Age differences in the relationship between frailty and depression among community-dwelling older adults

The brain structure, inflammatory, and genetic mechanisms mediate the association between physical frailty and depression

Cross-sectional studies have demonstrated strong associations between physical frailty and depression. However, the evidence from prospective studies is limited. Here, we analyze data of 352,277 participants from UK Biobank with 12.25-year follow-up. Compared with non-frail individuals, pre-frail and frail individuals have increased risk for incident depression independent of many putative confounds. Altogether, pre-frail and frail individuals account for 20.58% and 13.16% of depression cases by population attributable fraction analyses. Higher risks are observed in males and individuals younger than 65 years than their counterparts. Mendelian randomization analyses support a potential causal effect of frailty on depression. Associations are also observed between inflammatory markers, brain volumes, and incident depression. Moreover, these regional brain volumes and three inflammatory markers-C-reactive protein, neutrophils, and leukocytes-significantly mediate associations between frailty and depression. Given the scarcity of curative treatment for depression and the high disease burden, identifying potential modifiable risk factors of depression, such as frailty, is needed.

Changes in frailty and depressive symptoms among middle-aged and older Chinese people: a nationwide cohort study

BACKGROUND AND AIMS

The older people bears a severe burden of disease due to frailty and depressive symptoms, however, the results of association between the two in the older Chinese people have been conflicting. Therefore, this study aimed to investigate the developmental trajectories and interactions of frailty and depressive symptoms in the Chinese middle-aged and older adults.

METHODS

The study used four waves of data from 2011, 2013, 2015 and 2018 in the China Health and Retirement Longitudinal Study (CHARLS) database, focused on middle-aged and older people ≥ 45 years of age, and analyzed using latent growth models and cross-lagged models.

RESULTS

The parallel latent growth model showed that the initial level of depressive symptoms had a significant positive predictive effect on the initial level of frailty. The rate of change in depressive symptoms significantly positively predicted the rate of change in frailty. The initial level of frailty had a significant positive predictive effect on the initial level of depressive symptoms, but a significant negative predictive effect on the rate of change in depressive symptoms. The rate of change in frailty had a significant positive predictive effect on the rate of change in depressive symptoms. The results of the cross-lagged analysis indicated a bidirectional causal association between frailty and depressive symptoms in the total sample population. Results for the total sample population grouped by age and gender were consistent with the total sample.

CONCLUSIONS

This study recommends advancing the age of concern for frailty and depressive symptoms to middle-aged adults. Both men and women need early screening and intervention for frailty and depressive symptoms to promote healthy aging.

Physical activity, physical frailty and depressive symptoms among Chinese male and female older adults: do different indicators make a difference?

Objectives

Older adults become more inactive and frailer with aging. Physical status is closely linked to mental health, but it is unclear which physical indicator is more strongly associated with depressive symptoms in older adults. The present study aimed to compare relationships between self-reported physical activity, physical frailty (muscle mass, muscle strength, and gait ability) and depressive symptoms in community male and female older adults.

Methods

A total of 1,180 adults aged 60 years and older were recruited to participate in this study from a Chinese community receiving annual check-up service from September 2018 to May 2019. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). The Bio-electrical Impedance Analyzer was used to determine the muscle mass. As the indicators of muscle function, grip strength and gait ability were assessed by the dynamometer and Timed Up and Go Test (TUGT), respectively. The 15-item version of Geriatric Depression Scale (GDS-15) was used to examine depressive symptoms. Demographic variables, health status and sleep quality were collected using questionnaire.

Results

11.8% men and 11.9% women reported depressive symptoms. Logistic regression showed that depressive symptoms was associated with low grip strength (OR = 2.42, 95% CI: 1.04-5.63), slow gait ability (OR = 3.60, 95% CI: 1.28-10.13) in older males, and associated with low level of self-reported physical activity (OR = 3.85, 95% CI: 2.00-7.42) in older females. No significant association was found between muscle mass and depressive symptoms.

Conclusion

There were gender differences in the relationship between physical activity, physical frailty, and depressive symptoms. Grip strength and gait ability may be a better indicator of frailty for predicting depressive symptoms in older men while physical activity may be useful in predicting depressive symptoms in older women.

