Brown, Patrick J2; Roose, Steven P2; Fieo, Robert2; Liu, Xinhua2; Rantanen, Taina2; Sneed, Joel R2; Rutherford, Bret R2; Devanand, D P2; Avlund, Kirsten4
1 Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet2 unknown3 Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet4 Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet
A High-Risk Clinical Population
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. CONCLUSION: 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.
Journal of Geriatric Psychiatry and Neurology, 2014, Vol 22, Issue 11, p. 1083-95