The increasing pool of older individuals in the U.S. population who can develop late-onset systemic lupus erythematosus (SLE) and longer life expectancy for younger SLE patients will likely result in a dramatic increase in the numbers of older SLE patients over the next 20 years. The complex interactions of altered immunity, stress, and morbidity from long-standing chronic disease potentially put all SLE patients?regardless of age?at risk for functional impairments, which are generally associated with the aged population. But there is some evidence that even relatively young SLE patients have reported perceived physical and cognitive functional impairment. In a recently completed pilot study (n=60) ancillary to the ongoing Georgians Organized Against Lupus (GOAL) cohort, we performed detailed, in-person assessments of physical and cognitive functioning. We found that levels of physical and cognitive performance, self-reported physical functioning, independence in activities of daily living, falls, and community mobility were similar to, or worse than, those seen in older non-SLE populations. These results suggest that a novel, geriatric approach to care may be beneficial in SLE. To begin to address this goal, we first need to better characterize the burden of impairment of physical and cognitive functioning in a real-world SLE population, in order to determine what resources may be needed to support SLE patients? functioning as they age, and for which patients these resources are most needed. Furthermore, understanding the relative contributions of age, disease activity, cumulative organ damage, inflammation, and other patient characteristics to impairment in the setting of SLE will help to identify patients most likely to be impaired and target population-level interventions to reduce risk associated with poor functioning. Finally, understanding how impairment affects health outcomes in this population will assist with risk stratification and prevention of costly care, by providing information on the most predictive functioning measures among patients with SLE. GOAL, with its rich, existing longitudinal data and ongoing, population- based, diverse cohort of SLE patients, provides a unique opportunity to address these gaps. Our study aims to: (i) assess the burden and patterns of physical and cognitive dysfunction across age groups in a cohort of 450 SLE patients; (ii) identify patient risk factors for impairment in physical and cognitive functioning; and (iii) estimate associations of functioning measures with outcomes utilizing secondary and linked data. We will estimate the prevalence of dysfunction on multiple physical and cognitive functioning domains among GOAL patients, overall and by age, using validated instruments. We will then estimate associations of functioning with sociodemographic and clinical characteristics and measured inflammatory markers, overall and by age group. Finally, GOAL data and its linkage of administrative data can be leveraged to examine associations of functioning parameters with quality of life, depression, work/disability status, mortality, and severe morbidity, including hospitalization and progression to end-stage renal disease.

Public Health Relevance

Functional impairment, or reduced ability to carry out day-to-day tasks, is often associated with older populations but may occur in lupus patients of all ages. Our study aims to: estimate the burden of both physical and cognitive functional impairment; identify potential risk factors for this impairment among lupus patients; and compare outcomes among lupus patients with and without signs of impairment. The results of this study will help adapt and target geriatric interventions to support lupus patients with impairment, which will be essential for the maintenance of high-quality, patient-centered, efficient clinical care of the rapidly aging U.S. lupus population.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Neurological, Aging and Musculoskeletal Epidemiology (NAME)
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Joseph, Lyndon
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Emory University
Internal Medicine/Medicine
Schools of Medicine
United States
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