The relationship between frailty, walking ability, and depression in elderly Chinese people

To explore the relationship between depression symptoms, frailty, and walking ability in Chinese elderly people, and to provide new evidence for research on the prevention and treatment of depression in Chinese elderly people. The data of this study is sourced from the 2018 CHARLS data (China Health and Retirement Longitudinal Study). Z-test, logistic regression, and linear stratified regression were used to analyze the walking ability, frailty, and depressive symptoms of 2927 participants. Good walking ability and non frailty were significantly negatively correlated with depression symptoms in the elderly (P < .05). This important negative association persists even after adjusting for demographic, health condition, and lifestyle factors. (P < .05). Elderly women are at a higher risk of developing depression than men, while elderly people with good walking ability and no frailty are at a lower risk of developing depression. At the same time, elderly people with disabilities, hypertension, arthritis, and low levels of physical activity are more likely to experience depressive symptoms. It is recommended that elderly people pay attention to maintaining walking ability and avoiding frailty to reduce the risk of depression.

Association of oral status with frailty among older adults in nursing homes: a cross-sectional study

BACKGROUND

The oral status of an individual is a vital aspect of their overall health. However, older adults in nursing homes have a higher prevalence of frailty and poor oral health, particularly in the context of global aging. The objective of this study is to explore the association between oral status and frailty among older adults residing in nursing homes.

METHODS

The study involved 1280 individuals aged 60 and above from nursing homes in Hunan province, China. A simple frailty questionnaire (FRAIL scale) was used to evaluate physical frailty, while the Oral Health Assessment Tool was used to assess oral status. The frequency of tooth brushing was classified as never, once a day, and twice or more a day. The traditional multinomial logistic regression model was used to analyze the association between oral status and frailty. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated while controlling for other confounding factors.

RESULTS

The study found that the prevalence of frailty among older adults living in nursing homes was 53.6%, while the prevalence of pre-frailty was 36.3%. After controlling for all potential confounding factors, mouth changes requiring monitoring (OR = 2.10, 95% CI = 1.34-3.31, P = 0.001) and unhealthy mouth (OR = 2.55, 95% CI = 1.61-4.06, P < 0.001) were significantly associated with increased odds of frailty among older adults in nursing homes. Similarly, both mouth changes requiring monitoring (OR = 1.91, 95% CI = 1.20-3.06, P = 0.007) and unhealthy mouth (OR = 2.24, 95% CI = 1.39-3.63, P = 0.001) were significantly associated with a higher prevalence of pre-frailty. Moreover, brushing teeth twice or more times a day was found to be significantly associated with a lower prevalence of both pre-frailty (OR = 0.55, 95% CI = 0.34-0.88, P = 0.013) and frailty (OR = 0.50, 95% CI = 0.32-0.78, P = 0.002). Conversely, never brushing teeth was significantly associated with higher odds of pre-frailty (OR = 1.82, 95% CI = 1.09-3.05, P = 0.022) and frailty (OR = 1.74, 95% CI = 1.06-2.88, P = 0.030).

CONCLUSIONS

Mouth changes that require monitoring and unhealthy mouth increase the likelihood of frailty among older adults in nursing homes. On the other hand, those who brush their teeth frequently have a lower prevalence of frailty. However, further research is needed to determine whether improving the oral status of older adults can change their level of frailty.

Association between Perceived Health-Related Quality of Life and Depression with Frailty in the FRASNET Study

