Background Many of the symptoms, consequences, and risk factors for frailty are shared with late-life depression. However, thus far, few studies have addressed the conceptual and empirical interrelationships between these conditions. This review synthesizes existing studies that examined depression and frailty among older adults and provides suggestions for future research. Methods A search was conducted using PubMed for publications through 2010. Reviewers assessed the eligibility of each report and abstracted information on study design, sample characteristics, and key findings, including how depression and frailty were conceptualized and treated in the analysis. Results Of 133 abstracted articles, 39 full-text publications met inclusion criteria. Overall, both cross-sectional (n = 16) and cohort studies (n = 23) indicate that frailty, its components, and functional impairment are risk factors for depression. Although cross-sectional studies indicate a positive association between depression and frailty, findings from cohort studies are less consistent. The majority of studies included only women and non-Hispanic Whites. None used diagnostic measures of depression or considered antidepressant use in the design or analysis of the studies. Conclusions A number of empirical studies support for a bidirectional association between depression and frailty in later life. Extant studies have not adequately examined this relationship among men or racial/ethnic minorities, nor has the potential role of antidepressant medications been explored. An interdisciplinary approach to the study of geriatric syndromes such as late-life depression and frailty may promote cross-fertilization of ideas leading to novel conceptualization of intervention strategies to promote health and functioning in later life.

Results indicate that the correlation of frailty and depression in late life is substantial. The association between the two constructs cannot be fully explained by symptom overlap, suggesting that psychological vulnerability may be an important component of frailty.

To assess the feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported integrated medical and psychiatric self-management intervention for older adults with serious mental illness. Ten older adults with serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder) and medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 60 years and older received the PeerTECH intervention in their homes. Three certified peer specialists were trained to deliver PeerTECH. Data were collected at baseline, one-month, and three-month. The pilot study demonstrated that a three-month, peer-delivered and technology-supported integrated medical and psychiatric self-management intervention ("PeerTECH") was experienced by peer specialists and participants as feasible and acceptable. PeerTECH was associated with statistically significant improvements in psychiatric self-management. In addition, pre/post, non-statistically significant improvements were observed in self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment. This pre/post pilot study demonstrated it is possible to train peers to use technology to deliver an integrated psychiatric and medical self-management intervention in a home-based setting to older adults with serious mental illness with fidelity. These findings provide preliminary evidence that a peer-delivered and technology-supported intervention designed to improve medical and psychiatric self-management is feasible, acceptable, and is potentially associated with improvements in psychiatric self-management, self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment with older adults with serious mental illness and chronic health conditions.

Background Depression and frailty both predict disability and morbidity in later life. However, it is unclear to what extent these common geriatric syndromes represent overlapping constructs. Objective To examine the joint relationship between the constructs of depression and frailty. Methods Data come from 2004/5 wave of the Baltimore Epidemiologic Catchment Area Study and analysis is limited to participants aged 40 and older with complete data on frailty and depression indicators (N = 683). Depression was measured using the Diagnostic Interview Schedule and frailty was indexed by modified Fried criteria. A series of confirmatory latent class analyses (LCA) were used to assess the degree to which depression and frailty syndromes identify the same populations. A latent Kappa coefficient (Кl) was also estimated between the constructs. Results Confirmatory LCA indicated that depression and frailty represent distinct syndromes rather than a single construct. The joint modeling of the two constructs supported a three class solution for depression and two class solution for frailty, with 2.9% categorized as severe depression, 19.4% as mild depression, and 77.7% as not depressed, and 21.1% categorized as frail and 78.9% as not frail. The chance-corrected agreement statistic indicated moderate correspondence between the depression and frailty constructs (Кl: 66, 95% CI: 0.58 – 0.74). Conclusions Results suggest that depression and frailty are interrelated concepts, yet their operational criteria identify substantively overlapping subpopulations. These findings have implications for understanding factors that contribute to the etiology and prognosis of depression and frailty in later life.

