title: Frailty, depression, and anxiety in later life.
abstract: BACKGROUND
  Anxiety and depression are common in older people but are often missed; to improve detection we must focus on those elderly people at risk. Frailty is a geriatric syndrome inferring increased risk of poor outcomes. Our objective was to explore the relationship between frailty and clinically significant anxiety and depression in later life.
  
  
  METHODS
  This study had a cross-sectional design and involved the assessment of 567 community-dwelling people aged ≥ 60 years recruited from the Technology Research for Independent Living (TRIL) Clinic, Dublin. Frailty was measured using the Fried biological syndrome model; depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale; and anxiety symptoms measured using the Hospital Anxiety and Depression Scale.
  
  
  RESULTS
  Higher depression and anxiety scores were identified in both pre-frail and frail groups compared to robust elders (three-way factorial ANOVA, p ≤ 0.0001). In a logistic regression model the odds ratio for frailty showed a significantly higher likelihood of clinically meaningful depressive and anxiety symptoms even controlling for age, gender and a history of depression or anxiety requiring pharmacotherapy (OR = 4.3; 95% CI 1.5, 11.9; p = 0.005; OR = 4.36; 95% CI 1.4, 13.8; p = 0.013 respectively).
  
  
  CONCLUSIONS
  Our findings suggest that even at the earliest stage of pre-frailty, there is an association with increased symptoms of emotional distress; once frailty develops there is a higher likelihood of clinically significant depression and anxiety. Frailty may be relevant in identifying older people at risk of deteriorating mental health.
authors.affiliation: TRIL Clinic (Technology Research for Independent Living), St James's Hospital, Dublin, Ireland. ainemullen@gmail.com
authors.forename: Aine M
authors.initials: AM
authors.lastname: Ní Mhaoláin
authors.forename: Chie Wei
authors.initials: CW
authors.lastname: Fan
authors.forename: Roman
authors.initials: R
authors.lastname: Romero-Ortuno
authors.forename: Lisa
authors.initials: L
authors.lastname: Cogan
authors.forename: Clodagh
authors.initials: C
authors.lastname: Cunningham
authors.forename: Rose-Anne
authors.initials: RA
authors.lastname: Kenny
authors.forename: Brian
authors.initials: B
authors.lastname: Lawlor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D016330:Frail Elderly / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D008297:Male; D008609:Mental Status Schedule; D016017:Odds Ratio; D012307:Risk Factors; D013223:Statistics as Topic