Frailty is a major challenge facing the aging world. The phenotype of the frail subject is still far from being satisfactorily defined. We report data on mood, cognition, and quality of life (QoL) in relation to anamnestic factors, health, and socio-economic status in the FRASNET geriatric population (1204 subjects in stable health conditions), which is an observational cohort study that includes fairly balanced groups of Italian frail (421, 35%), pre-frail (449, 37.3%) and robust (334, 27.7%) subjects. A conditional inference tree analysis revealed a substantial influence of psychological variables on frailty. The physical indicator of QoL (Short Form Survey-36-Physical Component Summary, SF-36-PCS) was the predominant variable in the full model (threshold at 39.9, p < 0.001): higher frailty was found in subjects with a caregiver and lower SF-36-PCS. Frailty was also associated with the mental indicator of QoL (Short Form Survey-36-Mental Component Summary, SF-36-MCS), depression (Geriatric Depression Scale, GDS-15), leisure activities, and level of education. In support of the prominent role of inflammation in aging and mental illness, the SF-36-PCS score was correlated with the blood concentration of C-X-C motif chemokine ligand 10 (CXCL10) (r Pearson -0.355, p = 0.015), a critical signal in cell senescence and inflammaging, while the rs7567647 variant in FN1 gene encoding a glycoprotein in the extracellular matrix was significantly associated with frailty in a multivariable model (p = 0.0006). The perception of health-related QoL and subclinical depression contribute to frailty. Their assessment could improve the identification of older patients at increased risk of adverse outcomes.

The effect of perceived social support on frailty and depression: A multicategorical multiple mediation analysis

The mediating effects of three sources of perceived social support on frailty severity and depression were examined. Conducted in rural China, data on 570 frail older women were studied. Results showed that significant others' support (mainly daughters) (β = 0.177 for frailty score = 3) mediated the relationship between frailty severity and depression, and the 95 % bias-corrected bootstrap confidence intervals did not straddle zero (0.013-0.419), while the mediating effects of family support (mainly sons) and friends support were not observed. Support from daughters contributes to frail mothers' mental health.

Frailty in individuals with depression, bipolar disorder and anxiety disorders: longitudinal analyses of all-cause mortality

BACKGROUND

Frailty is a medical syndrome that is strongly associated with mortality risk and an emerging global health burden. Mental disorders are associated with reduced life expectancy and elevated levels of frailty. In this study, we examined the mortality risk associated with frailty in individuals with a lifetime history of mental disorders compared to individuals without a history of mental disorders.

METHODS

The UK Biobank study recruited > 500,000 adults, aged 37-73, between 2006 and 2010. We derived the two most common albeit distinctive measures of frailty, the frailty phenotype and the frailty index. Individuals with lifetime depression, bipolar disorder or anxiety disorders were identified from multiple data sources. The primary outcome was all-cause mortality. We have also examined differences in frailty, separately by sex and age.

RESULTS

Analyses included up to 297,380 middle-aged and older adults with a median follow-up of 12.19 (interquartile range = 1.31) years, yielding 3,516,706 person-years of follow-up. We observed higher levels of frailty in individuals with mental disorders for both frailty measures. Standardised mean differences in the frailty index ranged from 0.66 (95% confidence interval [CI] 0.65-0.67) in individuals with anxiety disorders to 0.94 (95% CI 0.90-0.97) in individuals with bipolar disorder, compared to people without mental disorders. For key comparisons, individuals with a mental disorder had greater all-cause mortality hazards than the comparison group without mental disorders. The highest hazard ratio (3.65, 95% CI 2.40-5.54) was observed among individuals with bipolar disorder and frailty, relative to non-frail individuals without mental disorders.

CONCLUSIONS

Our findings highlight elevated levels of frailty across three common mental disorders. Frailty and mental disorders represent potentially modifiable targets for prevention and treatment to improve population health and life expectancy, especially where both conditions coexist.

Frailty and predictive factors in Chinese hospitalized patients with chronic heart failure: A Structural Equation Model Analysis

AIMS

Frailty is closely related to the prognosis and quality of life of patients with heart failure (HF). However, the predictors of it are still unclear. Our study aimed to describe the frailty status of Chinese hospitalized patients with heart failure and explore predictive factors guided by Theory of Unpleasant Symptoms.

METHODS AND RESULTS

In this cross-sectional descriptive study, questionnaire-based survey was conducted among 323 patients hospitalized with heart failure in three tertiary hospitals in Wuhan, China. Frailty was measured by the Tilburg Frailty Indicator (TFI) in this study. The model based on Theory of Unpleasant Symptoms fits the sample well (root mean square error of approximation = 0.063, goodness of fit index = 0.977, normed fit index = 0.901, comparative fit index = 0.940). Frailty among Chinese patients hospitalized with heart failure was at high level (TFI = 6.57 ± 3.05). General demographic characteristics (older age, female gender, lower education level, and medical payment method), physical factors (higher New York Heart Association cardiac function class), psychological factors (more severe depression), and social factors (poorer social support) were significant predictors of more severe frailty (p < 0.05). Depression played an important mediating role in this study.

