Frailty is Associated with Anxiety in Community‐Dwelling Elderly Adults

Abstract

To the Editor: Frailty, a biological syndrome characterized by poor resilience and low physiological reserves, has been associated with functional decline and adverse health-related outcomes.1 It has also been associated with psychiatric conditions, because maladaptive psychological responses including anxiety, which is the most common psychiatric illness in elderly adults, may accompany the transition from independence to functional decline.2, 3 Well-established risk factors for anxiety include female sex, chronic medical conditions, cognitive impairment, disability, or previous history of anxiety.4 Few researchers have studied the association between anxiety and the frailty syndrome, although both have adverse health-related outcomes;5, 6 therefore, it is imperative to understand their association. The aim of this study was to establish the association between frailty and anxiety in community-dwelling elderly adults. A cross-sectional study was conducted of 927 adults aged 70 and older living in Mexico City and participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty (The Coyoacan Cohort).7 Anxiety was measured using the seven-item subscale from the Hospital Anxiety and Depression Scale (HADS-A)8 (range 0–21, ≥8 indicates clinical anxiety). Frailty was measured according to the Fried phenotype, which has been previously validated for this population.3, 8 Multivariate logistic regression analyses were performed to test the independent association between frailty and anxiety, adjusting for age, sex, comorbidity (stroke, myocardial infarction, hypertension, diabetes mellitus, and hypercholesterolemia), functional status (Katz scale), cognitive status (Mini-Mental State Examination), and depressive symptoms (Geriatric Depression Scale). All statistical tests were performed at the 0.05 level. Mean age was 78.2 ± 6.2, and 54.9% of participants were female. The most frequent chronic disease was hypertension (55.9%); 29.1% had disability in one or more activities of daily living (ADLs). Fourteen percent of participants were frail, and 18.7% experienced clinical anxiety. Table 1 compares the groups with and without clinical anxiety. Participants with clinical anxiety were more likely to be female (P < .001), to have had a stroke (P = .047), to have disability in one or more ADLs (P < .001), and to have depressive symptoms (P < .001). As expected, frailty was more frequent in anxious participants (26.0%) than in those who were not anxious (11.4%; P < .001). Multivariate logistic regression showed an independent association between prefrail (odds ratio (OR) = 2.29, 95% confidence interval (CI) = 1.33–3.95; P = .003) and frail (OR = 2.28, 95% CI = 1.06–4.87; P = .003) status and clinical anxiety. Prefrail and frail status are independently associated with anxiety. These results suggest that persons who become increasingly frail have a higher likelihood of emotional disturbances, as described previously,5, 6 or that elderly persons with anxiety are more likely to develop frailty. It seems that frail people experience more anxiety symptoms. This may be due to poor physical performance, decrease in strength, extenuation, and slow gait velocity, although it is possible that anxious people have more characteristics of frailty secondary to the self-perception of less confidence and poorer self-efficacy, which are associated with functional decline.9 Moreover, a longitudinal study with 1 year of follow-up showed that anxiety increases the risk of cognitive decline.10 Because it has been proposed that cognitive decline be included as part of the frailty phenotype,7 it could be another hypothesis for the association between frailty and anxiety. The present results suggest the intimate relationship between frailty and psychological components and that the first can lead to the second. The main limitation of this study is its cross-sectional design and that the direction of the association cannot be established. Longitudinal research is required to clarify causality between frailty and anxiety in elderly adults, with the intention of establishing prevention measures. This research was conducted as part of the Mexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly. This project was funded by the National Council for Science and Technology of Mexico (SALUD-2006-C01-45075). Dr. J. A. Ávila-Funes is supported by a Bourse ECOS (2010–2012) from the Ministère des Affaires Étrangères in France and the Secretaría de Educación Pública, the Asociación Nacional de Universidades e Instituciones de Educación Superior, and CONACyT in Mexico. Conflict of Interest: All authors state no financial interest, stock, or derived direct financial benefit. Author Contributions: Dr. Bernal-López developed the concept and design of the study, conducted the analyses, and interpreted the data. She wrote the manuscript under the supervision of Drs. Potvin and Ávila-Funes. All authors participated substantially in the conceptualization and design of this work and the analysis of the data as well as the writing of the manuscript. They have reviewed the final version of the manuscript, and have approved it for publication. Sponsor's Role: None.