Many people living with HIV (PLWH) are aging with geriatric syndromes, but few undergo comprehensive geriatric assessment (CGA) due to limited resources. Our study evaluates tools to identify aging PLWH who may forego CGA. We conducted a cross-sectional study on 357 PLWH ≥50 years old at the Red Cross, Thailand. Tools evaluated were the Veterans Aging Cohort Study Index (VACSI) and G-8, which is predictive among older cancer patients. CGA consists of eight tests: history of fall within 12 months, timed-up-and-go test (TUG), activities of daily living (ADL), instrumental ADL (IADL), Montreal cognitive assessment (MoCA), Thai depression scale (TDS), mini nutritional assessment (MNA), and HIV symptom index (HSI). We considered ≥2 impaired domains on CGA to be abnormal results. Forty-nine percent (n = 175) had ≥2 impaired domains on CGA. Few participants had experienced a fall (11%) or abnormal TUG/ADL/IADL (<2%), and only MoCA/TDS/MNA/HSI were analyzed. A VACSI < 17 produces 85% sensitivity (Se) and 30% specificity (Sp) (area under the ROC curve [AUC] = 63, 95%CI 58–69) and G-8 > 15.5 produces 90%Se and 33%Sp (AUC = 74, 95%CI 69–79) in identifying patients with <2 impaired domains. A G-8 > 13.5 produces 91%Se and 77%Sp (AUC = 89, 95%CI 86–92) in ruling out abnormal nutrition. Patients with VACSI < 17 and G-8 > 15.5 may forego CGA due to low likelihood of abnormal cognition, mood, nutrition, or symptom burden.
BrooksJTBuchaczKGeboKA, et al.
HIV infection and older Americans: the public health perspective. Am J Public Health2012;
102: 1516–1526.
4.
GreeneMCovinskyKEValcourV, et al.
Geriatric syndromes in older HIV-infected adults. J Acquir Immune Defic Syndr2015;
69: 161–167.
5.
BrañasFRyanPTroyaJ, et al.
Geriatric-HIV medicine: the geriatrician’s role. Eur Geriatr Med2018;
10(2): 259–265.
6.
BelleraCARainfrayMMathoulin-PelissierS, et al.
Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol2012;
23: 2166–2172.
7.
StuckAESiuALWielandGD, et al.
Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet1993;
342: 1032–1036.
8.
EllisGWhiteheadMARobinsonD, et al.
Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ2011;
343: d6553.
9.
HussAStuckAERubensteinLZ, et al.
Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci2008;
63: 298–307.
10.
RubensteinLZJosephsonKRWielandGD, et al.
Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med1984;
311: 1664–1670.
11.
TateJPJusticeACHughesMD, et al.
An internationally generalizable risk index for mortality after one year of antiretroviral therapy. AIDS2013;
27: 563–572.
12.
JusticeACModurSPTateJP, et al.
Predictive accuracy of the Veterans Aging Cohort Study Index for mortality with HIV infection: a North American cross cohort analysis. J Acquir Immune Defic Syndr2013;
62: 149–163.
13.
SalinasJLRentschCMarconiVC, et al.
Baseline, time-updated, and cumulative HIV care metrics for predicting acute myocardial infarction and all-cause mortality. Clin Infect Dis2016;
63: 1423–1430.
14.
BarakatLAJuthani-MehtaMAlloreH, et al.
Comparing clinical outcomes in HIV-infected and uninfected older men hospitalized with community-acquired pneumonia. HIV Med2015;
16: 421–430.
15.
MarquineMJUmlaufARooneyAS, et al.
The Veterans Aging Cohort Study Index is associated with concurrent risk for neurocognitive impairment. J Acquir Immune Defic Syndr2014;
65: 190–197.
16.
Nestlé Nutrition Institute. MNA Mini Nutritional Assessment, http://www.mna-elderly.com/ (accessed 1 February 2019).
17.
ExtermannMHurriaA.Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol2007;
25: 1824–1831.
18.
ErlandsonKMAllshouseAAJankowskiCM, et al.
Risk factors for falls in HIV-infected persons. J Acquir Immune Defic Syndr2012;
61: 484–489.
19.
RuizMAReskeTCefaluC, et al.
Falls in HIV-infected patients: a geriatric syndrome in a susceptible population. J Int Assoc Provid AIDS Care2013;
12: 266–269.
20.
ErlandsonKMPlankeyMWSpringerG, et al.