CONCLUSIONS

Theory of Unpleasant Symptoms can be used to guide the research on the frailty of heart failure patients. It is suggested to strengthen emotional support and health education for heart failure patients in China. In addition, more attention should be paid to the less educated population by providing more personalized health guidance.

The Association between Trajectories of Loneliness and Physical Frailty in Chinese Older Adults: Does Age Matter?

Background: The present study aimed to examine age differences in the relationship between trajectories of loneliness and physical frailty among Chinese older adults. Methods: A total of 4618 participants aged ≥60 years old were taken from pooled data created from the 2011−2015 China Health and Retirement Longitudinal Study (CHARLS). Loneliness was assessed by a single question from the Centre for Epidemiological Studies scale, whereas physical frailty (PF) was examined by the physical frailty phenotype scale. We characterized trajectories of loneliness and PF using transition types and changes within the survey period. Results: Logistic regression models revealed that baseline loneliness was significantly related to remaining robust PF (OR = 0.55, 95% CI = 0.49−0.63, p < 0.001) and worsening in PF (OR = 1.17, 95% CI = 1.05−1.30, p < 0.01) at follow-up. Baseline PF status was also significantly related to the transitions in loneliness (worsen: OR = 1.41, 95% CI = 1.11−1.78, p < 0.01; improve: OR = 0.65, 95% CI = 0.47−0.91, p < 0.05). The cross-lagged panel model found that baseline PF or loneliness had a significant predictive effect on the changes in each other. The associations between trajectories of loneliness and PF were weakened with age and clustered in the under 75 age groups. Conclusions: Bidirectional associations may exist between trajectories of loneliness and PF among Chinese older adults. Interventions should mainly target the young-old to reduce the adverse reciprocal effects of loneliness and PF.

Prevalence of frailty and associated socio-demographic factors among community-dwelling older people in southwestern Iran: a cross-sectional study

OBJECTIVES

This community-based cross-sectional study aimed to identify the frailty prevalence and associated socio-demographic factors among older adults in five cities of the south west of Iran.

METHODS

We selected a random sample of adults aged 60 years and above from five Southwest cities in Iran. Data for this study were retrospectively collected from 540 community-dwelling older adults. To measure frailty, we utilized the frailty index of cumulative deficit (FICD). Data were collected from medical records and socio-demographic factors, including gender, age, marital status, education level, lifestyle, income, and job status. The chi-square test and Spearman's correlation coefficient test were used to assess the relationship between the demographic variables and frailty status (SPSS version 22). Also, multiple binary logistic regression models were used to estimate the effects of demographic characteristics on the frailty recurrence.

RESULTS

The overall frailty prevalence was as follows: 77 (14.3%) frail, 139 (25.7%) pre-frail, and 324 (60%) not frail. The findings showed that all variables except education level and marital status are significantly associated with frailty status (P < 0.05). Multiple ridge logistic regression model indicated that age, gender, marital status, job status have significant, and education level, living arrangement, and economic status have no considerable effect on the frailty.

CONCLUSIONS

This study has shown that age and gender significantly contributed to the frailty process in older adults. The research also has shown the syndrome's occurrence affected by the aging process, and it supports the biological characteristics of frailty.

"Age-Related Positivity Effect" in the Relationship Between Pain and Depression Among Chinese Community-Dwelling Older Adults: Sex Differences

PURPOSE

To examine the "age-related positivity effect" and its sex differences in the pain-depression relationship among Chinese community-dwelling older adults.

DESIGN

Cross-sectional design.

METHODS

The study was conducted with a sample of 1,913 older adults in Jinan, China. Data were collected on pain intensity, age, sex, depressive symptoms, and potential covariates.

