Frailty Predicts New and Persistent Depressive Symptoms Among Community-Dwelling Older Adults: Findings From Singapore Longitudinal Aging Study

doi:10.1016/j.jamda.2013.10.001

Journal of the American Medical Directors Association

Volume 15, Issue 1, January 2014, Pages 76.e7-76.e12

https://doi.org/10.1016/j.jamda.2013.10.001 Get rights and content

Abstract

Objective

This study aimed to examine the cross-sectional and longitudinal relationships between physical frailty at baseline and depressive symptoms at baseline and at follow-up.

Design

Four-year prospective study.

Setting

Communities in the South East Region of Singapore.

Participants

We analyzed data of 1827 older Chinese adults aged 55 and above in the Singapore Longitudinal Aging Study-I.

Measurements

The frailty phenotype (based on Fried criteria) was determined at baseline, depressive symptoms (Geriatric Depression Scale ≥5) at baseline and follow-ups at 2 and 4 years.

Results

The mean age of the population was 65.9 (standard deviation 7.26). At baseline, 11.4% (n = 209) had depressive symptoms, 32.4% (n = 591) were prefrail and 2.5% (n = 46) were frail. In cross-sectional analysis of baseline data, the adjusted odds ratios (OR)s and 95% confidence intervals controlling for demographic, comorbidities, and other confounders were 1.69 (1.23–2.33) for prefrailty and 2.36 (1.08–5.15) for frailty, (P for linear trend <.001). In longitudinal data analyses, prospective associations among all participants were: prefrail: OR = 1.86 (1.08–3.20); frail: OR = 3.09 (1.12–8.50); (P for linear trend = .009). Among participants free of depressive symptoms at baseline, similar prospective associations were found: prefrail OR = 2.26 (1.12–4.57); frail: OR = 3.75 (1.07–13.16); (P for linear trend = .009).

Conclusion

These data support a significant role of frailty as a predictor of depression in a relatively younger old Chinese population. Further observational and interventional studies should explore short-term dynamic and bidirectional associations and the effects of frailty reversal on depression risk.

Section snippets

Population

This study used 4-year follow-up data from the SLAS-I, a population-based prospective cohort study of aging and health among community-dwelling older residents of Singapore. Details of the methodology have been described previously.²⁰ Briefly, eligible participants were identified via door-to-door census in 5 districts in the South East Region of Singapore. The eligible population consisted of all older persons, Singaporean citizens or permanent residents, who were aged 55 years and over,

Results

Table 1 describes the baseline characteristics among nonfrail, prefrail, and frail groups. The mean age of participants was 65.9 (SD ± 7.26); 64.3% (n = 652) were female, and 17.5% (n = 320) had no formal education. The prevalence of frail and prefrail was 2.5% (n = 46) and 32.4% (n = 591), respectively. The prevalence of depressive symptoms was 11.4% (n = 209) at baseline, 3.8% (n = 62) at first follow-up, and 2.4% (n = 28) at second follow-up. Compared with nonfrail participants, frail

Discussion

In this study of community-dwelling Chinese older adults, we found in the cross-sectional analysis that prefrail and frail participants had greater prevalence of depressive symptoms compared with nonfrail subjects, controlling for sociodemographic factors, comorbidities, and functional disability. Several prior cross-sectional studies15, 16 using similar modified Fried criteria also support a concurrent association between physical frailty and depressive symptoms in older adults. However, the

Conclusion

In conclusion, these data support a significant role of frailty as a comorbidity and predictor of depression in older adults. Further prospective studies should elucidate the complex bidirectional time course relationship between frailty and depression, and interventional studies should investigate the potential positive effects of frailty reduction on the risk of depression in older adults.

