Depression and frailty in later life: a systematic review

L. Vaughan, A.L. Corbin, J.S. Goveas

Clin Interv Aging 2015;10:1947-58

Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age.

This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Participants of included studies were ≥ 55 years old and community dwelling. Fourteen studies met the inclusion/exclusion criteria.

The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥ 55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. 

Comment: The findings of this systematic review suggest that more than one in ten older adults are either frail or have depressive symptomatology, and that a high percentage of older adults who are frail also have depressive symptomatology. Although the prevalence rates of both frailty and depression are highly variable across both cross-sectional and longitudinal studies at baseline (2.5%–21.1% and 6.5%–25.3% for frailty and depressive symptomatology, respectively), incident frailty rates are less variable (7.2%–18.6%) with most reports in the range of 13.6%–18.6%. Incident depressive symptomatology is reported in very few of these studies to make generalizations. The coexistence of the two syndromes is also variable (16.4%–53.8%) and infrequently reported at follow-up in longitudinal studies. The moderating role of newer generation antidepressants in the depression–frailty relationship remains unclear. In addition, this article consider conditions, pathologies and drugs that could affect frailty and depression in older people, but also the possible interventions which could decrease the rate of frailty and depression in older adults.