Burden, correlates, and outcomes of poor cognitive and physical functioning in the lupus population

狼疮人群认知和身体功能不良的负担、相关性和结果

• 批准号: 10533824
• 负责人: Laura Plantinga
• 金额: $ 11.14万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10533824
• 关键词: Activities of Daily Living; Acute; Address; Affect; Age; Aging; Ancillary Study; Caring; Characteristics; Chronic Disease; Clinical; Cognitive; Communities; Complex; Data; Disease; Elderly; End stage renal failure; Functional disorder; Goals; Health; High Prevalence; Hospitalization; Immunity; Impaired cognition; Impairment; Individual; Inflammation; Intervention; Life Expectancy; Link; Lupus; Maintenance; Measurement; Measures; Mental Depression; Morbidity - disease rate; Neurobehavioral Manifestations; Older Population; Organ; Outcome; Patient Self-Report; Patient risk; Patients; Pattern; Persons; Physical Function; Physical Performance; Physical assessment; Pilot Projects; Population; Prevalence; Prevention; Preventive; Quality of life; Rare Diseases; Reporting; Resources; Risk; Risk Factors; Risk Reduction; Sampling; Stress; Supportive care; Systemic Lupus Erythematosus; Target Populations; Treatment Cost; Woman; Work; age group; aged; aging population; care costs; clinical care; cognitive function; cognitive performance; cohort; cost; disability; experience; falls; functional disability; inflammatory marker; instrument; men; middle age; mortality; novel; older patient; overtreatment; patient oriented; patient population; population based; potential biomarker; risk stratification; sociodemographics; young woman

PROJECT SUMMARY 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.

项目摘要 在美国人群中，越来越多的年龄较大的人可以发展出较晚的系统性狼疮 年轻SLE患者的红血病（SLE）和更长的预期寿命可能会导致戏剧性 在未来20年内，老年SLE患者的数量增加。改变的复杂相互作用 长期慢性疾病的免疫力，压力和发病率可能使所有SLE患者 - 无人 年龄 - 功能障碍的风险，通常与老年人群有关。但是那里 有证据表明即使相对年轻的SLE患者也报告了感知的身体和认知 功能障碍。在最近完成的试点研究（n = 60）中，正在进行的格鲁吉亚人有组织 反对狼疮（目标）队列，我们​​对身体和认知进行了详细的面对面评估 功能。我们发现身体和认知表现的水平，自我报告的身体功能， 在日常生活，跌倒和社区流动性活动中的独立性类似于或更糟糕 参见较旧的非sle人群。这些结果表明，一种新颖的老年护理方法可能是 在SLE中有益。为了开始解决这个目标，我们首先需要更好地表征损害的燃烧 在现实世界中的身体和认知功能中，以确定可能的资源 需要随着年龄的增长而支持SLE患者的功能，并且这些资源最多 需要。此外，了解年龄，疾病活动，累积器官的相对贡献 在SLE的情况下，损害，炎症和其他患者特征将有助于识别 患者最有可能受到损害并靶向人群水平的干预措施，以降低与差的风险 功能。最后，了解损害如何影响该人群中的健康结果将有助于 通过提供有关最预测性功能的信息，风险分层和预防昂贵的护理 SLE患者的措施。目标，具有丰富的现有纵向数据和正在进行的人群 - 基于SLE患者的潜水员队列为解决这些差距提供了独特的机会。我们的研究目的是： （i）评估450人群中年龄段的身体和认知功能障碍的烧伤和模式 SLE患者； （ii）确定患者的身体和认知功能损害的风险因素； （iii） 利用次级和链接数据的结果估算功能度量的关联。我们将 估计目标之间多个物理和认知功能域上功能障碍的流行率 使用经过验证的仪器，总体和逐年的患者。然后，我们将估计功能的关联 社会人口统计学和临床​​特征以及总体和按年龄组测量的炎症标记。 最后，目标数据及其行政数据的链接可以利用 具有生活质量，抑郁，工作/残疾状况，死亡率和严重发病的功能参数， 包括住院和发展为终末期肾脏疾病。