Frailty Worsens Antidepressant Treatment Outcomes in Late Life Depression

Brown, Patrick J.; Ciarleglio, Adam; Roose, Steven P.; Garcia, Carolina Montes; Chung, Sam; Alvarez, J E Sánchez; Stein, Alexandra; Gomez, Stephanie; Rutherford, Bret R.

doi:10.1016/j.jagp.2020.12.024

Cited by 15 publications

(6 citation statements)

References 36 publications

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“…For example, as speech recognition can vary among individuals with the same degree of HL, poor speech recognition may identify individuals with communication difficulties who may be at highest risk for depression and thus benefit most from hearing rehabilitation. In addition, HL has been associated with decreased physical functioning 18 and frailty 19 ; as frailty is highly comorbid in older adults with MDD and is associated with worse antidepressant treatment response, 20 it would be instructive to know whether poor physical functioning may affect an individual's depressive symptom response to hearing aids.…”

Section: Introductionmentioning

confidence: 99%

A precision medicine tool to understand who responds best to hearing aids in late‐life depression

Brewster

Zilcha‐Mano

Wallace

et al. 2022

Int J Geriat Psychiatry

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Objectives Accumulating evidence suggests that hearing loss (HL) treatment may benefit depressive symptoms among older adults with Major Depressive Disorder (MDD), but the specific individual characteristics of those who stand to improve most are unknown. Methods N = 37 patients ≥60 years with HL and MDD received either active or sham hearing aids in this 12‐week double‐blind randomized controlled trial. A combined moderator approach was utilized in the analysis in order to examine multiple different pretreatment individual characteristics to determine the specific qualities that predicted the best depressive symptom response to hearing aids. Pretreatment characteristics included: Hearing Handicap Inventory for the Elderly (HHIE‐S), pure tone average (PTA), speech reception threshold (SRT), Short Physical Performance Battery (SPPB), cognition (Repeatable Battery for the Assessment of Neuropsychological Status). Results The analysis revealed a combined moderator, predicting greater improvement with active versus sham hearing aids, that had a larger effect size than any individual moderator (combined effect size [ES] = 0.49 [95% CI: 0.36, 0.76]). Individuals with worse hearing‐related disability (HHIE‐S: individual ES = −0.16), speech recognition (SRT: individual ES = −0.14), physical performance (SPPB: individual ES = 0.41), and language functioning (individual ES = 0.19) but with relatively less severe audiometric thresholds (PTA: individual ES = 0.17) experienced greater depressive symptom improvement with active hearing aids. Conclusions Older adults with relatively worse HL‐related, physical, and cognitive functioning may stand to benefit most from hearing aids. Given the large number of older adults experiencing HL and MDD, a non‐invasive and scalable means of targeting those most likely to respond to interventions would be valuable.

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Section: Introductionmentioning

confidence: 99%

A precision medicine tool to understand who responds best to hearing aids in late‐life depression

Brewster

Zilcha‐Mano

Wallace

et al. 2022

Int J Geriat Psychiatry

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“…For the present study, we operationalised a FI within the Netherlands Study of Depression in Older persons (NESDO) cohort in order to (1) study the prevalence of frailty among depressed patients, (2) study the impact of frailty on the outcome of depression and (3) to study the impact of depression on the course of frailty. We hypothesize that (a) the FI predicts a protracted course of depression 14 and that (b) the FI increases significantly more over time among patients suffering from depressive disorder compared to a never depressed comparison group.…”

