Could Frailty be an Explanatory Factor of the Association between Depression and Other Geriatric Syndromes in Later Life?

Abstract

Objectives: This study aimed to investigate whether frailty could be an explanatory factor of the association between depression and the number of geriatric syndromes. Methods: Cross-sectional baseline data from a cohort study (MiMiCS-FRAIL) were analyzed in a sample of 315 older adults. Depression was measured according to DSM-5 criteria and a selfreport questionnaire (PHQ-9). Frailty was assessed according to the FRAIL questionnaire and a 30item Frailty Index (FI). We considered six geriatric syndromes. Multiple linear regression analyses were performed and adjusted for potential confounders. Results: Multiple linear regression analyses yielded significant associations between depression and geriatric syndromes. These associations decreased substantially in strength when frailty was added to the models. Findings were consistent for different definitions of depression and frailty. Conclusions: Among depressed patients, frailty may be hypothesized as a causal pathway toward adverse health outcomes associated with depression. Longitudinal studies should explore the causality of this association. Clinical implications: Frailty should be treated or prevented in order to minimize the impact of other geriatric syndromes among depressed older adults. Screening for frailty would be of utmost importance in mental health care, as frailty is neglected especially in this field. Integrated care models are crucial for clinical practice in mental illness care.

Longitudinal Association between Late-Life Depression (LLD) and Frailty: Findings from a Prospective Cohort Study (MiMiCS-FRAIL)

“…GDS-15 and PHQ-9) do not immediately lead to a diagnosis but can accurately identify patients who are at risk. In addition, our findings can contribute with the assessment of depressive symptoms that seem to yield similar and good results (32,33). These results could be explained by findings that depressive symptoms were associated with an increased risk for frailty (OR = 2.20, [95% CI = 1.88-2.57]) over 3-years follow-up (48).…”

“…Eligible participants of the MiMiCS-FRAIL are all new referrals to the clinic (from general practitioners or patient's direct access) aged 60 years or over, with regular clinical appointment and follow-up (at least one visit to the clinic every 12 months). Exclusion criteria are: All included participants had a baseline assessment with a comprehensive geriatric assessment (CGA) protocol including a structured diagnostic interview, a complete physical and psychiatric evaluation and validated self-report questionnaires with a team of geriatricians, psychiatrists and physical therapists (32)(33)(34). Subsequently, patients are routinely followed-up every 12 months (at least) with the CGA.…”

“…Validated versions of the 15-item Geriatric Depression Scale (GDS-15) (36) and the Patient Health Questionnaire (PHQ) 9-item version (37,38) were used to measure depressive symptoms and depression severity (32,33). Mild MDD corresponded to a score between 5 to 9 points, moderate from 10 to 14, moderately severe from 15 to 19, and severe from 20 to 27 points in PHQ-9 (6).…”

“…The FI has a higher predictive ability of adverse events than other frailty measurements in both hospital and community settings (26,31). Although the FI can be easily calculated based on data routinely collected in digital health records, it has been rarely used for assessing frailty in association with LLD and thus far only by cross-sectional analyses (32,33). The aim of the present study was to investigate whether late-life depression (LLD) is associated with incident frailty.…”

Community-Level Social Support to Mitigate the Impact of Combined Frailty and Multimorbidity on Psychological Distress Among Rural Chinese Older Adults During the COVID-19 Pandemic: Multilevel Modeling Study

“…Frailty and multimorbidity are common and major age-related clinical syndromes and well-established independent risk factors for psychological health in older people [6][7][8]. Separate studies have reported that frailty or multimorbidity can independently increase the levels of psychological distress in older people [7,9,10]. However, an individual can be multimorbid but not frail or frail while having multimorbidity.…”