Doctors who treat people with HIV spend almost 80% of their time managing non-HIV, age-related illnesses. Chronic “non-AIDS” conditions that are typically associated with aging include heart disease, cancers, and lung and bone diseases. HIV is now classified as a chronic disorder. Someone with two or more chronic illnesses is described as having multimorbidity.
PLACING EMPHASIS ON SUSTAINING FUNCTION
Older adults with HIV are developing more comorbidities of aging compared to older adults without HIV. Older adults with HIV can benefit from care models developed by geriatricians who are trained to manage multimorbidity. Geriatricians focus on sustaining a person’s function rather than trying to target and manage each illness separately. By emphasizing function, the patient can sustain their independence and age in place (i.e. at home), thereby experiencing a better quality of life.
MORE PILLS DOES NOT MEAN BETTER HEALTH
Geriatricians know that as a person develops more disorders with ago, they will take more medications that can increase the risks for adverse effects, falls, and dangerous drug-drug interactions. The simultaneous use of multiple drugs is called polypharmacy (see pill burden below). Geriatricians know that people who take multiple medications are less likely to be adherent, including to HIV meds. Most research reports show that older adults with HIV experience polypharmacy at significantly higher rates than those without HIV. In addition to polypharmacy, geriatricians are also aware of other conditions such as frailty, dementia, compromised mobility, and risk for falls. When making treatment decisions, geriatricians know the social support that an older adult can receive from family members, friends, and neighbors can positively affect health outcomes. Similarly, they are aware of the negative impact of social isolation and unaddressed mental health issues.
What you can do with your doctor
Older adults with multimorbidity often discover that there is too little or no communication between their primary care physician (HIV treating physician) and specialists to whom they have been referred. This underlines the need for a person who can coordinate the care among providers and the patient. Without a care coordinator, the patient needs to inform the primary care physician of the care they received from a specialist. This may include details of new treatments and medications that have been prescribed. You should alert your doctor when there are any changes that specialists may have made to your medications or dosages.