Dementia Duration Linked to Higher Emergency Department Use in Older Adults With SLE

Dementia duration is significantly associated with increased emergency department (ED) use among older adults with systemic lupus erythematosus (SLE), according to study results recently published in the Journal of Clinical Rheumatology.

While previous studies have suggested a link between SLE and dementia, its prevalence among older patients and the associated impact on ED use have not been well-characterized.

Researchers conducted a historical cohort study using a 5% random sample of Medicare claims data from 2006 to 2015. Adults with SLE aged at least 65 years were age- and sex-matched in a 1:4 ratio with comparators who had osteoarthritis. Dementia was treated as a time-varying exposure. Data on the annual number of ED visits were collected for the years 2006 to 2015.

The study included 1338 Medicare beneficiaries with SLE and 5352 comparators, among whom the median age was 73.4 years and 88.1% were women.

Dementia prevalence was similar between the SLE and comparator groups at baseline (4.6% vs 5.7%; P =.13) and at study completion (17.8% vs 17.5%; P =.91), though dementia duration was shorter among the SLE group (mean, 0.66 vs 0.79 years; P =.04).

Over a follow-up period of nearly 10 years, the median number of ED visits among the SLE vs comparator groups was 5 vs 4 visits (P <.01), respectively. Notably, the number of ED visits increased significantly with each additional year of dementia duration, with a stronger effect observed among the SLE group. For patients with SLE, the incidence rate ratio (IRR) for ED visits was 1.10 (95% CI, 1.07-1.13), compared with an IRR of 1.05 (95% CI, 1.03-1.06) for comparators. Among those with dementia, ED visit risk rose by 7% per year among the SLE group (IRR, 1.07; 95% CI, 1.05-1.10) and 1% per year among comparators (IRR, 1.01; 95% CI, 1.00-1.03).

Study limitations include reliance on administrative claims data and associated misclassification bias, as well as the lack of granularity on disease severity, dementia type, and health behaviors.

“Greater attention to geriatric assessment, including screening for dementia, in older adults with SLE may be warranted in clinical settings and requires further investigation,” the study authors concluded.

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Rheumatology Advisor