Abstract
ObjectiveFrailty and depression, as two common conditions among older adults in China, have been shown to be closely related to each other. The aim of this study was to investigate the bidirectional effects between frailty and depressive symptoms in Chinese population.MethodsThe bidirectional effect of frailty with depressive symptoms was analyzed among 5,303 adults ≥ 60 years of age from the China Health and Retirement Longitudinal Study (CHARLS). Phenotype and a frailty index were used to measure frailty. Depressive symptoms were evaluated using the Epidemiological Studies Depression Scale (CES-D). Logistic regression and Cox proportional hazard regression models were used to determine the bidirectional effects of frailty and depressive symptoms in cross-sectional and cohort studies, respectively. Subgroup and sensitivity analyses were further used to further verify the associations.ResultsIn the cross-sectional study, the multivariate-adjusted ORs (95% CIs) for depressive symptoms among pre-frail and frail adults, as defined by the frailty index and phenotype, were 3.05 (2.68–3.49), and 9.78 (8.02–12.03), respectively. Depressed participants showed higher risks of pre-frailty and frailty [frailty index, 3.07 (2.69–3.50); and phenotypic frailty, 9.95 (8.15–12.24)]. During follow-up, the multivariate-adjusted HRs (95% CIs) for depressive symptoms among pre-frail and frail participants, as defined by the frailty index and phenotype, were 1.38 (1.22–1.57), and 1.30 (1.14–1.48), respectively. No significant relationship existed between baseline depressive symptoms and the incidence of frailty. Moreover, the results from subgroup and sensitivity analyses were consistent with the main results.ConclusionAlthough a cross-sectional bidirectional association between depressive symptom and frailty has been observed in older (≥60 years old) Chinese adults, frailty may be an independent predictor for subsequent depression. Moreover, no effect of depressive symptoms on subsequent frailty was detected. Additional bidirectional studies are warranted in China.
Highlights
The aging population is a global phenomenon, with 1 billion adults ≥ 60 years of age
3,157 or 3,082 participants remained in the cohort analysis with baseline frailty, as defined by a frailty index or phenotype, respectively, and the incidence of depressive symptoms, while 2,086 or 1,491 participants were included for the cohort analysis between baseline depressive symptoms and incidence of frailty assessed by a frailty index or phenotype, respectively
These findings suggest that frailty is a longitudinal predictor of depressive symptoms
Summary
The aging population is a global phenomenon, with 1 billion adults ≥ 60 years of age This number is estimated to reach 1.4 billion by 2030, and will be on the rise in the ensuing decades (World Health Organization, 2018, 2019). The prevalence of frailty has been estimated to range from 10% among community-dwellers (Collard et al, 2012) to 18–40% in hospitalized patients (Cunha et al, 2019). When stressors, such as acute illness, occur, a person with frailty rapidly has a deterioration in functional capacity. The frailty index is based on the cumulative deficit model, and covers non-specific diseases, deficits, signs, symptoms, disabilities, and mental factors (Rockwood and Mitnitski, 2007)
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