Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV

Abstract

Background: To understand the effects of frailty, geriatric syndromes, and comorbidity on quality of life and mortality in older adults with HIV (OAWH).

Methods: Cross-sectional study of the FUNCFRAIL multicenter cohort. The setting was outpatient HIV-Clinic. OAWH, 50 year or over were included. We recorded sociodemographic data, HIV infection-related data, comorbidity, frailty, geriatric syndromes (depression, cognitive impairment, falls and malnutrition), quality of life (QOL) and the estimated risk of all-cause 5-year mortality by VACS Index. Association of frailty with geriatric syndromes and comorbidity was evaluated using the Cochran-Mantel-Haenszel test.

Results: Seven hundred ninety six patients were included. 24.7% were women, mean age was 58.2 (6.3). 14.7% were 65 or over. 517 (65%) patients had ≥3 comorbidities, ≥ 1 geriatric syndrome and/or frailty. There were significant differences in the estimated risk of mortality [(frailty 10.8%) vs. (≥ 3 comorbidities 8.2%) vs. (≥ 1 geriatric syndrome 8.2%) vs. (nothing 6.2%); p = 0.01] and in the prevalence of fair or poor QOL [(frailty 71.7%) vs. (≥ 3 comorbidities 52%) vs. (≥ 1 geriatric syndrome 58.4%) vs. (nothing 51%); p = 0.01]. Cognitive impairment was significantly associated to mortality (8.7% vs. 6.2%; p = 0.02) and depression to poor QOL [76.5% vs. 50%; p = 0.01].

Conclusions: Frailty, geriatric syndromes, and comorbidity had negative effects on mortality and QOL, but frailty had the greatest negative effect out of the three factors. Our results should be a wake-up call to standardize the screening for frailty and geriatric syndromes in OAWH in the clinical practice.

Trial registration: NCT03558438.

Keywords: Frailty; Geriatric syndromes; HIV; Mortality; Quality of life.

Fig. 1

Prevalence and overlap of frailty, geriatric syndromes, and comorbidity in older adults with HIV. a Frailty vs non-frailty. b Frailty/prefrailty vs robust. Frailty and prefrailty defined according to Frailty Phenotype. Geriatric Syndromes were considered when the patient had at least one of the following: falls, cognitive impairment, depression, and risk of malnutrition. Falls considered whether the patient had at least one fall in the last year. Cognitive impairment defined as MOCA test score < 20 points. Depression defined as SF-GDS score ≥ 6 points. Risk of malnutrition defined as MNA-SF score < 11 points. Comorbidities were recorded due to self-reported, physician-diagnosed chronic conditions: hypertension, type 2 diabetes, dyslipidemia, coronary heart disease, stroke, COPD, chronic kidney disease, cancer (< 5 years from the diagnosis), history of cancer (≥ 5 years from the diagnosis; not active disease), psychiatric disorders, and osteoarticular disease

Fig. 2

Risk of all-cause 5-year mortality and quality of life of frail patients compared with non-frail. a Mortality. b Fair or poor QOL. Non-frail patients were divided in four groups: patients with only > 1 geriatric syndrome (light grey); patients with only > 3 comorbidities (medium grey); patients with geriatric syndromes and comorbidity (dark grey), and those without frailty, comorbidity, and geriatric syndromes (out of the Venn’s Diagram). The risk of all-cause 5-year mortality was calculated with Veterans Aging Cohort Study Index (VACS Index) and expressed as percentage of probability. The median VACS Index score was expressed as absolute number (p25-p75). QOL is expressed by the number of OAWH reporting fair or poor QOL and the proportion it represents in each group