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Exploring the CORE Healthy Aging Initiative

What we did over a very short period, a two-month period from March to May of [2016], was have our peer educators who are part of our clinic population hand out paper surveys to patients as they’re waiting for their appointments, either scheduled or walk-in visits. [We were] trying to get a sense as to who they were, how long they’ve been living with HIV, what their comorbidities were, what their concerns were, [and then] having a rank [of] what we thought their top 10 concerns [were], based on information that we’d heard from our patients. We [wanted] to get an idea on how well they rated their health and, importantly, how tech savvy [they were] and how they liked to be communicated with. Knowing what the issues are, we need to figure out how well to engage patients and those needs and get those things met. Now with people living well with HIV, our [patients may visit the] clinic sometimes twice, maybe three times a year, if they’re doing well from their HIV standpoint. If we have these initiatives, we have to be able to figure out how to get information to patients, and figure out ways to engage them.
There’s a lot of stuff about social media and the younger adults with HIV, and how to reach younger adults, and we really wanted to figure out do [these older adults] use social media, are [they] on Facebook, Twitter, do [they] have a cell phone, do [they use] text messaging, because that allows us an opportunity to constantly reach them with targeted messaging [to] tell them about events or initiatives for aging [with HIV]. [We also want to] work with our non-infectious disease people in geriatrics, in social services, in psychiatry, in mental health services, to actually leverage some of those resources for our patients. We wanted to get an idea, in summary, of who [the patients] were, what their burden of illness was based on HIV and other comorbidities, what their top concerns were, what their psychosocial issues [were]– we wanted to look at social isolations, things that really do matter– and then figure out what their modes of communication were, so that when we did develop these strategies we could have an easier way to communicate with our patients.
What we did find was like we thought. The median age was about 56, so we really only were looking at people who were 50 and older; our oldest participant was 75. [Patients] were mostly African American in the demographics of our clinic, but we also do have, in my clinic, about 18% of our patients who are monolingual Spanish. [Due to this], we made sure that some of our surveys were in Spanish, because we do realize that the older population is not a homogenous group. They have very different needs based on gender, race, and language of communication. We found that more than 70% of them had been living with HIV for more than 10 years, [and] a lot of them for more than 15 or 20 years. There were very few who were newly diagnosed. [The patients also] had a lot of comorbidities: high rates of hypertension, diabetes, history of cancer, memory issues, hepatitis C, bone disease, a lot of things, but they also had a lot of other concerns. When we looked at the top five concerns, of the 10 that were listed, we had 30 or 40% [of the patients have the same top concerns]. The top ones were about living with HIV, money concerns, retirement planning, who’s going to care for [them] as [they] get older, memory issues, sexual health issues; so, they had a lot of concern.
As well as we do with HIV in our clinic, more than 90% of our older adults are suppressed, which is great, but [when] they self-rated their health we only had about 40% say that their health was very good or excellent. The rest of them [said] fair or poor. We do know that outside of HIV, that the more medical problems you have the less-likely you are to report your self-health as very good, and they had a lot. The average number of prescribed medications was four. [So although] a lot of them may be on single tablet regimens for their HIV, there were all these other medications for all their other comorbidities.
Polypharmacy [is] another big issue. Drug interactions that come with medications prescribed for heart disease and bone disease and kidney disease interact with HIV medicines. [We have some patients] who hide history of falls, [and] we know that has to do with frailty. So, they did have concerns, but the beauty of this study is that we find that a lot of them were tech savvy. More than 70% of them had a cell phone, they use text messaging, they’re on social media. We did see that very few of them were in social clubs or groups, so they did this by themselves, which is not surprising, but it kind of tells us that we will have to do a lot of targeted interventions, because a lot of them were not in large group settings. Most of them were their [own] primary health caregiver: 80% of them said they were their own caregivers, not [receiving] a lot of support in that regard. We asked about if they were willing to quit smoking, more than 70% of the active smokers (which about almost half of our patients were still smoking) said they were interested in quitting smoking, more than half said they would be interested in exercise classes at the Center, more said they would be interested in nutrition and lifestyle interventions and being in a focus group.
We did get a lot of information; close to 400 patients in 2 months were willing and eager to give us information about who they were, what their concerns were, what their medical issues were, what they were interested in, and how to get in touch with them. In this short time, we got a lot of information.”

In a follow-up discussion, Dr. Adeyemi stated the following.

"As a follow up, we are starting the CHAI monthly series at our clinic in Mach 2017 with a brainstorming meeting with our community advisory board and peers in February 2017 to finalize format and objectives. The series will be open to all adults over age 50yrs and will include exercise sessions, seminars on health and psychosocial topics chosen by participants and a resource table available to get additional information."
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