Conditions identified by common comprehensive geriatric assessment measures and subsequent acute care among adults with SLE

Objective The value of comprehensive geriatric assessment (CGA) in the setting of chronic disease, regardless of age, has been increasingly recognised. We examined whether geriatric conditions identified by measures commonly used in CGA were associated with subsequent acute care utilisation among individuals with SLE. Methods In this longitudinal cohort study, data from participants from a population-based cohort of adults (≥18 years) with validated SLE were included if they completed a study visit during which data on CGA measures were collected and a subsequent (12–24 months later) questionnaire that included items on emergency department (ED) visit and hospital admissions. Associations (incidence rate ratios (IRRs)) of CGA-identified conditions (impairments in physical or cognitive performance; limitations in self-reported physical function or instrumental or basic activities of daily living (ADLs); restrictions in community mobility; polypharmacy; urinary incontinence) with ED visits and hospital admissions were assessed with multivariable negative binomial models, adjusting for demographic and clinical characteristics. Results Nearly all (97.1%) participants (n=241; mean age, 45.9; 93.0% female; 83.8% black) had at least one CGA-identified condition. Those with CGA-identified conditions with physical performance (IRR=1.69, 95% CI 1.17 to 2.43), cognitive performance (IRR=2.24; 95% CI 1.32 to 3.79), self-reported physical function (IRR=1.77; 95% CI 1.10 to 2.85), basic ADLs (IRR=1.55, 95% CI 1.09 to 2.20) and falls (IRR=1.57; 95% CI 1.08 to 2.27) had higher rates of ED visits. However, after full adjustment, only cognitive impairment was statistically significantly associated with ED visits (IRR=1.79; 95% CI 1.05 to 3.03) and hospital admissions (IRR=2.44; 95% CI 1.20 to 4.96). Conclusions Identification of CGA-identified conditions, particularly cognitive impairment, may be useful for mitigating the risk of subsequent acute care utilisation among patients with SLE. Future studies should examine the effectiveness of CGA measures in improving other important outcomes, such as patient quality of life and satisfaction.