Vaughan Leslie, Corbin Akeesha L, Goveas Joseph S
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, MI, USA.
Clin Interv Aging. 2015 Dec 15;10:1947-58. doi: 10.2147/CIA.S69632. eCollection 2015.
Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. 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. Key search terms were "frailty", "frail", "frail elderly", "depressive", "depressive disorder", and "depression". Participants of included studies were ≥ 55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al's criteria and a screening measure to identify depressive symptomatology. 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. Measurement variability of depressive symptomatology and inclusion of older adults who are severely depressed, have cognitive impairment or dementia, or stroke may confound the frailty syndrome with single disease outcomes, accounting for a substantial proportion of shared variance in the syndromes. Further study is needed to identify medical and behavioral interventions for frailty and depressive symptomatology that prevent adverse sequelae such as falls, disability, and premature mortality.
衰弱和抑郁是影响老年人的重要问题。在高龄老年人中，抑郁综合征在临床上可能难以与衰弱区分开来。目前关于该主题的综述包括方法学差异很大的研究。本综述考察了已发表的关于衰弱与抑郁症状之间横断面和纵向关联的文献，其中以综合征为结果、这种关系的调节因素、结构重叠以及相关的医学和行为干预措施。报告了两者的患病率。在PubMed、Cochrane系统评价数据库和PsychInfo中对2000年至2015年发表的研究进行了系统评价。关键检索词为“衰弱”“虚弱的”“衰弱老年人”“抑郁的”“抑郁症”和“抑郁”。纳入研究的参与者年龄≥55岁且居住在社区。纳入研究基于Fried等人的标准对衰弱采用明确的生物学定义，并使用一种筛查措施来识别抑郁症状。十四项研究符合纳入/排除标准。在≥55岁的老年人中，抑郁症状、衰弱或两者共现的患病率大于10%，且这些患病率差异很大，但在关于新发衰弱的大型流行病学研究中差异较小。抑郁症状与新发衰弱风险增加之间的前瞻性关系很显著，而相反的关系则不太确定。与抑郁症状相互作用的合并症的存在增加了新发衰弱风险。抑郁症状的测量变异性以及纳入严重抑郁、有认知障碍或痴呆或中风的老年人可能会使衰弱综合征与单一疾病结局混淆，这在综合征的共享方差中占很大比例。需要进一步研究以确定针对衰弱和抑郁症状的医学和行为干预措施，以预防跌倒、残疾和过早死亡等不良后果。