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Assessment of Bidirectional Relationships between Frailty and Mental Disorders: A Bidirectional Mendelian Randomization Study
2024, Journal of the American Medical Directors Association
Although observational studies have reported the association between frailty and mental disorders, the causality remains unclear. We aimed to evaluate the bidirectional causal association between frailty levels and mental disorders using a 2-sample Mendelian randomization (MR) analysis.
A bidirectional, 2-sample Mendelian randomization (MR) analysis.
Instrumental variables were obtained from large-scale genome-wide association study (GWAS) of a European-descent population for frailty index (FI, n = 175,226), Fried Frailty Score (FFS, n = 386,565), major depressive disorder (MDD, n = 674,452), bipolar disorder (n = 353,899), anxiety and stress-related disorder (ASRD, n = 31,880), and schizophrenia (n = 127,906).
Two-sample MR analyses were conducted using inverse variance-weighted method, with sensitivity analyses using MR-Egger, weighted median, and simple median methods.
Per SD increase in genetically predicted FI and FFS increased the risk of MDD [odds ratio (OR) 1.56, 95% CI 1.27-1.94, P = 3.65 × 10⁻⁵, and OR 1.67, 95% CI 1.26-2.20, P = 3.02 × 10⁻⁴, respectively]. Per-SD increase in genetically predicted FI also increased the risk of ASRD (OR 2.76, 95% CI 1.36-5.60, P = .005). No significant effect was observed for frailty levels on the risk of bipolar disorder and schizophrenia. In the reverse direction, genetically predicted MDD was associated with higher FI (β 0.182, 95% CI 0.087-0.277, P = 1.79 × 10⁻⁴) and FFS (β 0.121, 95% CI 0.087-0.155, P = 4.43 × 10⁻¹²). No reliable evidence supported the effects of genetically predicted bipolar disorder, ASRD, or schizophrenia on frailty levels.
A bidirectionally causal association exists between frailty levels and MDD, and higher FI is associated with a higher risk of ASRD. No reliable evidence suggested the causal associations of other mental disorders with frailty. Our findings provided evidence for introduction of psychological-related strategies in management of frailty.
Effectiveness of subjective support-focused cognitive behavioral therapy on depressive symptoms among (pre)frail community-dwelling older adults: A randomized controlled trial
2024, Journal of Affective Disorders
Subjective support could ameliorate the adverse effect of (pre)frailty on depressive symptoms. However, there is scarce evidence regarding subjective support-focused intervention in preventing depression among (pre)frail community-dwelling older adults. This study aims to explore the effectiveness of subjective support-focused cognitive behavioral therapy (SS-CBT) in preventing depression among this group of population.
A total of 100 community-dwelling (pre)frail older adults were recruited from six communities in a Chinese city and were randomized to an 8-week SS-CBT group or a wait-list control group. Depressive symptoms and subjective support were assessed at baseline (T0), and at 8 week (T1), 12 week (T2), 16 week (T3) after randomization. Generalized estimating equation was used to examine the effectiveness of SS-CBT on depressive symptoms and subjective support. Hierarchical linear regression models and Bootstrapping method were used to examine whether subjective support mediated the effectiveness of SS-CBT on depressive symptoms.
Participants in SS-CBT group reported significant reduction in depressive symptoms (Wald χ² = 20.800, p < 0.001) and improvement in subjective support (Wald χ² = 92.855, p < 0.001) compared to those in wait-list control group. Changes in subjective support mediated the effectiveness of SS-CBT on changes in depressive symptoms.
Restricted regions to recruit participants, inclusion of the most motivated participants, lack of diagnosis of depression, potential experimenter bias and contamination, short follow-up period, and lack of an active control group.
The findings support the benefits of SS-CBT in preventing depression among (pre)frail community-dwelling older adults, and provide insight into possible mechanisms.
Incident and recurrent depression among older adults with asthma during the COVID-19 pandemic: Findings from the Canadian Longitudinal Study on Aging
2023, Respiratory Medicine
(1) In a subsample of older adults with asthma without a history of depression, to determine the factors associated with developing depression during the COVID-19 pandemic; (2) in a subsample of older adults with asthma with a history of depression, to identify factors associated with recurrent depression during the pandemic.
Data came from four waves (Baseline [2011–2015], Follow-up 1 [2015–2018]; COVID Spring 2020, COVID Autumn 2020) of the Canadian Longitudinal Study on Aging's comprehensive cohort (n = 2,047 with asthma). The outcome of interest was a positive screen for depression based on the CES-D-10 during the autumn of 2020. Bivariate and multivariate logistic regression analyses were conducted.
Among older adults with asthma without a history of depression (n = 1,247), approximately 1 in 7 (13.5%) developed depression for the first time during the COVID-19 pandemic. Among those with a history of depression (n = 770), approximately 1 in 2 (48.6%) experienced a recurrence of depression. The risk of incident depression and recurrent depression was higher among those who were lonely, those experiencing family conflict during the pandemic, and those who had difficulty accessing healthcare resources during the pandemic. The risk of incident depression only was higher among those who had difficulty accessing resources and/or loss of income during the pandemic. The risk of recurrent depression only was higher among those with functional limitations.
