Bidirectional Longitudinal Study of Frailty and Depressive Symptoms Among Older Chinese Adults

Cao, Limin; Zhou, Yuhan; Liu, Huiyuan; Shi, Mengyuan; Wei, Yingjin; Xia, Yang

doi:10.3389/fnagi.2022.791971

Cited by 18 publications

(10 citation statements)

References 55 publications

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“…The ndings of this study were consistent with a number of earlier ndings, which indicated that frailty in the middle-aged and elderly Chinese population predicted the development of depressive symptoms [17,31] . Meanwhile, frailty was found to be a predictor of depressive symptoms in a cross-sectional research of 576 older persons in an urban community in Shenzhen, China, who were 65 years of age or older [32] .…”

Section: Discussionsupporting

confidence: 90%

Changes in frailty and depressive symptoms among middle-aged and elderly Chinese: a nationwide cohort study

Sang,

Liu,

Zhang

et al. 2023

Preprint

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Background and Aims: The elderly population bears a severe burden of disease due to frailty and depressive symptoms, however, the results of association between the two in the elderly Chinese population have been conflicting. Therefore, this study aimed to investigate the developmental trajectories and interactions of frailty and depressive symptoms in the Chinese middle-aged and elderly population. Methods The study used three waves of data from 2011, 2013, and 2015 in the China Health and Retirement Longitudinal Study (CHARLS) database, focused on middle-aged and elderly people ≥ 45 years of age, and analyzed using latent growth models and cross-lagged models. Results According to the parallel latent growth model's findings, the initial level of depressive symptoms had a significant positive predictive effect on the initial level of frailty and a significant negative predictive effect on the rate of change in frailty. A substantial positive predictive relationship existed between the rate of change in depressive symptoms and the rate of change in response to frailty. The overall sample population, the middle-aged population, and the elderly population all showed evidence of a bidirectional causal connection between frailty and depressive symptoms as a result of cross-lagged analyses. Conclusions This study recommended advancing the age of concern for frailty and depressive symptoms to middle-aged adults. In the middle-aged and elderly Chinese population, the higher the initial level of frailty and the faster the rate of change, the higher the initial level of depressive symptoms and the faster the rate of change.

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Section: Discussionsupporting

confidence: 90%

Changes in frailty and depressive symptoms among middle-aged and elderly Chinese: a nationwide cohort study

Sang,

Liu,

Zhang

et al. 2023

Preprint

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“…Cao et al found that pre-frail and frail people, as defined by the frailty index and phenotype, are at a higher risk of developing depressive symptoms compared with those who are robust, based on a cohort study of 5303 older Chinese adults. 28 However, no effect of depressive symptoms on subsequent incidence of frailty was observed. Another 5-year follow-up study with 167 729 participants living in Netherlands demonstrated that depression and anxiety are reciprocally associated with frailty, as measured by the frailty index, in both younger and older adults.…”

Section: Discussionmentioning

confidence: 97%

“…Most existing studies have focused on investigating only one direction (either from depression to frailty or from frailty to depression), with very few examining the bidirectional association simultaneously, especially in a population‐based prospective design. Cao et al found that pre‐frail and frail people, as defined by the frailty index and phenotype, are at a higher risk of developing depressive symptoms compared with those who are robust, based on a cohort study of 5303 older Chinese adults 28 . However, no effect of depressive symptoms on subsequent incidence of frailty was observed.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the bidirectional causal association between frailty and depression: A Mendelian randomization study