Fall frequency and associated factors among men and women with or at risk for HIV infection. HIV Med2016;
17: 740–748.
21.
PodsiadloDRichardsonS.The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc1991;
39: 142–148.
22.
GrinspoonSCorcoranCLeeK, et al.
Loss of lean body and muscle mass correlates with androgen levels in hypogonadal men with acquired immunodeficiency syndrome and wasting. J Clin Endocrinol Metab1996;
81: 4051–4058.
23.
GrinspoonSCorcoranCAskariH, et al.
Effects of androgen administration in men with the AIDS wasting syndrome. A randomized, double-blind, placebo-controlled trial. Ann Intern Med1998;
129: 18–26.
24.
KatzSFordABMoskowitzRW, et al.
Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA1963;
185: 914–919.
25.
LawtonMPBrodyEM.Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist1969;
9: 179–186.
26.
MorganEEIudicelloJEWeberE, et al.
Synergistic effects of HIV infection and older age on daily functioning. J Acquir Immune Defic Syndr2012;
61: 341–348.
27.
StantonDLWuAWMooreRD, et al.
Functional status of persons with HIV infection in an ambulatory setting. J Acquir Immune Defic Syndr1994;
7: 1050–1056.
28.
Montreal Cognitive Assessment. The Montreal cognitive assessment MoCA is a brief cognitive screening tool for mild cognitive impairment, http://www.mocatest.org/ (accessed 1 February 2019).
29.
Molina-GarridoMJGuillen-PonceC.Overvaluation of the vulnerable elders survey-13 as a screening tool for vulnerability. J Clin Oncol2011;
29: 3201–3202.
30.
StanekVSanchezMDLSierraMDP, et al.
MoCA utility as a quick testing tool for neurocognitive disorders in HIV patients: analysis of a prospective cohort. Open Forum Infect Dis2017;
4: S207.
31.
HakkersCSKraaijenhofJMvan Oers-HazelzetEB, et al.
HIV and cognitive impairment in clinical practice: the evaluation of a stepwise screening protocol in relation to clinical outcomes and management. AIDS Patient Care STDS2017;
31: 363–369.
32.
ChartierMCrouchPCTullisV, et al.
The Montreal Cognitive Assessment: a pilot study of a brief screening tool for mild and moderate cognitive impairment in HIV-positive veterans. J Int Assoc Provid AIDS Care2015;
14: 197–201.
LiLLeeSJThammawijayaP, et al.
Stigma, social support, and depression among people living with HIV in Thailand. AIDS Care2009;
21: 1007–1013.
35.
RuizMKamermanLA.Nutritional screening tools for HIV-infected patients: implications for elderly patients. J Int Assoc Physicians AIDS Care2010;
9: 362–367.
36.
JusticeACHolmesWGiffordAL, et al.
Development and validation of a self-completed HIV Symptom Index. J Clin Epidemiol2001;
54: S77–S90.
37.
KilbourneAMJusticeACRollmanBL, et al.
Clinical importance of HIV and depressive symptoms among veterans with HIV infection. J Gen Intern Med2002;
17: 512–520.
38.
WhalenCCAntaniMCareyJ, et al.
An index of symptoms for infection with human immunodeficiency virus: reliability and validity. J Clin Epidemiol1994;
47: 537–546.
39.
DoTCKerrSJAvihingsanonA, et al.
HIV-associated cognitive performance and psychomotor impairment in a Thai cohort on long-term cART. J Virus Erad2018;
4: 41–47.
40.
RuschMNixonSSchilderA, et al.
Impairments, activity limitations and participation restrictions: prevalence and associations among persons living with HIV/AIDS in British Columbia. Health Qual Life Outcomes2004;
2: 46.
41.
HardingRClucasCLampeFC, et al.
What factors are associated with patient self-reported health status among HIV outpatients? A multi-centre UK study of biomedical and psychosocial factors. AIDS Care2012;
24: 963–971.
Mini-Cog. Screening for cognitive impairment in older adults, https://mini-cog.com/ (accessed 1 February 2019).
44.
Mathias S, Nayak US, Isaacs B Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil 1986; 67: 387–389.
45.
Podsiadlo D, Richardson S The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142–148.
46.
Nasreddine ZS, Phillips NA, Bedirien V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53(4): 695–699.
47.
Guigoz Y, Vellas B, Garry P Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol 1994; 4(Suppl 2): 15–59.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
