title: Frailty and depression in older adults: a high-risk clinical population.
abstract: OBJECTIVE
  To identify salient characteristics of frailty that increase risk of death in depressed elders.
  
  
  METHODS
  Data were from the Nordic Research on Ageing Study from research sites in Denmark, Sweden, and Finland. Participants were 1,027 adults aged 75 years (436 men and 591 women). Time of death was obtained, providing a maximum survival time of 11.08 years (initial evaluation took place between 1988 and 1991).
  
  
  RESULTS
  Depressed elders showed greater baseline impairments in each frailty characteristic (gait speed, grip strength, physical activity levels, and fatigue). Simultaneous models including all four frailty characteristics showed slow gait speed (hazard ratio: 1.84; 95% confidence interval: 1.05-3.21) and fatigue (hazard ratio: 1.94; 95% confidence interval: 1.11-3.40) associated with faster progression to death in depressed women; none of the frailty characteristics in the simultaneous model was associated with death in depressed men. In women, the effect of impaired gait speed on mortality rates nearly doubled when depression was present (nondepressed women: no gait impairment = 26%; slow gait = 40%; depressed women: no gait impairment = 32%; slow gait = 58%). A similar pattern was observed for fatigue.
  
  
  CONCLUSIONS
  The confluence of specific characteristics of frailty (fatigue and slow gait speed) and depressive illness is associated with an increased risk of death in older adults; this association is particularly strong in older depressed women. Future research should investigate whether multimodal interventions targeting depressive illness, mobility deficits, and fatigue can decrease mortality and improve quality of life in older depressed individuals with characteristics of the syndrome of frailty.
authors: Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY. Electronic address: pb2410@columbia.edu.
authors: Patrick J
authors: PJ
authors: Brown
authors: Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY.
authors: Steven P
authors: SP
authors: Roose
authors: Sergievsky Center and the Taub Institute, Columbia University College of Physicians and Surgeons, New York, NY.
authors: Robert
authors: R
authors: Fieo
authors: Division of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
authors: Xinhua
authors: X
authors: Liu
authors: The Finnish Centre for Interdisciplinary Gerontology, University of Jyväskylä, Jyväskylä, Finland.
authors: Taina
authors: T
authors: Rantanen
authors: Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY; Queens College, City University of New York, New York, NY.
authors: Joel R
authors: JR
authors: Sneed
authors: Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY.
authors: Bret R
authors: BR
authors: Rutherford
authors: Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY.
authors: D P
authors: DP
authors: Devanand
authors: Department of Public Health and Center for Health Ageing, University of Copenhagen, Copenhagen, Denmark; Danish Aging Research Centre, Universities of Aarhus, Southern Denmark and Copenhagen, Denmark.
authors: Kirsten
authors: K
authors: Avlund
mesh_terms: D000368:Aged; D003863:Depression / Q000453:epidemiology* / Q000401:mortality; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly / Q000523:psychology* / Q000706:statistics & numerical data; D005684:Gait; D018737:Hand Strength; D006801:Humans; D008297:Male; D009043:Motor Activity; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis
keywords: Depression; frailty; mortality
references: Prev Chronic Dis. 2008 Jan;5(1):A22
references: 18082011
references: Am J Psychiatry. 1997 Apr;154(4):562-5
references: 9090349
references: Arch Gen Psychiatry. 2003 Nov;60(11):1090-6
references: 14609884
references: J Aging Health. 2011 Apr;23(3):387-416
references: 20935250
references: Am J Geriatr Psychiatry. 2001 Spring;9(2):99-101
references: 11316614
references: Dialogues Clin Neurosci. 2007;9(1):9-17
