Clinical Perspective End of Life Care for HIV Dr. Ann S tewart, - - PowerPoint PPT Presentation

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Clinical Perspective End of Life Care for HIV Dr. Ann S tewart, - - PowerPoint PPT Presentation

Aug 17, 2023 482 likes •622 views

Clinical Perspective End of Life Care for HIV Dr. Ann S tewart, Medical Director, Casey House Obj ectives To review local data on end of life care for patients with HIV/ AIDS in Toronto To look at changing cause of death To

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Clinical Perspective

End of Life Care for HIV

  • Dr. Ann S

tewart, Medical Director, Casey House

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  • www. caseyhouse.com

Obj ectives

  • To review local data on end of life care for

patients with HIV/ AIDS in Toronto

  • To look at changing cause of death
  • To discuss recent cases of admission for end of

life care

  • To look at strategies for end of life care

planning

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  • www. caseyhouse.com

Presenter Disclosure

  • Dr. Ann Stewart
  • Employee of Casey House
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  • www. caseyhouse.com
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  • www. caseyhouse.com

Deaths at Casey House

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% 1988 2010 2012 2014 Percentage of admissions

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  • www. caseyhouse.com

Casey House Chart Review, 2008

  • Average age of death 48 +/ - 2.4 years
  • Average number of years living with HIV

14.6 +/ -7.6

  • Pre-HAART average age of death 39 +/ -

2.4 years

  • Mean number of years of living with HIV

pre-HAART 1.5 +/ - 0.2

Halman et al, 2013; To et al, 2011

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  • www. caseyhouse.com

Cause of Death: Pre and Post HAART

81% 19%

Deaths Pre-HAART (1988)

AIDS related deaths Non-AIDS related deaths

25% 75%

Deaths Post-HAART (2006-2008)

AIDS related deaths Non-AIDS related deaths

From To et al. CAHR 2011 Mycobacterium Avium Complex, Toxoplasmosis, Pneumocystis Pneumonia, Kaposi Sarcoma Non‐AIDS malignancy, liver disease, respiratory disease, organ failure

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  • www. caseyhouse.com

Mature patients

  • Present in late forties and fifties
  • On ARV therapy, suppressed
  • Develop malignancy
  • Do poorly on chemo and radiation
  • May be well-supported by friends and

family – may not have much of a plan

  • S

low decline, with many hospital interventions

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  • www. caseyhouse.com

Y

  • ung patients
  • Can present in their 20’s
  • May have history of opioid use with inj ection,

and/ or mental health issues

  • Often unhoused with few personal connections
  • Unable to tolerate regular medication regimes
  • Develop multiple complications of immuno-

suppression and infectious disease: MAC, C Diff, CMV , endocarditis

  • S

till die of the classic complications of AIDS

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  • www. caseyhouse.com

Next…..

  • Claire Kendall
  • Associate Professor, Department of Family

Medicine, University of Ottawa

  • Greg Robinson
  • Physician and community activist from Toronto
  • Richard Harding
  • Reader in Palliative Care, King’s College London UK
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  • www. caseyhouse.com

Thanks

  • OHTN
  • Fellow presenters
  • Terrific team at Casey House
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  • www. caseyhouse.com

Complexity

7 patients (8.4%) experienced all three complexities

Only 1 (1.2%) patient had no complexity

From Halman et al 2013, chart review of all patients admitted in 2008 N= 83

Frequency Percentage Homeless: no home, shelter, with friends/family, on street 16 19.3% Psychiatric: more than 1 Axis 1 diagnosis 77 92.8% Medical: more than 2 medical co-morbidities 28 33.7%