Prevalence and Impact of frailty in older adults with polymyalgia rheumatica
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ABSTRACT Polymyalgia rheumatica (PMR) is the most common systemic rheumatic disease affecting older adults. Despite this, PMR remains critically understudied. One in three individuals with PMR have persistent symptoms for several years, which leads to prolonged use of glucocorticoids and prescribed analgesics. Gaps in understanding why symptoms persist and treatment is prolonged have limited the development of interventions to improve the well-being of this vulnerable population. Frailty is a syndrome of aging characterized by increased vulnerability to stressors and associated with increased morbidity and mortality. Preliminary data has shown a high prevalence of frailty in patients with PMR and an association with worse self-reported pain and physical function. Frailty might identify a subset of older adults with PMR with worse symptoms and at risk for prolonged treatment, where tailored interventions and management could lead to improved outcomes. Physical activity interventions such as physical and occupational therapy (PT/OT), have been shown to improve symptoms and mobility in older adults with chronic musculoskeletal conditions. Little is known about the factors that determine access to PT/OT in older adults with PMR as well the impact of PT/OT utilization on glucocorticoid treatment duration. Instead of utilizing a disease-centric approach, this proposal intends to address existing knowledge gaps by better understanding the impact of a clinically relevant geriatric syndrome and the potential benefits of function modification in older adults with PMR. In the absence of large cohorts, large administrative data allows the study of older adults with PMR and the assessment of frailty, medication usage, and PT/OT interventions, to effectively address important knowledge gaps and inform healthcare interventions. This study will utilize Medicare data to create an inception cohort of older adults with PMR (incident PMR) and achieve the following 2 aims. In Aim, we 1 will determine the association of frailty with glucocorticoid duration and prescription analgesic use. And in Aim 2, we will examine the association of the utilization of PT services with glucocorticoid duration in older adults with PMR, including its effect on frail and non-frail older adults with PMR. This proposal will provide a novel focus assessing the impact of frailty in older adults with PMR utilizing real-world and population-level data. Understanding the role of frailty in these patients could change the paradigm of treatment of PMR, highlighting the importance function modification management complementing disease-oriented treatment. Better understanding of the use of PT/OT interventions in older adults with PMR could be expanded to older adults living with other systemic rheumatic diseases. This proposal will also support my training and transition towards a career as an independent clinician-scientist focused on improving the care of older adults living with systemic rheumatic diseases.
