Frailty and depression predict instrumental activities of daily living in older adults: A population-based longitudinal study using the CARE75+ cohort

Abstract

Objectives To evaluate if depression contributes, independently and/or in interaction with frailty, to loss of independence in instrumental activities of daily living (ADL) in older adults with frailty. Methods Longitudinal cohort study of people aged ≥75 years living in the community. We used multi-level linear regression model to quantify the relationship between depression (≥5 Geriatric Depression Scale) and frailty (electronic frailty index), and instrumental activities of daily living (Nottingham Extended Activities of Daily Living scale; range: 0–66; higher score implies greater independence). The model was adjusted for known confounders (age; gender; ethnicity; education; living situation; medical comorbidity). Results 553 participants were included at baseline; 53% were female with a mean age of 81 (5.0 SD) years. Depression and frailty (moderate and severe levels) were independently associated with reduced instrumental activities of daily living scores. In the adjusted analysis, the regression coefficient was -6.4 (95% CI: -8.3 to -4.5, p<0.05) for depression, -1.5 (95% CI: -3.8 to 0.9, p = 0.22) for mild frailty, -6.1 (95% CI: -8.6 to -3.6, p<0.05) for moderate frailty, and -10.1 (95% CI: -13.5 to -6.8, p<0.05) for severe frailty. Moreover, depression interacted with frailty to further reduce instrumental activities of daily living score in individuals with mild or moderate frailty. These relationships remained significant after adjusting for confounders. Conclusion Frailty and depression are independently associated with reduced independence in instrumental activities of daily living. Also, depression interacts with frailty to further reduce independence for mild to moderately frail individuals, suggesting that clinical management of frailty should integrate physical and mental health care.

Validation of the five‐item version of the Geriatric Depression Scale (GDS‐5) in a Turkish elderly population

“…A significant difference was found in IADL scores, which is consistent with the adverse effects of depression on daily instrumental life in the literature 13 . The relationship between frailty and depression, which was previously shown in the literature, 36 was also demonstrated in this study. The scores of SARC‐F used to screen for sarcopenia and EAT‐10 test scores used for screening for oropharyngeal dysphagia also showed significant differences between the groups with and without depression.…”

Physical Functioning, Depressive Symptoms, and Suicidal Ideation among Older Korean Adults

“…In most studies, ADL and IADL have been used as continuous variables [9,13,14,16,17]. However, some studies have used ADL or IADL categorized by scores [11,12,18].…”

Identifying Frail Patients by Using Electronic Health Records in Primary Care: Current Status and Future Directions

“…For example, a dietitian acting as a first contact practitioner for frail patients rather than a GP may be a cost-effective way to alter the nutritional status of frail patients (eFI 0.26–0.36) ( 89 ). Additionally, depression interacts with frailty (by the eFI) to further reduce the daily functioning of frail patients, suggesting that the clinical management of frailty should integrate physical and mental healthcare ( 90 ).…”