Falls and frailty are associated with negative perceived ageing and lower quality of life in people living with HIV using the EmERGE mHealth platform

Background:

As we streamline long-term HIV care through novel service models, emerging concerns including age-related issues must be addressed. We aimed to evaluate frailty, falls and perceptions of ageing among stable individuals with HIV engaged with remote healthcare delivered via a novel smartphone application.

Method:

Cross-sectional, questionnaire-based sub-study of EmERGE participants. Frailty assessment used the FRAIL scale, a five-item screening tool. Present criteria were summed and categorised: 0=robust, 1–2=pre-frail, 3–5 frail. Falls history and EQ-5D-5L quality of life tool were completed. Participants were asked: how old they felt & personal satisfaction with ageing.

Results:

1373 individuals participated across five European sites. Mean age was 45 (SD 9.8), 93% were male. 1310/1373 (96%) had full frailty data. 74% were robust; 24% pre-frail; and 2% frail. Those exhibiting any frailty characteristics (pre-frail/frail) had greater female representation (p=0.025), higher multimorbidity (p<0.001), and greater falls risk (p<0.001) compared to robust individuals.165/1331(12%) had fallen in the last year, 59% of whom fell recurrently. Fallers were older than non-fallers (p=0.003), with greater proportion aged>50 (p<0.001). Fallers were more likely to be multimorbid and have prefrailty/frailty (p<0.001). All data shown in Table P115.1.1016/1330 (76%) were satisfied with how they were ageing.75% of participants felt younger than their actual age (by 8 years; IQR 4–12), with 13.5% feeling older (by 5 years; IQR 3–9). Pre-frail/frail individuals were more likely to feel older than their chronological age and less likely to report that they were ageing well than if robust. Similarly, fallers felt older and were less frequently ageing well than non-fallers (p<0.001).Pre-frail/frail individuals and fallers reported lower subjective general health scores and more problems on all dimensions of the EQ-5D-5L (p<0.001). Over half reported pain or anxiety/depression, and a third problems with mobility and day-to-day tasks. Around 10% in each group had problems with self-care.

Conclusion:

Ageing issues were relatively uncommon, though 12% had fallen and 26% had at least one marker of frailty. Falls and frailty were interrelated and associated with multimorbidity, functional problems, and poorer perceptions of health and ageing. Identifying and tackling ageing concerns should be retained within any mHealth delivered care.