Are Depression and Frailty Overlapping Syndromes in Mid- and Late-life? A Latent Variable Analysis

doi:10.1016/j.jagp.2012.12.019

The American Journal of Geriatric Psychiatry

Volume 21, Issue 6, June 2013, Pages 560-569

https://doi.org/10.1016/j.jagp.2012.12.019 Get rights and content

Background

Depression and frailty both predict disability and morbidity in later life. However, it is unclear to what extent these common geriatric syndromes represent overlapping constructs.

Objective

To examine the joint relationship between the constructs of depression and frailty.

Methods

Data come from 2004–2005 wave of the Baltimore Epidemiologic Catchment Area Study, and the analysis is limited to participants 40 years and older, with complete data on frailty and depression indicators (N = 683). Depression was measured using the Diagnostic Interview Schedule, and frailty was indexed by modified Fried criteria. A series of confirmatory latent class analyses were used to assess the degree to which depression and frailty syndromes identify the same populations. A latent kappa coefficient (κ_l) was also estimated between the constructs.

Results

Confirmatory latent class analyses indicated that depression and frailty represent distinct syndromes rather than a single construct. The joint modeling of the two constructs supported a three-class solution for depression and two-class solution for frailty, with 2.9% categorized as severely depressed, 19.4% as mildly depressed, and 77.7% as not depressed, and 21.1% categorized as frail and 78.9% as not frail. The chance-corrected agreement statistic indicated moderate correspondence between the depression and frailty constructs (κ_l: 66, 95% confidence interval: 0.58–0.74).

Conclusions

Results suggest that depression and frailty are interrelated concepts, yet their operational criteria identify substantively overlapping subpopulations. These findings have implications for understanding factors that contribute to the etiology and prognosis of depression and frailty in later life.

Section snippets

Sample

Data come from the Baltimore Epidemiologic Catchment Area (ECA) Study, a longitudinal population-based survey of adults that began in 1981 as part of a multisite study investigating prevalence of mental illness in the United States. Details concerning data collection procedures have been described previously.12, 13 The Baltimore ECA cohort was reinterviewed in 1982, 1993–1996, and 2004–2005. This analysis is limited to data collected during the fourth follow-up in 2004–2005, in which interviews

Results

Table 1 shows the demographic characteristics of the sample stratified by lifetime MD status. Consistent with previous research, individuals who met criteria for MD were younger and more likely to be women. The symptoms of frailty were fairly common (prevalence 8.5%–27%), and with the exception of exhaustion, MD was not significantly associated with indicators of frailty.

Table 2 shows the model fit statistics and class proportion estimates for the series of confirmatory LCA models described

Discussion

This study empirically evaluated the construct overlap between two common syndromes in later life: depression and frailty. The primary finding is that the operational criteria of these constructs identify distinct, but highly overlapping, subpopulations. The overlap between these constructs is substantial as suggested by the κ_l and indicates that these syndromes should be considered jointly in studies aimed at identifying predictors and consequences of health and disability in later life.

This

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Citation Excerpt :
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We considered 13 mediators and two outcomes, giving a total of 26 mediator-outcome pairs. Of these, only six showed evidence of cross-loading items, supporting the suggestion that the chosen mediator and outcome constructs were conceptually distinct.
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It is estimated that 7.2% of community-dwelling older adults worldwide have major depression. Therefore, this study aimed to investigate the relationship between geriatric syndromes and depressive symptoms. Data were obtained from the Kaizuka Dementia Prevention Study 2018 and 2019, which was a community-based health check conducted in collaboration with the Osaka Kawasaki Rehabilitation University (Kaizuka City Office) and Cognitive Reserve Research Center in Osaka, Japan. The participants comprised 363 older adults (mean age 73.6 ± 6.6 years; women = 75.8%) who participated in a community-based health check. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). Depressive symptoms were defined as a GDS-15 score of ≥ 5. Furthermore, geriatric syndromes in participants—such as frailty, sarcopenia, and locomotive syndrome—were assessed. There was a 28.1% prevalence of depressive symptoms. In a logistic regression analysis with depressive symptoms as the dependent variable, both pre-frailty (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.09–3.01) and frailty (OR 5.45, 95% CI 2.23–13.31) were found to be significantly higher in the depressive group. There were no significant differences in sarcopenia and locomotive syndrome between the depressive groups. Our findings suggest that depressive symptoms are associated with frailty and pre-frailty in community-dwelling older adults in Japan. Physical frailty should be evaluated in depressed individuals and may contribute to the prioritization of clinical evaluation of geriatric syndromes.
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Regular Research ArticleAre Depression and Frailty Overlapping Syndromes in Mid- and Late-life? A Latent Variable Analysis

Background

Objective

Methods

Results

Conclusions

Section snippets

Sample

Results

Discussion

Lancet

J Affect Disord

Am J Geriatr Psychiatr

Comparing models of frailty: the Health and Retirement Study

J Am Geriatr Soc

Frailty in older adults: evidence for a phenotype

J Gerontol A Biol Sci Med Sci

Antecedents of frailty over three decades in an older cohort

J Gerontol B Psychol Sci Soc Sci

A comparison of two approaches to measuring frailty in elderly people

J Gerontol B Psychol Sci Soc Sci

Depression without sadness: alternative presentations of depression in late life

Am Fam Physician

Depression and frailty: the need for multidisciplinary research

Am J Geriatr Psychiatry

Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care

J Gerontol A Biol Sci Med Sci

Phenotype of frailty: characterization in the Women's Health and Aging studies

J Gerontol A Biol Sci Med Sci

Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes

JAMA

A novel aging phenotype of slow gait, impaired executive function, and depressive symptoms: relationship to blood pressure and other cardiovascular risks

J Gerontol A Biol Sci Med Sci

Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program

Regular Research Article
Are Depression and Frailty Overlapping Syndromes in Mid- and Late-life? A Latent Variable Analysis