FRI0081 WERE FRAIL RA PATIENTS AT YOUNGER AGE MORE LONELY, DEPRESSED OR ANXIOUS THAN NON-FRAIL RA PATIENTS?

Abstract

Background:Frailty is a state that reflects reduced reserve and resistance to stressors among elderly persons. A preceding study showed that 38 out of 90 (42%) RA patients aged ≥ 55 years who visited our outpatient clinic were frail. Presence of frailty was not age-dependent. Patients were mainly classified as frail because of positive answers on single items that report on depressive feelings (73.7%), anxiety (57.9%), missing people around (65.8%) and emptiness (63.2%) [1]. It is unclear whether frailty is a cause, consequence or comorbidity of poor psycho-emotional health. Alternatively, they could also be congruent conditions. Exploring whether poor psycho-emotional health might be a longitudinal predictor of frailty, might shed light upon the relation between frailty and psycho-emotional health.Objectives:In this mixed qualitative / quantitative study, we assessed whether older frail RA patients were already more lonely, depressed, and/or anxious than non-frail RA patients at 40 years.Methods:All 90 RA patients who participated in our previous study on frailty in 2017 were invited for the current study. Participants were invited to rate validated multidimensional questionnaires on depression and anxiety (Geriatric Depression Scale (GDS) and Hospital Anxiety and Depression Scale (HADS)), loneliness (de Jong Gierveld loneliness scale) social support (Social Support List) for their current situation, but also retrospectively for their situation at the age of 40. Current frailty was assessed by the Groningen Frailty Indicator (GFI). Semi-structured interviews took place in an age-stratified sample to explore how the diagnosis of RA has influenced patients’ life. Items of questionnaires were compared using the chi-square test. Interviews were annotated by two independent readers. Codes were taxonomically organized and linked to themes using NVivo 12.Results:32 (36%) of the 90 invited patients participated and 28 completed all psycho-emotional questionnaires. Twelve out of 32 patients (37.5%) were classified as frail by the GFI. On the GDS at current age, 6/12 frail patients had signs of depression compared to 2/17 non-frail patients (p=0.04) (Table 1). More frail patients had signs of an anxiety disorder on the HADS, both at current age and age 40 (age 40: 7/11 frail patients versus 0/0 non-frail patients, p<0.01; Table 1). Results on the individual level were more blurred: 3 (42%) out of 7 frail patients were anxious at age 40, but not at current age. The loneliness, social support and HADS depression questionnaires showed no difference between frail and non-frail patients, both at current age and age 40. A stratified sample of 10/32 (31%) patients were interviewed of which 5 (50%) were frail on the GFI. Frail patients more often expressed anxious feelings at current age. Since the diagnosis of RA, frail patients worried more about the future, i.e. about the progression of RA. Non-frail patients tended to be more optimistic. In the interviews, patients expressed not having feelings of depression and anxiety at age 40.Table 1.Number of frail and non-frail patients per questionnaire at current age and age 40.QuestionnaireFrailNon-frailTotalp-valueGDS nowNo depression615210.04Depression628GDS age 40No depression917260.06Depression303HADS anxiety nowNo indication anxiety617230.01Indication anxiety505HADS anxiety age 40No indication anxiety41721<0.01Indication anxiety707Conclusion:Although it is difficult to disentangle the causal conundrum between psycho-emotional health and frailty, frail patients were on a group level more anxious at younger age on the HADS in our study. Psychiatric symptomatology might be misinterpreted for frailty at current age. Limitations of our study include a high chance on amplified memory bias.