There is a need for targeted interventions to support the mental health of older adults with asthma who have the above identified vulnerabilities during the pandemic.
Associations of physical frailty with health outcomes and brain structure in 483 033 middle-aged and older adults: a population-based study from the UK Biobank
2023, The Lancet Digital Health
Physical frailty is a state of increased vulnerability to stressors and is associated with serious health issues. However, how frailty affects and is affected by numerous other factors, including mental health and brain structure, remains underexplored. We aimed to investigate the mutual effects of frailty and health using large, multidimensional data.
For this population-based study, we used data from the UK Biobank to examine the pattern and direction of association between physical frailty and 325 health-related measures across multiple domains, using linear mixed-effect models and adjusting for numerous confounders. Participants were included if complete data were available for all five indicators of frailty, all covariates, and at least one health measure. We further examined the association between frailty and brain structure and the role of this association in mediating the relationship between frailty and health outcomes.
483 033 participants aged 38–73 years were included in the study at baseline (between Dec 19, 2006, and Oct 1, 2010); at a median follow-up of 9 years (IQR 8–10), behavioural data were available for 46 501 participants and neuroimaging data for 40 210 participants. The severity of physical frailty was significantly associated with decreased cognitive performance (Cohen's d=0·025–0·162), increased early-life risks (d=0·026–0·111), unhealthy lifestyle (d=0·013–0·394), poor physical fitness (d=0·007–0·668), increased symptoms of poor mental health (d=0·032–0·607), severe environmental pollution (d=0·013–0·064), and adverse biochemical markers (d=0·025–0·198). Some associations were bidirectional, with the strongest effects on mental health measures. The severity of frailty correlated with increased total white matter hyperintensity and lower grey matter volume, particularly in subcortical regions (d=0·027–0·082), which significantly mediated the association between frailty and health-related outcomes, although the mediated effects were small.
Physical frailty is associated with diverse unfavourable health-related outcomes, which can be mediated by differences in brain structure. Our findings offer a framework for guiding preventative strategies targeting both frailty and psychiatric disorders.
National Institute of Mental Health, National Science Foundation.
A pandemic toll in frail older adults: Higher odds of incident and persistent common mental disorders in the ELSA-Brasil COVID-19 mental health cohort
2023, Journal of Affective Disorders
We aimed to investigate the association of frailty with persistent and incident common mental disorders (CMD) in older adults during the pandemic.
We included 706 older adults who participated in the onsite wave of the ELSA-Brasil study (2017–2019) and the online COVID-19 assessment (May–July 2020). CMD were assessed in both waves by the Clinical Interview Schedule-Revised. Frailty was defined according to the physical phenotype and Frailty Index in the 2017–2019 wave. Logistic regression was used to investigate the association of frailty with persistent and incident CMD, adjusted for sociodemographics.
Frailty according to both definitions were associated with persistent CMD (Frailty Index: OR = 8.61, 95 % CI = 4.08–18.18; physical phenotype: OR = OR = 23.67, 95 % CI = 7.08–79.15), and incident CMD (Frailty Index: OR = 2.79, 95 % CI = 1.15–6.78; physical phenotype OR = 4.37, 95 % CI = 1.31–14.58). The exclusion of exhaustion (that overlaps with psychiatric symptoms) from the frailty constructs did not change the association between frailty and persistent CMD, although the associations with indent CMD were no longer significant.
Fluctuations in CMD status were not captured between both assessments.
Frailty status before the COVID-19 outbreak was associated with higher odds of persistent and incident CMD in older adults during the pandemic first wave. Identifying individuals at higher risk of mental burden can help prioritize resources allocation and management.
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2022, Journal of Affective Disorders
To date, few studies have focused on examining either the direct or indirect effect of physical frailty on cognitive impairment. This study aimed to investigate the moderating effects of social relationships, including their individual components in the role of depressive symptoms as a mediator between frailty and cognitive impairment.
This study included a total of 7525 Chinese older adults from the 2017–2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Mediation analyses and moderated mediation effect analysis fully adjusted for all potential confounding factors were conducted.
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The cross-sectional design of this study precludes any conclusion from the results as to the causality of cognitive impairment.
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View all citing articles on Scopus