RESULTS

The hierarchical linear regression analyses revealed that pain intensity was significantly related to depressive symptoms, there was a significant two-way interaction between age and pain intensity, and there was a significant three-way interaction between sex, age, and pain intensity. The Johnson-Neyman plot revealed that the relationship between pain and depressive symptoms decreased with advancing age, indicating an "age-related positivity effect." And the age-related positivity effect in the pain-depression relationship was significant only in men, but not in women.

CONCLUSIONS

The study suggests that all older women and "young-old" men (younger senior citizens aged 60-79) in China are more likely to experience depressive symptoms from pain. Interventions on cognitive psychology should particularly target all older women and young-old men to reduce the detrimental effect of pain on emotional well-being.

Relationship between the living-alone period and depressive symptoms among the elderly

OBJECTIVE

The study aims to understand the relationship between the living-alone period and depressive symptoms among the elderly in South Korea.

METHODS

The study obtained data on the elderly over 65 years old from the 2006 to 2019 Korea Welfare Panel Study. Generalized estimating equation (GEE) analysis was performed to understand changes in depressive symptoms over periods of living alone. Additional subgroup analysis of age and gender was conducted to observe differences.

RESULTS

A total 568 (19% of the study samples) elderly transitioned from living with others into a living-alone state. Males and females showed a significant increase in depressive symptoms as they started to live alone, which gradually decreased with prolonged periods of living alone. The result of the GEE analysis demonstrated high odds of depressive symptoms during the first (OR = 1.857; 95% CI: 1.492-2.310), second (OR = 1.414; 95% CI: 1.127-1.774), and third (OR = 1.413; 95% CI: 1.105-1.808) years of living alone compared with living with others. Regarding additional subgroup analysis, the female and old-old groups showed high odds of depressive symptoms in the first 3 years of living alone, whereas the male and young-old groups showed high odds for the first year only.

CONCLUSIONS

The study provides valuable insights into the relationship between the living-alone period and depressive symptoms among the elderly. Future research using the living-alone period on various social factors are recommended.

Functional disability mediates the relationship between pain and depression among community-dwelling older adults: Age and sex as moderators

OBJECTIVE

To examine the moderating effects of age and sex in the role of functional disability as a mediator between pain and depression.

METHODS

Participants were 1917 community-dwelling older adults from Jinan, China. Data were collected on pain intensity, functional disability in activities of daily living and instrumental activities of daily living, depressive symptoms and covariates.

RESULTS

Functional disability partially mediated the relationship between pain intensity and depressive symptoms (estimate = 0.015, SE = 0.007, 95% CI [0.004, 0.030]). Age and sex moderated both the direct and indirect effect of the mediation model. The mediating effect of functional disability was significant in the old-old men, young-old men, and young-old women, but not in the old-old women.

CONCLUSIONS

Interventions should target both pain and pain-related functional disability to improve their emotional well-being among community-dwelling older adults. Importantly, strategies should be tailored across different age and sex groups to improve their effectiveness.

Frailty and depression: Reciprocal influences or common causes?

BACKGROUND

Previous research demonstrated substantial associations between frailty and depression in late life, but it remains unclear whether this relationship is best explained by reciprocal influences of these variables or by common causes. This study investigated the interdependencies between frailty and depression across time by examining cross-lagged effects within individuals, while accounting for variability in baseline levels and long-term development between individuals.

METHODS

We modeled longitudinal data from six panel waves gathered in the Survey of Health, Ageing and Retirement in Europe, covering a time period of up to 14 years. The total sample size was N = 58,152 individuals aged 50 years or older. Frailty was based on a deficit accumulation frailty index and depressive symptoms were measured with the EURO-D scale. We used a latent curve model with structured residuals for statistical analysis.

RESULTS

The results did not demonstrate relevant cross-lagged effects of frailty and depression at the within-person level. However, within-person increases in frailty were accompanied by within-person increases in depression at the same point in time. At the between-person level, it showed that individuals with higher levels and steeper trajectories in frailty also tend to show higher levels and steeper trajectories in depression.

CONCLUSION

These findings question the notion that frailty and depression reciprocally influence each other over the course of time, but rather indicate that frailty and depression might be both affected by common causes, in both the short and the long term.