references: 17506222
references: Psychol Med. 1997 Jan;27(1):231-5
references: 9122304
references: J Am Geriatr Soc. 2012 Oct;60(10):1901-5
references: 23002714
references: Med Clin North Am. 2011 May;95(3):427-38, ix
references: 21549870
references: N Engl J Med. 2010 Apr 1;362(13):1173-80
references: 20357280
references: Am J Geriatr Psychiatry. 2009 Sep;17(9):769-81
references: 19700949
references: J Gerontol A Biol Sci Med Sci. 2012 May;67(5):523-9
references: 22016363
references: Am J Geriatr Psychiatry. 2001 Spring;9(2):102-12
references: 11316615
references: J Gerontol A Biol Sci Med Sci. 2013 Apr;68(4):456-64
references: 23051974
references: Am J Public Health. 1994 Nov;84(11):1796-9
references: 7977920
references: J Gerontol A Biol Sci Med Sci. 2006 Nov;61(11):1201-5
references: 17167163
references: Arch Gen Psychiatry. 2010 Mar;67(3):277-85
references: 20194828
references: Dan Med Bull. 1993 Nov;40(5):618-24
references: 8299404
references: Am J Geriatr Psychiatry. 2010 Feb;18(2):128-35
references: 20104069
references: Am J Geriatr Psychiatry. 2008 Jan;16(1):65-73
references: 17998306
references: Clin Interv Aging. 2007;2(3):485-94
references: 18044198
references: Aging Clin Exp Res. 2002 Jun;14(3 Suppl):5-9
references: 12475128
references: Arch Gen Psychiatry. 1997 Oct;54(10):915-22
references: 9337771
references: Aging Ment Health. 2003 Nov;7(6):469-80
references: 14578009
references: Scand J Med Sci Sports. 2002 Oct;12(5):296-300
references: 12383075
references: J Am Geriatr Soc. 2011 Jul;59(7):1188-96
references: 21718259
references: Dialogues Clin Neurosci. 2008;10(3):345-57
references: 18979948
references: Am J Epidemiol. 1977 Sep;106(3):203-14
references: 900119
references: J Clin Epidemiol. 1994 Jul;47(7):747-60
references: 7722588
references: J Gerontol A Biol Sci Med Sci. 2010 Apr;65(4):407-13
references: 19933749
references: Aging Ment Health. 2007 Jan;11(1):61-8
references: 17164159
references: Am J Geriatr Psychiatry. 2012 May;20(5):425-32
references: 21422907
references: Arch Gen Psychiatry. 2011 Jun;68(6):617-26
references: 21646578
references: Arch Gen Psychiatry. 2000 Nov;57(11):1071-6
references: 11074873
references: J Am Geriatr Soc. 2002 Dec;50(12):1921-8
references: 12473001
references: Int J Geriatr Psychiatry. 2012 Sep;27(9):879-92
references: 21984056
references: Arch Gerontol Geriatr. 2012 Jan-Feb;54(1):9-15
references: 21763008
references: Am J Geriatr Psychiatry. 2007 Jul;15(7):553-63
references: 17586780
references: Am J Geriatr Psychiatry. 2013 Jun;21(6):560-9
references: 23567406
references: Acta Med Scand Suppl. 1986;711:233-7
references: 3535411
references: J Affect Disord. 2011 Mar;129(1-3):126-42
references: 20926139
references: Biol Psychiatry. 2008 Sep 15;64(6):491-7
references: 18490003
references: J Gerontol A Biol Sci Med Sci. 2006 Mar;61(3):262-6
references: 16567375
references: Am J Geriatr Psychiatry. 2013 Jul;21(7):675-84
references: 23567401
references: Clin Interv Aging. 2010 Sep 07;5:259-70
references: 20852673
references: PLoS One. 2011;6(7):e21841
references: 21747961
references: J Psychiatry Neurosci. 2011 May;36(3):187-94
references: 21138658
references: Ageing Res Rev. 2013 Mar;12(2):719-36
references: 22426304
references: J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
references: 11253156
references: J Gerontol A Biol Sci Med Sci. 2008 Sep;63(9):984-90
references: 18840805
references: J Gerontol A Biol Sci Med Sci. 2008 Jul;63(7):707-14
references: 18693225
references: J Community Health. 1990 Apr;15(2):93-104
references: 2141337
references: J Gerontol A Biol Sci Med Sci. 2006 Nov;61(11):1157-65
references: 17167156
references: Aging Clin Exp Res. 2002 Jun;14(3 Suppl):10-5
references: 12475129
references: Am J Geriatr Psychiatry. 2004 Jan-Feb;12(1):1-6
references: 14729553
references: Arch Intern Med. 2009 Nov 23;169(21):1952-60
references: 19933955
references: J Am Geriatr Soc. 2012 May;60(5):854-61
references: 22568404