Depression in Frail Older Adults: Associations and Gender Difference

Abstract

Objective: Depression is highly prevalent in frail older adults and both clinical situations share similar clinical and prognostic factors. The aim of this study was to investigate the relationship between frailty and depression by considering each component of frailty, in both genders. Methods: Six hundred and forty-one patients aged 60 years and older, admitted to a Geriatrics outpatient clinic in a tertiary hospital, were included in this cross-sectional study. FRIED criteria were used for defining frailty. Depression was assessed by the Geriatric depression scale (GDS). Evaluations related to disability, nutrition, and cognition were performed by the Katz/Lawton scales, mini nutritional assessment (MNA), and the mini mental state examination (MMSE), respectively. Results: Prevalence of frailty and depression was 48.7% and 36.7%, respectively. Co-occurrence of frailty and depression was observed as 24.0%. Both in men (OR: 3.977, CI: 1.423–11.114, p=0.008) and in women (OR: 2.704, CI: 1.695–4.315, p<0.001), depression was independently associated with frailty, after adjusting with confounders regarding frailty. All FRIED criteria were significantly correlated with the higher GDS scores in women. Two FRIED criteria regarding physical activity and strength measures were not related to depressive symptoms in men. Lawon (p<0.001), MMSE (p=0.004), and MNA scores (p<0.001) were lower in patients with co-occurring frailty and depression, than both as separate conditions. Conclusion: Depression may play a key role in the development of frailty in both genders. Albeit, depressed men seem to be at a higher risk than women for development of frailty are, physical activity and strength measures in the FRIED criteria had a high impact in women for depressive symptoms. Patients with co-occurring frailty and depression are more prone to develop geriatric syndrome related disabilities.

Factors Determining the Occurrence of Frailty Syndrome in Hospitalized Older Patients

“…The strongest association was observed with FS, especially with HGS in the men, whereas in the women there was no such a strong relationship. Depression also turned out to be, to a certain extent, a determinant of FS in both sexes, which is also confirmed by many available scientific reports [34,[37][38][39][40][41]. Our research has shown that widowhood is one of the risk factors for FS.…”

“…In a cross-sectional study conducted by Thinuan et al the existence of such a relationship was confirmed, especially in developed countries [34]. Research conducted by Firuzan et al confirms that depression may have an important role in the development of FS in both sexes [37]. Furthermore, in the study of Boyer et al a large part of cohort was frail or pre-frail and presented signs of loss of independence, which may be explained by multiple factors including poor FA and depression [38].…”

Fragilidade, depressão e mortalidade em uma coorte de pessoas idosas residentes na comunidade

“…Neste estudo, pode-se aventar a possibilidade de que depressão tenha sido a variável ordenadora dos riscos uma vez que sua presença isolada, e posteriormente, combinada com fragilidade, representou riscos superiores ao da condição de fragilidade isoladamente 35 . Na agenda de investimentos futuros de pesquisa sobre a temática, as análises de mortalidade por todas as causas deverão comparar os efeitos representados pelas associações de depressão com os níveis de fragilidade, com cada um dos seus critérios e com a pré-fragilidade, com ajustes por doenças específicas, como por exemplo as cardiovasculares 30 .…”

Frailty, depression and mortality in a cohort of community-dwelling older adults

“…In this study, it seems reasonable to affirm that depression was the ordering variable of the risks, since its presence in isolation, and again in combination with frailty, represented higher risks than the condition of frailty alone 35 . In future research on the subject, analyzes of all-cause mortality should aim to compare the effects represented by the associations of depression with the levels of frailty, with each of its criteria and with pre-frailty, with adjustments for specific diseases, for example, cardiovascular diseases 30 .…”