Abstract
BACKGROUND: With increased life expectancy of people living with HIV comes increased rates of multimorbidity and frailty, which services are not currently managing well. A geriatric day hospital (GDH) screening program was offered in our infectious disease department for all people living with HIV aged 70 years and older coming for follow-up, with the aim to provide more holistic ageing care. In order to evaluate our professional practice, we assessed the proportion of participants who had a planned change in their care pathway following this screening, and describe the population who benefited from this GDH. METHODS: From July 2021 up to January 2024, a cross-sectional study was performed. Demographic data was collected from participant's medical records along with various validated geriatric screening scores. Changes in the care pathway included referrals to a health professional and/or a change in treatment. Changes were indicated by the results of the screening program, planned by the clinician if the changes were considered relevant and if the participant agreed, and finally implemented or not at the next consultation. The percentage of participants with a change in their care pathway following the geriatric screening test is presented with a 95% confidence interval. The factors associated with it were studied using the Chi-squared test or the Fisher's exact test for categorical variables, and Student's t test or Mann-Whitney test for continuous variables. RESULTS: A total of 63 people living with HIV, aged 75.2 ± 4.6 years, were included, 57.1% of whom had at least three comorbidities. According to the geriatric screening evaluations, a change in the care pathway was indicated in 56/63 (88.9%; 95%CI: 78.4 to 95.4%) people living with HIV, and planned by the doctor with the participant's agreement in 34/63 (54.0%; 95%CI: 40.9 to 66.6%) participants. Factors associated with a planned change in the care pathway were Dat'AIDS mortality score (p=0.02), EPICES score (p=0.03), Fried frailty phenotype (p=0.007) and GFST (p=0.04). At least one planned change in the care pathway was implemented before the next consultation six months later in 30/63 (47.6%) people living with HIV. CONCLUSIONS: This study demonstrates the feasibility of organising geriatric screening in an infectious diseases unit. The proportion of changes that were implemented highlights the relevance of using these screening tests. It is, however, important to improve some of the screening tests used and raise awareness amongst people living with HIV and their doctors. TRIAL REGISTRATION: This study was registered in the institution's data processing register under number M23JC0704 and approved by the ethics committee (IRB00013412, "CHU de Clermont Ferrand IRB #1", number IRB 2023CF089).