Zhu,

Zhou,

Nie

et al. 2023

J cachexia sarcopenia muscle

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BackgroundObservational studies have demonstrated a strong bidirectional association between frailty and depression, but it remains unclear whether this association reflects causality. This study aimed to examine the bidirectional causal relationship between frailty and depression.MethodsUsing genome‐wide association study summary data, two‐sample Mendelian randomization was performed to test for the potential bidirectional causality between frailty, as defined by both the frailty index and the frailty phenotype, and depression. Several frailty‐related traits were additionally investigated, including weaker hand grip strength, slower walking pace and physical inactivity. Findings were replicated using an independent depression data source and verified using multiple sensitivity analyses.ResultsGenetically predicted higher frailty index (odds ratio [OR], 1.86; P < 0.001), higher frailty phenotype score (OR, 2.79; P < 0.001), lower grip strength (OR, 1.23; P = 0.003), slower walking pace (OR, 1.55; P = 0.027) and physical inactivity (OR, 1.44; P = 0.003) all were associated with a higher risk of depression. As for the reverse direction, genetic liability to depression showed consistent associations with a higher frailty index (beta, 0.167; P < 0.001) and a higher frailty phenotype score (beta, 0.067; P = 0.001), but not with other frailty‐related traits that were investigated. The results were stable across sensitivity analyses and across depression datasets.ConclusionsOur findings add novel evidence supporting the bidirectional causal association between frailty and depression. Improving balance and muscle strength and increasing physical activity may be beneficial in both depression and frailty.

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“…Frailty was measured with a frailty index (FI), constructed from 30 indicators, including thirteen healthrelated diagnoses from physicians, five on disabilities, and twelve on limitations with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) (see Supplemental Table 1). The indicators were selected following recommended procedures [33] and scored consistent with previous studies [7,[34][35][36][37][38][39]. The sum of the individual indicator scores was divided by 30 to create the FI (range: 0-1).…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Prior studies highlighted the interrelationships among frailty, cognitive impairment, and depressive symptom among older adults living in China. More severe depressive symptoms were associated with a higher level of frailty [7], and frailty predicted incident depressive symptoms [8]. The one-year incidence of frailty is estimated to be 19.5% higher in older adults with cognitive impairment compared to those without cognitive impairment [9].…”

Section: Introductionmentioning

confidence: 99%

Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis

Yuan,

Peng,

Burr

et al. 2023

BMC Geriatr

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Background Frailty, cognitive impairment, and depressive symptoms are closely interrelated conditions in the aging population. However, limited research has longitudinally analyzed the concurrent trajectories of these three prominent conditions in older adults in China. This study aimed to explore the eight-year trajectories of frailty, cognitive impairment, and depressive symptoms, and to identify individual-level and structural-level factors associated with the trajectories. Methods Four waves of data from the China Health and Retirement Longitudinal Study (2011–2018) were used to identify 6,106 eligible older adults. The main measures included frailty by the frailty index constructed using 30 indicators, cognitive impairment by the summary score of immediate and delayed word recall, figure drawing, serial subtraction, and orientation, and depressive symptoms by the Center for Epidemiologic Studies Depression Scale. Multi-trajectory models identified the trajectories of frailty, cognitive impairment, and depressive symptoms over time. Multinomial logistic regression was employed to estimate the associations between individual-level capital factors and one structural factor (hukou and geographic residency) with the identified trajectories, adjusting for demographic characteristics. Results Four trajectories emerged: (1) worsening frailty, worsening cognitive impairment, depression (14.0%); (2) declining pre-frailty, declining cognition, borderline depression (20.0%); (3) pre-frailty, worsening cognitive impairment, no depression (29.3%); and (4) physically robust, declining cognition, no depression (36.7%). Using the “physically robust, declining cognition, no depression” as the reference, not working, no social activity participant, worse childhood family financial situation, and poorer adult health were most strongly associated with the “worsening frailty, worsening cognitive impairment, depression” trajectory; worse health during childhood had the highest association with the “declining pre-frailty, declining cognition, borderline depression” trajectory; less education, lower household consumption, and rural hukou had the greatest association with the increased likelihood of the “pre-frailty, worsening cognitive impairment, no depression” trajectory. Conclusions Findings could inform the understanding of the interrelationship of frailty, cognitive impairment, and depressive symptoms in older adults in China and may help practitioners detect adults at risk for adverse trajectories to implement strategies for proper care.

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Bidirectional Longitudinal Study of Frailty and Depressive Symptoms Among Older Chinese Adults

Cited by 18 publications

References 55 publications

Changes in frailty and depressive symptoms among middle-aged and elderly Chinese: a nationwide cohort study

Changes in frailty and depressive symptoms among middle-aged and elderly Chinese: a nationwide cohort study

Assessment of the bidirectional causal association between frailty and depression: A Mendelian randomization study

Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis

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