Section: Introductionmentioning

confidence: 99%

A 6‐year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder

Voshaar

Dimitriadis

vandenBrink

et al. 2021

Int J Geriat Psychiatry

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Introduction: Depressive disorder has been conceptualised as a condition of accelerated biological ageing. We operationalised a frailty index (FI) as marker for biological ageing aimed to explore the bidirectional, longitudinal association between frailty and either depressive symptoms or depressive disorder. Methods:A cohort study with 6-year follow-up including 377 older (≥60 years) outpatients with a DSM-IV-defined depressive disorder and 132 never-depressed controls. Site visits at baseline, 2 and 6-year follow-up were conducted and included the CIDI 2.0 to assess depressive disorder and relevant covariates.Depressive symptom severity and mortality were assessed every 6 months by mail and telephone. A 41-item FI was operationalised and validated against the 6-year morality rate by Cox regression (HR FI = 1.04 [95% CI: 1.02-1.06]).Results: Cox regression showed that a higher FI was associated with a lower chance of remission among depressed patients (HR FI = 0.98 [95% CI: 0.97-0.99]). Nonetheless, this latter effect disappeared after adjustment for baseline depressive symptom severity. Linear mixed models showed that the FI increased over time in the whole sample (B[SE] = 0.94 (0.12), p < .001) with a differential impact of depressive symptom severity and depressive disorder. Higher baseline depressive symptom severity was associated with an attenuated and depressive disorder with an accelerated increase of the FI over time. Conclusions:The sum score of depression rating scales is likely confounded by frailty. Depressive disorder, according to DSM-IV criteria, is associated with accelerated biological ageing. This argues for the development of multidisciplinary geriatric care models incorporating frailty to improve the overall outcome of latelife depression.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…Thus, our study excluded patients with clinically diagnosed depressive or anxiety disorders who were taking antidepressants in order to avoid confounding the observed associations. Another study also found that frailty itself, in turn, worsened antidepressant treatment responses and outcomes [ 52 , 53 ]. Furthermore, chronic pain, as the origin of various health hazards, was closely associated with comorbidities such as depression and sleep disorders, and further contributed to frailty and increased adverse outcomes among older adults [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Associations of poor sleep quality, chronic pain and depressive symptoms with frailty in older patients: is there a sex difference?

et al. 2022

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Background Sleep disturbance, chronic pain and depressive symptoms later in life are modifiable risk factors and may contribute to frailty. However, much less is known about sex differences in the association between these concurrent symptoms and frailty in older patients. Therefore, we conducted this study to explore the associations of poor sleep quality, chronic pain, and depressive symptoms with frailty in older patients, and the sex-specific associations. Methods In an observational population-based study, 540 older hospitalized patients from Zhejiang Hospital in China were enrolled. We collected data on poor sleep quality, pain, depressive symptoms and frailty using the Pittsburgh Sleep Quality Index, the Numerical Rating Scale, the 15-item Geriatric Depression Scale, and the Clinical Frailty Scale. Multivariate logistic regression models were used to explore the total sample and sex-specific associations among symptom burdens, symptom combination patterns and symptom counts, and frailty. Results After adjusting for the potential covariates, concurrent poor sleep quality and depressive symptoms (OR = 4.02, 95% CI 1.57–10.26), concurrent poor sleep quality and chronic pain (OR = 2.05, 95% CI 1.04–4.05), and having three symptoms (OR = 3.52, 95% CI 1.19–10.44) were associated with a higher likelihood of frailty in older inpatients. In addition, older patients with 2 or 3 symptoms (2 and 3 vs. 0 symptoms) had a higher risk of frailty, and the odds ratios were 2.40 and 3.51, respectively. Interaction analysis and sex-stratified associations exhibited conflicting results. The nonsignificant effect of the interaction of sex and symptoms on frailty, but not the sex-stratified associations, showed that individual symptoms, symptom combination patterns, and symptom counts were associated with elevated risks of frailty in older male patients, but not in older female patients. Conclusions Increased symptom burdens were associated with a higher risk of frailty in older inpatients, especially in those with poor sleep quality concurrent with at least one of the other two symptoms. Thus, a multidisciplinary program addressing these common symptoms is required to reduce adverse outcomes.

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Frailty Worsens Antidepressant Treatment Outcomes in Late Life Depression

Cited by 15 publications

References 36 publications

A precision medicine tool to understand who responds best to hearing aids in late‐life depression

A precision medicine tool to understand who responds best to hearing aids in late‐life depression

A 6‐year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder

Associations of poor sleep quality, chronic pain and depressive symptoms with frailty in older patients: is there a sex difference?

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