Frailty and depression in later life
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Background: Although criteria for frailty and depression partially overlap and both syndromes are associated with adverse health outcomes, there is a lack of research into their (reciprocal) relationship. Due to symptom overlap, frail elderly may be misdiagnosed as depressed. If true, the classical correlates of depression would be less prevalent in this group. Objectives: 1) to compare the prevalence of frailty in depressed older adults with the prevalence of frailty in non-depressed older adults, and 2) to compare classical correlates of depression (neuroticism, anxiety, feeling of guilt and worthlessness, age of onset, and somatic comorbidity) between depressed elderly with and those without frailty. Methods: The reported cross-sectional observational study was embedded within a larger, multisite research project; the Netherlands Study of Depression in Older people. Participants were 300 older adults (aged ≥ 60 years) with depression and 55 non-depressed elderly. Depression was assessed with the Composite International Diagnostic Interview. Severity of depression was measured with Inventory of Depressive Symptomatology (IDS). Frailty was defined according to the criteria of Fried and colleagues. In this definition three or more of the following criteria must be present: weight loss, slowness, poor endurance and energy, weakness and low physical activity level. Results: The prevalence of frailty was significantly higher in the depressed group than in the non-depressed group (21.3% versus 1.8%). After controlling for covariates (age, gender, living circumstances, educational level, somatic comorbidity and severity of depression), there was no difference in correlates of depression between frail depressed elderly and non-frail depressed elderly, except for the frequency of comorbid somatic diseases. Post-hoc analyses with both unidimensional definitions of frailty (weakness, slowness) and different symptom profiles of depression (IDS factor analysis, adjusted IDS-score without somatic items) confirmed these results. Conclusion: The prevalence of frailty among depressed older adults is high, and cannot be explained fully by symptom overlap. This argues for the need of frailty screening, as well as multidisciplinary care. Given their holistic view and expertise with practical methods of intervention, this approach is preferably to be conducted and coordinated by nurses.