Depressive symptoms and frailty

Background: Frailty and depressive symptoms are common issues facing older adults and may be associated.

Objectives: To determine if: (i) depressive symptoms are associated with frailty; (ii) there is a gradient in this effect across the range of depressive symptoms; and (iii) the association between depressive symptoms and frailty is specific to particular types of depressive symptoms (positive affect, negative affect, somatic complaints, and interpersonal relations).

Method: Secondary analysis of an existing population-based study was conducted.

Population: In 1991, 1751 community-living adults aged 65+ years were interviewed.

Measures: Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. Frailty was graded from 0 (no frailty) to 3 (moderate/severe frailty). Age, gender, education, marital status, self-rated health, and the number of comorbid conditions were self-reported.

Analyses: Logistic regression models were constructed with the outcome of no frailty/urinary incontinence only versus frailty.

Results: Depressive symptoms were strongly associated with frailty, and there was a gradient effect across the entire range of the CES-D scale. The odds ratio and 95% confidence interval was 1.08 (1.06, 1.09) per point of the CES-D in unadjusted models. After potential confounding factors were adjusted, the adjusted odds ratio (95% confidence interval) was 1.03 (1.01, 1.05). Positive affect, negative affect, and somatic complaints were all associated with frailty, whereas interpersonal relations were not associated with frailty.

Conclusions: Depressive symptoms are associated with frailty. Clinicians should consider assessing frail older adults for the presence of depression.