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Elderly & Older PLWH Need New Standard of Care in Clinic & Support Social Services
  NYS just announced $20 mll 5 year funding project naming 1 clinics throughout NYC & NYS. This follows last year where NYC DOH funded 3 new aging/HIV clinics at major HIV hospital based HIV clinics fr African-Americans & Latinos. This followed HRSA announcing $10 mill funding for 10 national aging/HIV clinics All of which I worked closely with officials on. This seeming success is inadequate, it fails to address the biggest need - to integrate aging needs into the HIV clinic system on a national Standard of Care basis in every city in the USA. As I describe immediately below our HIV Clinics are failing the aging & in particular the elderly HIV population - who need specific aging care, screening, support services which include housing, income, transportation, social needs. Standalone separate aging clinics outside where the PLWH receives there oroman HIV care is a model that is not good enough, its a bandaid, we need this aging & elder care right in the HIV clinic where all PLWH receive their care. Right now 250,000 PLWH in the USA are over 60 (CDC data 2019), its predicted that by 2030 70% will be over 50. Right now in NYC 80% are over 40 meaning that by 2030 80% will be over 50. By 2030 30% will be over 70 since 30% are over 60 now. The same can be said for San Francisco but NY has by far the biggest numbers. Where are our federal leaders? Yes the funded through SPNS 10 national clinics and NYS these 10 clinics. This is a major step. BUT this care & services need to be integrated right into the HIV clinic where PLWH receive granular care - this sound be Aging/HIV Standard of Care.
Attached here is the recently announced Glasgow Manifesto, a global coalition paper demanding good care for all older & elderly PLWH. 75 HIV organizations signed on to endorse this paper.



NYS People Aging with HIV (PAWH) Pilot (NYC too) - (11/21/22)
New York State AIDS Institute Initiatives to Improve Care For Older People With HIV and Long-Term Survivors: An Example of a Government-Academic-Community Partnership - (10/17/22)
Glasgow: The Glasgow Manifesto International Coalition of Older People with HIV (iCOPe HIV) - (10/26/22)
The HIV healthcare system has ignored Aging Issues That Are Coming Back to Haunt Elderly PLWH Who Are Abandoned
- there are no built in systems such as discussed in this NY times article in our HIV care system that adequately addresses out needs. Healthcare in the clinic very often ignores screening that is mandatory in normal doctor-patient scenarios outside HV including Bone Mineral Density testing & comprehensive heart disease screenings by a cardiologist at the appropriate age. The HIV policy, research & health systems are dominated in many ways by the needs if the young, drug users, and endless so far futile search for a cure, as well as a focus on the HIV-neg with PrEP, but aging needs & clinical care for the HIV+ elderly and older deserves parity at least to these concerns yet is marginalized receiving less attention, often no attention in certain circles such as in some major NYC HIV clinics & large hospital systems where aging screenings & care are all too often ignored. This is in part to a lack of leadership to addresss these problems in a comprehensive, wholistic, thoughtful planning approach by leaders at the federal, state & city levels.
As Gen X and Boomers Age, They Confront Living Alone
More older Americans are living by themselves than ever before. That shift presents issues on housing, health care and personal finance.
Nearly 26 million Americans 50 or older now live alone, up from 15 million in 2000. Older people have always been more likely than others to live by themselves, and now that age group - baby boomers and Gen Xers - makes up a bigger share of the population than at any time in the nation's history.
Compounding the challenge of living solo, a growing share of older adults - about 1 in 6 Americans 55 and older - do not have children, raising questions about how elder care will be managed in the coming decades.
"I still feel pretty indestructible, foolishly or not," he said.
His options for maintaining independence are "all terrible," he said. "I'm totally freaked out by it."
https://www.nytimes.com/2022/11/27/us/living-alone-aging.html?unlocked_article_code= g8IZexveS2opQ5VbAl5rUE06W1kqm5og8hDhQa3p0qYYqYd_T2XFympWRNGGlYsif9yU42xfy2T6KN3mvxa35-fGc2CHuYhtFVEQ4gDSikT8Ia665wtAnvytb_JSwjUwOPVwexJ1Wq0Q6PLaLCKMk7hch5hfkpcY7i7uDdNv6h35hvqx GrNznOWgo4FN8W_CHr0SxkPs4-fbIvqv_Gz9ZGdQzrPs3NqmxIelkoIHg6A6Ay8gkKp0eYJq1gmYZPjshLbs8nUOVwuYEcFLNSPdOFE4UBuglGG2nLlJ sX7NwLzoQWEu2lNqVTo7bScYfCkBGbqSYWEOHA&smid=share-url
Social isolation, loneliness in older people pose health risks
But while many people in their 50s and 60s thrive living solo, research is unequivocal that people aging alone experience worse physical and mental health outcomes and shorter life spans.
Older adults living alone with cognitive impairment-a growing and vulnerable population-face unique challenges.
Beyond genetics, understanding social determinants of health, and the role of social and interpersonal processes in healthy aging and longevity, is another research direction at NIH. Scientists are beginning to apply this framework to research on social isolation and loneliness.
Another structural obstacle is limited affordable services that address the specific needs of cognitively impaired people living alone. Home care aides are seldom trained to support older adults with cognitive impairment, and their fees are often too high for most older adults on a long-term basis, explained Dr. Portacolone. In addition, some older adults with cognitive impairment have had their driver's license revoked, but they do not get help with replacement transportation, which dramatically increases their isolation.
As a result, older adults with cognitive impairment living alone spend much of their time managing their household and their health, Dr. Portacolone said. They are often reluctant to show they need help because they fear being forced to move from their homes.
"We need to identify people who are most prone to suffer from social isolation and loneliness and those who would benefit most from interventions," said Dr. Pedersen. "Interventions for social isolation may look very different from interventions for those who feel lonely."
in my prior investigation of older residents of high-crime neighborhoods, who were mostly African-American older adults, a tension emerged between participants' longing to participate in society and obstacles that made this participation difficult to attain." These structural obstacles included fear of being robbed, distrust of neighbors, limited availability of appropriate services, dilapidated surroundings, and limited meaningful and positive relationships. Having few friends or family members attuned to their concerns was another factor exacerbating social isolation. Study participants expressed a desire to be socially integrated, an idea that runs against the prevailing assumption that isolated older adults are alone by choice.
Health effects of social isolation, loneliness
Research has linked social isolation and loneliness to higher risks for a variety of physical and mental conditions: high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer's disease, and even death."
People who find themselves unexpectedly alone due to the death of a spouse or partner, separation from friends or family, retirement, loss of mobility, and lack of transportation are at particular risk."
Conversely, people who engage in meaningful, productive activities with others tend to live longer, boost their mood, and have a sense of purpose. These activities seem to help maintain their well-being and may improve their cognitive function, studies show."
loneliness may alter the tendency of cells in the immune system to promote inflammation, which is necessary to help our bodies heal from injury, Dr. Cole said. But inflammation that lasts too long increases the risk of chronic diseases."
"Individuals who are not prone genetically to feeling lonely may, for example, suffer much less from social isolation, while others feel lonely even though they are surrounded and part of a rich social life," according to Nancy Pedersen, Ph.D., a professor of genetic epidemiology at the Karolinska Institutet in Stockholm, Sweden.

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