Tailored Geriatric Assessment and Management for HIV Care Settings

项目摘要/摘要 在很大程度上由于抗逆转录病毒疗法的成功开发，感染艾滋病毒的成年人活了下来 在美国，所有艾滋病毒携带者中有47%的人年龄在50岁及以上。这个老龄化的人口 越来越多地经历多病、多药，以及重大的心理健康和心理社会 挑战。年长的艾滋病毒阳性成年人也经历了包括跌倒在内的高发老年病， 虚弱，和功能障碍。老年评估和管理可以帮助解决这一医疗和 社会的复杂性。支持老年评估的作用，研究表明评估可以预测 老年艾滋病毒阳性成年人的住院和死亡率与老年疾病有关 生活质量更差。然而，关于如何更好地整合艾滋病毒的老年评估和管理，人们知之甚少。 护理设置。制定的战略需要是有效的，能够由受过培训的非老年病医生实施 临床医生，还为受艾滋病毒感染影响的独特老龄化问题量身定做。我们的建议 通过开发和测试量身定制的老年评估和初始 管理指南侧重于艾滋病毒呈阳性的老年成年人的需求，也称为G-AIM艾滋病毒。 具体地说，这项提案的目标是1)通过结合患者和专家来开发G-AIM HIV 对最重要的老年医学评估领域和初步管理步骤的看法；2)检查 艾滋病毒提供者和工作人员对G-AIM艾滋病毒的态度，并确定其使用的促进者和障碍；以及3)试点 G-AIM HIV在两个HIV门诊环境中评估可行性、可接受性和初步报告的患者 结果，如生活质量。该提案的目标是支持#年的职业发展活动。 PI梅雷迪斯·格林博士专注于1)德尔福方法和利益相关者参与，2)定性 研究方法，3)对弱势人群的干预和临床试验研究，4)正在进行中 领导力发展。格林博士将在加州大学旧金山分校进行所有工作 卓越的指导团队，由肯尼斯·科文斯基博士领导。这项K76 Beeson提案将推进我们的 了解如何将老年学原则融入艾滋病毒护理，以提高艾滋病毒阳性老年患者的生活质量 成年人。它还将提供先进的研究技能和宝贵的数据，以启动格林博士的职业生涯 艾滋病毒和老年医学交叉领域的独立调查者和领导者。

PROJECT SUMMARY/ABSTRACT Due in large part to the successful development of antiretroviral therapy, adults with HIV infection are living longer; in the United States, 47% of all people living with HIV are age 50 and older. This aging population increasingly experiences multimorbidity, polypharmacy, and significant mental health and psychosocial challenges. Older HIV-positive adults also experience a high frequency of geriatric conditions including falls, frailty, and functional impairment. Geriatric assessment and management could help address this medical and social complexity. Supporting a role for geriatric assessment, studies show that assessments can predict hospitalization and mortality among older HIV-positive adults and geriatric conditions are associated with poorer quality of life. Yet little is known on how to best integrate geriatric assessment and management in HIV care settings. Strategies developed need to be efficient, able to be administered by non-geriatrics trained clinicians, and also tailored to the unique aging issues that are influenced by HIV infection. Our proposal addresses this knowledge gap by developing and testing a tailored Geriatric Assessment and Initial Management guide focused on the needs of older HIV-positive adults, also referred to as G-AIM HIV. Specifically, the objectives of this proposal are to 1) develop G-AIM HIV by incorporating patient and expert perspectives on the most important geriatric assessment domains and initial management steps; 2) examine HIV providers’ and staff attitudes towards G-AIM HIV and identify facilitators and barriers to its use; and 3) pilot G-AIM HIV in two HIV outpatient settings to evaluate feasibility, acceptability and preliminary patient reported outcomes such as quality of life. The objectives of this proposal support the career development activities of the PI Dr. Meredith Greene focused on 1) Delphi methodology and stakeholder engagement, 2) qualitative research methods, 3) intervention and clinical trial research with vulnerable populations, and 4) ongoing leadership development. Dr. Greene will conduct all work at the University of California, San Francisco with an exceptional mentoring team, led by Dr. Kenneth Covinsky. This K76 Beeson proposal will advance our knowledge of how to integrate geriatric principles into HIV care to improve quality of life for older HIV-positive adults. It will also provide advanced research skills and valuable data to launch Dr. Greene’s career as an independent investigator and leader at the intersection of HIV and geriatric medicine.