Complex but Unassessed: A Service Evaluation of Frailty Indicators in Older Adults Attending a Tertiary HIV Service

Introduction: 

As treatment for Human Immunodeficiency Virus (HIV) has developed, the proportion of older adults living with HIV has increased. These patients are susceptible to developing frailty, which is associated with functional impairment and prolonged hospitalisation. This project sought to evaluate the prevalence of frailty indicators and how often frailty and cognition were formally assessed among patients aged over 65 under the care of a tertiary HIV service. 

Methods: 

A retrospective service evaluation was conducted including 200 patients. Those who had died, or with incomplete or inaccessible records were excluded. This project did not require ethical approval and was registered with the local Trust audit and quality improvement team. Records were reviewed for demographics, comorbidities (Charlson Comorbidity Index), polypharmacy (over five medicines), body mass index and comprehensive geriatric assessment domains (falls, continence, cognition, care needs). As Clinical Frailty Scale (CFS) was rarely documented, it was assigned following record review. Frequency of Abbreviated Mental Test (AMT) assessment was recorded. Data were analysed using descriptive statistics.  

Results: 

The median patient age was 69 years (range 65 to 86). Of the cohort, 150/200 (75%) were male and 90/200 (45%) lived in the two lowest deprivation deciles. The median Charlson Comorbidity Index was 3 (IQR 3 to 4) and 69/200 (35%) were obese. Diabetes affected 50/200 (25%), cardiovascular disease 46/200 (23%), chronic kidney disease 101/200 (51%) and liver disease 55/200 (28%). By CFS, 174/199 (87%) were fit, 17/199 (9%) vulnerable and 8/199 (4%) frail. Polypharmacy affected 148/200 (74%) rising to 32/35 (91%) of those aged over 75. AMT was recorded in only 3/200 (2%) of patients. 

Conclusion: 

This cohort of older adults living with HIV showed a high burden of multimorbidity, polypharmacy and cardiometabolic disease. Frailty and cognition were rarely formally assessed. These findings suggest frailty may be under-recognised in this patient cohort.