TY - JOUR

T1 - Frailty and Depression in Older Adults

T2 - A High-Risk Clinical Population

AU - Brown, Patrick J

AU - Roose, Steven P

AU - Fieo, Robert

AU - Liu, Xinhua

AU - Rantanen, Taina

AU - Sneed, Joel R

AU - Rutherford, Bret R

AU - Devanand, D P

AU - Avlund, Kirsten

N1 - Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

PY - 2014/11

Y1 - 2014/11

N2 - OBJECTIVE: To identify salient characteristics of frailty that increase risk of death in depressed elders.METHODS: Data were from the Nordic Research on Ageing Study from research sites in Denmark, Sweden, and Finland. Participants were 1,027 adults aged 75 years (436 men and 591 women). Time of death was obtained, providing a maximum survival time of 11.08 years (initial evaluation took place between 1988 and 1991).RESULTS: Depressed elders showed greater baseline impairments in each frailty characteristic (gait speed, grip strength, physical activity levels, and fatigue). Simultaneous models including all four frailty characteristics showed slow gait speed (hazard ratio: 1.84; 95% confidence interval: 1.05-3.21) and fatigue (hazard ratio: 1.94; 95% confidence interval: 1.11-3.40) associated with faster progression to death in depressed women; none of the frailty characteristics in the simultaneous model was associated with death in depressed men. In women, the effect of impaired gait speed on mortality rates nearly doubled when depression was present (nondepressed women: no gait impairment = 26%; slow gait = 40%; depressed women: no gait impairment = 32%; slow gait = 58%). A similar pattern was observed for fatigue.CONCLUSION: The confluence of specific characteristics of frailty (fatigue and slow gait speed) and depressive illness is associated with an increased risk of death in older adults; this association is particularly strong in older depressed women. Future research should investigate whether multimodal interventions targeting depressive illness, mobility deficits, and fatigue can decrease mortality and improve quality of life in older depressed individuals with characteristics of the syndrome of frailty.

AB - OBJECTIVE: To identify salient characteristics of frailty that increase risk of death in depressed elders.METHODS: Data were from the Nordic Research on Ageing Study from research sites in Denmark, Sweden, and Finland. Participants were 1,027 adults aged 75 years (436 men and 591 women). Time of death was obtained, providing a maximum survival time of 11.08 years (initial evaluation took place between 1988 and 1991).RESULTS: Depressed elders showed greater baseline impairments in each frailty characteristic (gait speed, grip strength, physical activity levels, and fatigue). Simultaneous models including all four frailty characteristics showed slow gait speed (hazard ratio: 1.84; 95% confidence interval: 1.05-3.21) and fatigue (hazard ratio: 1.94; 95% confidence interval: 1.11-3.40) associated with faster progression to death in depressed women; none of the frailty characteristics in the simultaneous model was associated with death in depressed men. In women, the effect of impaired gait speed on mortality rates nearly doubled when depression was present (nondepressed women: no gait impairment = 26%; slow gait = 40%; depressed women: no gait impairment = 32%; slow gait = 58%). A similar pattern was observed for fatigue.CONCLUSION: The confluence of specific characteristics of frailty (fatigue and slow gait speed) and depressive illness is associated with an increased risk of death in older adults; this association is particularly strong in older depressed women. Future research should investigate whether multimodal interventions targeting depressive illness, mobility deficits, and fatigue can decrease mortality and improve quality of life in older depressed individuals with characteristics of the syndrome of frailty.

U2 - 10.1016/j.jagp.2013.04.010

DO - 10.1016/j.jagp.2013.04.010

M3 - Journal article

C2 - 23973252

VL - 22

SP - 1083

EP - 1095

JO - Journal of Geriatric Psychiatry and Neurology

JF - Journal of Geriatric Psychiatry and Neurology

SN - 0891-9887

IS - 11

ER -