Depression and frailty: concurrent risks for adverse health outcomes

Abstract

Objectives This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury. Methods Data come from five waves (2004-2012) of the Health and Retirement Study. Community-dwelling individuals age 51 and older (N=13,495) were analyzed using LGCM. Frailty was measured using a Frailty Index consisting of 30 deficits. Depressive symptoms were measured using the 8-item Centers for Epidemiologic Studies Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury. Results Prevalence of frailty increased over the study period (24.1% to 32.1%) while the prevalence of depression was relatively constant over time (approximately 13%). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: ORNursingHome=1.33, 95% CI: 1.09 to 1.66; ORFall=1.52, 95% CI: 1.12 to 2.08 ; Depression: ORNursingHome=3.63, 95% CI: 1.29 to 9.97; ORFall=1.16, 95% CI: 1.01 to 1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression. Conclusion Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes to a similar degree as frailty. Focus should be given to distilling elements of the Frailty Index which confer most risk for poor health outcomes.

Depression and Physical Frailty Have Additive Effect on the Nutritional Status and Clinical Outcome of Chinese Peritoneal Dialysis

“…In the non-dialysis elderly general population, depression and frailty are additive risk factors for mortality and other adverse health outcomes [18][19][20]. In previous studies on dialysis patients, physical frailty [6,7] and depression [12,13] have each been shown to be associated with adverse clinical outcomes.…”

“…On the other hand, depression is sometimes difficult to be discerned from frailty in the elderly. In community-dwelling people, depression and frailty are independent and probably additive risk factors for mortality and other adverse health outcomes [18][19][20]. A recent systematic review reported a consistent relationship between depression and new onset physical frailty [21].…”

Gerontological contributions to the care of elderly people in long-term care facilities

“…Depression rates were 95%, similar to the occurrence of frailty (18) . With respect to frailty, geriatric nurses testify to the importance of discussing the prognosis of elderly people in order to assist and improve decisions made in relation to institutionalized individuals (19) .…”

Frailty, Sarcopenia and Falls

“…There is no universally accepted definition [4,5], but experts agree that it is a clinical syndrome characterised by increased vulnerability and diminished resistance to stressors that can cause functional impairment and increase risks [6,7]; a minor stress or event such as an accidental fall or infection can worsen a person's health condition and increase dependency and/or mortality. Box 2.1 captures the main concepts in definitions of frailty.…”

“…Regardless of the perspective, frail patients are at increased risk of adverse health outcomes such as falls, hospitalisation, deterioration of mobility, disability, institutionalisation and death [5,6,8], and assessing patients for frailty is an important aspect of the assessment process with several tools available for this. Epidemiological studies [11] have estimated the prevalence of frailty at between 4% and 59%, depending on the population being studied [12], gender (higher in women than men) and age (the oldest have a higher prevalence) [13,14].…”