Vascular depression and frailty: a compound threat to longevity among older-old women

Abstract

Objectives The vascular depression hypothesis posits that cerebrovascular burden contributes to the development of depression symptoms in late life. Building on work that suggests that vascular depression is a prodrome for frailty (Paulson & Lichtenberg, 2011), this paper tests a theoretical framework that vascular depression symptoms are an early marker of a broader pattern of decline characterized by more frailty symptoms and shortened lifespan, and that vascular depression symptoms predict mortality through frailty. Methods The sample was drawn from the Health and Retirement Study and included 1,361 stroke-free women over the age of 80. Data was included from six biannual waves from 1998 to 2008 (waves 4-9). A vascular depression symptomatology variable was based on CES-D scores and number of cerebrovascular risk factors (hypertension, diabetes, cardiac disease and smoking). Frailty was measured based on wasting, slowness, weakness, fatigue, and falls. Vascular depression and frailty symptoms were modeled using slope and intercept terms. Mortality was modeled using a discrete-time survival term. Results The data supported the proposed model (RMSEA=.051; CFI=.971; X2=234.84, p<.001). Higher vascular depression symptom slope and intercept scores significantly predicted higher frailty slope and intercept scores, respectively. Frailty intercept scores significantly predicted mortality. Vascular depression symptoms indirectly predicted mortality through frailty symptoms. A second model testing the competing hypothesis that frailty symptoms lead to vascular depression symptoms and indirectly to mortality was not supported by the data. Conclusions Results suggest that vascular depression symptoms are associated with a clinical trajectory that includes greater frailty and shortened remaining lifespan.

Depression and frailty: concurrent risks for adverse health outcomes

“…For example, age-associated cardiovascular changes have been found to play a role in development of both frailty and depression (Alexopoulos et al, 1997; Hajjar et al, 2009; Newman et al, 2001; Strandberg, Pitkälä, Tilvis, O'Neill, & Erkinjuntti, 2013), and may help to explain comorbidity and common consequences of these two conditions. Consistent with this hypothesis, prior studies by Paulson and colleagues suggest that ‘vascular depression’ may represent a prodromal manifestation of cardiovascular changes which may eventually lead to frailty (Paulson & Lichtenberg, 2013a; Paulson & Lichtenberg, 2013b). Similarly, Hajjar and colleagues have identified an aging phenotype associated with hypertension, diabetes and other cardiovascular disorders characterized by symptoms of both depression and frailty (Hajjar et al, 2009).…”

“…As an independent predictor of adverse outcomes, depression may be a more direct and clinically expedient measure of risk compared to the Frailty Index. Furthermore, because depression is a treatable condition which is likely to precede onset of frailty in older adults (Paulson & Lichtenberg, 2013a; Paulson & Lichtenberg, 2013b), depression may be an important target for intervention to prevent frailty and its consequences.…”

The Paulson–Lichtenberg Frailty Index: evidence for a self-report measure of frailty

“…Considerable research has been devoted to identifying the prognostic implications of frailty. By contrast, there remain many interesting, timely, and empirically meaningful unanswered questions concerning predictors of frailty and how frailty can be integrated into broader models of late-life decline (Paulson & Lichtenberg, 2013a). The HRS data include a broad range of longitudinally collected information, making it an excellent resource for modeling these patterns of late-life change.…”

“…Several existing HRS-based studies have examined frailty bear mention here. Notably, our research team has published two studies using the frailty index described herein (Paulson & Lichtenberg, 2013a, 2013b). Our past studies included only stroke-free women over the age of 80, and thus were not characteristic of the full HRS sample or of the broader population of older Americans represented by the HRS.…”

“…The first of these studies (Paulson & Lichtenberg, 2013b) presented concluded that women with both high cerebrovascular burden and clinically significant depressive symptomatology (CES-D scores at or above the clinical cut-off) were at significantly higher risk for both prevalent frailty and incident frailty over a 4-year period. The second of these papers, (Paulson & Lichtenberg, 2013a) employed longitudinal modeling to identify a clinical trajectory relating vascular depression, frailty, and shortened remaining lifespan.…”