: The study is supported by a research grant (No. 03/1/21/17/214) from the Biomedical Research Council, Agency for Science, Technology, and Research (ASTAR).

: The authors declare no conflict of interest.

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Original StudyFrailty Predicts New and Persistent Depressive Symptoms Among Community-Dwelling Older Adults: Findings From Singapore Longitudinal Aging Study

Abstract

Objective

Design

Setting

Participants

Measurements

Results

Conclusion

Section snippets

Population

Results

Discussion

Conclusion

J Nutr Health Aging

Am J Geriatr Psychiatry

Arch Gerontol Geriatr

J Affect Disord

Am J Geriatr Psychiatry

Am J Med

Biological Psychiatry

Depression and frailty: The need for interdisciplinary research

Am J Geriatr Psychiatry

Caregivers of the frail elderly: A national profile

Gerontologist

Functional disability, disability transitions, and depressive symptoms in late life

J Aging Health

Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: Evidence for a phenotype

J Gerontol A Biol Sci Med Sci

Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women

Arch Intern Med

Frailty among community-dwelling elderly people in France: The three-city study

J Gerontol A Biol Sci Med Sci

Depressive symptoms, physician visits and hospitalization among community-dwelling older adults

Int Psychogeriatr

Depressive symptoms and physical decline in community-dwelling older persons

JAMA

Depressive symptomatology and hypertension-associated morbidity and mortality in older adults

Psychosom Med

Prevalence and predictors of depression in populations of elderly: A review

Acta Psychiatr Scand

Depression and frailty in later life: A synthetic review

Int J Geriatr Psychiatry

Social support as a mediator in the relation between functional status and quality of life in older adults

Psychol Aging

Patterns of comorbid inflammatory diseases in frail older women: The Women's Health and Aging Studies I and II

J Gerontol A Biol Sci Med Sci

Frailty, depression, and anxiety in later life

Int Psychogeriatr

Functional limitations and changes in levels of depression among older adults: A multiple-hierarchy stratification perspective

J Gerontol B Psychol Sci Soc Sci

An association between incident disability and depressive symptoms over 3 years of follow-up among older women

Aging Clin Exp Res

Prevalence and correlates of functional disability in multiethnic elderly Singaporeans

J Am Geriatr Soc

Geriatric Depression Scale

Psychopharmacol Bull

Original Study
Frailty Predicts New and Persistent Depressive Symptoms Among Community-Dwelling Older Adults: Findings From Singapore Longitudinal Aging Study