrams

4 Our HIV and Aging Prgram Is Yung Awareness Geri Grand Rnds Clinical cnfs. Ad hc cnsults Challenges Patient accrual Optimizing cnsult value Preparing fr LTC needs Linkage t CBSS Sustainability (50k) Frmal prgram Fundatin supprt Fcus grups Educatin Embedded geri sessins, inpt.

5 Assessment: Cmprehensive but Efficient Histry Gals, what s imprtant t them BADL and IADL (including cntinence, falls) PHQ-4 (depressin, anxiety) Frailty screen (Gérntpôle) Strength (handgrip) QL, pain Hearing, visin prblems MCA VACS (ahead f time) FRAX (ahead f time) PE, including bserving gait

6 Demgraphics n=75 Med. Age 67 (50-84) Med. yrs HIV 22 (5-36) Gender (%) 69M, 29F, 1TGF Ethnicity (%) AA r AC 43 Caucasian 33 Hispanic 21 Biracial 3 Risk factr (%) MSM 52 Heter sex 25 IDU 11 UPS M&W 3 Heter sex & IDU 5 Unk 4 VL <20 (%) 71; (9 100) Wh is Being Referred? Characteristic (%) Frailty 42 F; 16 PF, 41 NF Active Smker 16 ADL Independent 91 IADL Independent 65 PHQ4+ anxiety 36 PHQ4+ depressed 26 Living alne 60 c/ fatigue 52 c/ pr memry 60 DXA w/in 2 yrs 31 (any DXA: 11O; 13L; 7N) Be advised f runding errrs

7 Cgnitin is the Cmmnest Prblem Discussed Other: Retirement Anxiety/Depressin Nnadherence Lneliness Insmnia Driving Hearing Palliative/lng term care Chemical dependency N=75 patients

8 Our Older Patients Have a Range f Gals Many have nne 63 patients Fewer respnses: Prepare fr retirement Cmfrt Caregiving respite Teach/help thers Educatin

9 And Subptimal Health excellent very gd gd fair pr 44% rated their health as fair r pr 49% rated pain as at least mderate nne very mild mild mderate severe very severe

10 Cgnitive Impairment & Memry Cncerns Are Nt Clsely Linked N cmpleting MCA: 69 Median 23; range 6-30 Ttal MCA >=24 MCA <24 MCA and memry Q C/ memry lss Denied memry lss Overtn et al, di: /s

11 What Is Wrking? Embedding geriatrician in clinic enables creative cllabratin PT recmmendatins can be an pening, but CGA ffers mre MCA has been valuable prcedure SW are interested in Aging Services Netwrk

12 Whm Shuld We See and Hw D Clinicians dn t want autmatic referral based n age We must expand beynd memry cncerns and PT referrals I have t remind peple t refer Sme clinicians wn t refer Sme patients wn t see me We Advertise?

13 What Relatinship Shuld Geriatricians Have With PAH? Wh runs the prgram? Is there a subgrup whse primary care we shuld prvide? Shuld we be mre active in prvisin f care? What is the value f lngitudinal fllw up?

14 Hw Shuld CGA be Dne? Wh shuld d the assessment? NP r MD? Incrprated int clinical practice r utsurced? Wh has the time? Shuld it be cmprehensive r fcused? Hw shuld the infrmatin be disseminated and translated int actin?

15 Are We Truly Helping? Why must I cntinue t advertise? What des CGA add? Why aren t recmmendatins fllwed? Why are certain cmrbidities unaddressed? e.g., Bne health hw d we help clinicians vercme their discmfrt with bisphsphnates?

16 Demgraphics Recgnitin C/multimrbidity Management Aging-Related Syndrmes Lng term care The Field f HIV/Aging is Evlving

17 The Future f Geriatric-HIV Care is Outside the Office Hw d we meet psychscial and lng term care needs? Wh shuld pay fr these prgrams? Insurance (apprach SNPs) Feds (capitated prgrams) Husing rganizatins Philanthrpies Lcal health prgrams

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