OBJECTIVES To determine the degree of diagnostic overlap between frailty and depression and investigate whether gender differences in symptom endorsement influence this overlap. DESIGN Cross-sectional latent class analysis. SETTING Data come from the 2008 wave of the Health and Retirement Study, a nationally-representative longitudinal survey of health characteristics among older adults. PARTICIPANTS Community-dwelling adults aged 65 and older completing a generalhealth questionnaire and consenting to physical measurements (N=3,665). MEASUREMENTS Frailty was measured using criteria developed in the Cardiovascular Health Study and depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression scale. RESULTS Frailty and depression were best modelled as two distinct but highly correlated constructs with 3-classes and 4-classes of symptom response respectively. Measurement overlap was high among both men and women. Approximately 73% of individuals with severe depressive symptoms, and 86% of individuals with primarily somatic depressive symptoms, were categorized as concurrently frail. The degree of construct overlap between depression and frailty did not significantly vary by gender, but women were significantly more likely to endorse all frailty and depressive symptoms. CONCLUSION Measures of depression and frailty identify substantially overlapping populations of older men and women. More frequent endorsement of depressive symptoms, but not differential endorsement of somatic symptoms may contribute to the higher prevalence of frailty among women. The symptom of exhaustion is particularly important to the correlation between these two conditions. Findings will inform efforts by clinicians and researchers to refine the definition of geriatric syndromes like frailty and to develop effective interventions.

Objective Suicide risk is highest in later life, however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes, assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Methods Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4,073 unique research articles identified, 36 were selected for inclusion in this review. Results Of the included reports, 20were cross-sectional, 10 were longitudinal, three qualitative, and five were intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5 – 33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size, staffing) may also be relevant. Conclusions Existing research on suicide risk in long-term care facilities is limited, but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents.

Objective The recent emphasis of the importance of “aging in place” has highlighted the role of transportation in health promotion over the life course. Driving cessation in later life is associated with numerous poor health outcomes including limitations in social and physical functioning and increased risk of mortality. However, little is known about the relationship between driving cessation and change in cognitive functioning in late life. This study examined the association between driving mobility and trajectories of cognitive functioning among older adults. Methods Using data from six waves [1998–2008] of the Health and Retirement Study, trajectories of cognitive functioning were estimated over a 10-year period using longitudinal mixed effects models [N = 9,135]. Cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status. Driving status and health characteristics were assessed by self-report. Results Older adults who did not drive (former and never drivers) at baseline had lower average cognitive scores compared with active drivers. Former drivers had accelerated cognitive decline over the subsequent 10 years compared with active drivers (β= −0.35, 95% Confidence Interval [CI] = −0.43 to −0.26) even after controlling for baseline cognitive functioning and health status. The transition to non-driving was associated with a faster cognitive decline among those who were driving at baseline (β = −0.31, 95% CI = −0.40 to −0.22). Conclusions Older adults without driving mobility had poorer cognitive functioning at baseline and experienced accelerated cognitive decline relative to active drivers over follow-up.

OBJECTIVES To determine the relationship between frailty and overall and cardiovascular mortality. DESIGN Longitudinal mortality analysis. SETTING National Health and Nutrition Examination Survey (NHANES) 1999–2004. PARTICIPANTS Community-dwelling older adults aged 60 and older (N = 4,984; mean age 71.1 ± 0.19, 56% female). MEASUREMENTS We used data from 1999–2004 cross-sectional NHANES and mortality data from the National Death Index, updated through December 2011. An adapted version of Fried’s frailty criteria was used (low body mass index, slow walking speed, weakness, exhaustion, low physical activity). Frailty was defined as persons meeting 3 or more criteria, prefrailty as meeting 1 or 2 criteria, and robust (reference) as not meeting any criteria. The primary outcome was to evaluate the association between frailty and overall and cardiovascular mortality. Cox proportional hazard models were used to evaluate the association between risk of death and frailty category adjusted for age, sex, race, smoking, education, coronary artery disease, heart failure, nonskin cancer, diabetes, and arthritis. RESULTS Half (50.4%) of participants were classified as robust, 40.3% as prefrail, and 9.2% as frail. Fully adjusted models demonstrated that prefrail (hazard ratio (HR) = 1.64, 95% confidence interval (CI) = 1.45–1.85) and frail (HR = 2.79, 95% CI = 2.35–3.30) participants had a greater risk of death and of cardiovascular death (prefrail: HR = 1.84, 95% CI = 1.45–2.34; frail: HR = 3.39, 95% CI = 2.45–4.70). CONCLUSION Frailty and prefrailty are associated with increased risk of death. Demonstrating the association between prefrail status and mortality is the first step to identifying potential targets of intervention in future studies.