Frailty may predict adverse outcomes for older adults with depression

Frailty may help identify older individuals with late-life depression who are at increased risk for adverse negative health outcomes, according to results of a prospective clinical cohort study published in Journal of Clinical Psychiatry.

“Frailty is characterized by cumulative declines in multiple physiologic systems, accompanied by an increased vulnerability to stressors,” Matheus H. L. Arts, MD, PhD, MSc, of the University Center for Psychiatry at the University Medical Center Groningen in the Netherlands, and colleagues wrote. “In geriatric medicine, frailty is increasingly used for risk stratification to identify patients at increased risk [for] adverse health outcomes, including mortality, and to deliver patient-centered care. Frailty might be a pathway that may explain excess mortality in depression.”

The researchers aimed to assess the potential for frailty and biomarkers related to it to serve as predictors of mortality among older patients with depression. Specifically, they used Cox proportional hazard regression analyses adjusted for confounders to assess whether frailty predicted time-to-death during a 6-year follow-up of 378 patients aged 60 years or older with a depressive disorder according to DMS-IV criteria. They obtained baseline data between 2007 and September 2010. They defined frailty using the Fried Frailty Phenotype criteria, which accounted for factors including muscle weakness, slowness, exhaustion, low activity level and unintended weight loss. Further, they assessed the predictive capability of three inflammatory markers, vitamin D level and leukocyte telomere length, as well as if frailty phenotype impacted these effects.

Results showed 27 (26.2%) of 103 patients classified as frail and who had depression died during follow-up compared with 35 (12.7%) of 275 patients who were not classified as frail but who had depression (P < .001). The researchers reported an association after adjustment for confounders between the number of frailty components and increased mortality rate (HR = 1.38; 95% CI, 1.06-1.78). They noted a prospective association between mortality and all biomarkers, aside from interleukin-6; however, only higher high-sensitivity C-reactive protein levels and lower vitamin D levels were independent of frailty linked to mortality.

“Since frailty is identifiable in depressed older adults and prospectively associated with mortality independently of the extent of multimorbidity, sociodemographic and lifestyle characteristics, we hope that our findings will contribute to the evolution of mental health care services to better meet the needs of our increasingly complex patient populations,” Arts and colleagues wrote.