Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain.
Research Unit, Consorci Sanitari del Maresme, Barcelona, Spain.
Fam Pract. 2022 Sep 24;39(5):875-882. doi: 10.1093/fampra/cmab174.
Depression and frailty are closely related, but the mechanisms by which depressed older adults are at an increased risk of becoming frail are still not well understood.
To assess socioeconomic and depression-related risk factors for frailty in older adults with depression.
Observational and prospective cohort study, with 12-month follow-up, of nonfrail community-dwelling subjects aged ≥70 years old with depression. The main study factors were clinical characteristics of depression, including symptom severity (Hamilton Depression Rating Scale), accompanying anxiety and cognitive symptoms, pharmacological treatment, and social factors including educational level, income, housing conditions and living circumstances, and social network. Frailty status was established according to Fried criteria.
We recruited and analysed 216 subjects (mean age 76.5 years; 74% women), 65 (30%) of whom were lost to follow-up. Annual incidence of frailty was 23.2 new cases/100 persons. Age, female gender, osteoarthritis, pain, number of medications, major depression, first-degree family history of depression, depressive symptom severity, low educational level, and low-income level were risk factors for frailty. The multivariate analysis showed that age (odds ratio [OR] = 1.16; 95% confidence interval [CI]: 1.04-1.29), visual analogue scale (VAS)-pain (OR = 1.25; 95% CI: 1.01-1.55), and severe or very severe depressive symptoms (OR = 37.36; 95% CI: 2.68-518.53) were significantly associated with incident frailty at 12 months of follow-up.
Both clinical and social characteristics are risk factors for frailty, but severity of depressive symptoms had the highest independent effect on frailty in depressed aged subjects. Frailty requires a multidisciplinary approach that pays special attention to pain and depressed mood.
抑郁和衰弱密切相关，但抑郁老年人易患衰弱的机制仍不清楚。
评估与抑郁相关的社会经济和抑郁因素对老年抑郁患者衰弱的影响。
对≥70 岁、无衰弱的社区居住的、有抑郁症状的老年人进行了为期 12 个月的观察性、前瞻性队列研究。主要研究因素包括抑郁的临床特征，包括症状严重程度（汉密尔顿抑郁评定量表）、伴随的焦虑和认知症状、药物治疗以及包括教育程度、收入、住房条件和生活环境、社会网络在内的社会因素。衰弱状态根据 Fried 标准确定。
我们共招募并分析了 216 名受试者（平均年龄 76.5 岁，74%为女性），其中 65 名（30%）失访。衰弱的年发生率为 23.2 例/100 人。年龄、女性、骨关节炎、疼痛、用药数量、重度抑郁症、一级抑郁症家族史、抑郁症状严重程度、低教育水平和低收入水平是衰弱的危险因素。多变量分析显示，年龄（比值比 [OR] = 1.16；95%置信区间 [CI]：1.04-1.29）、视觉模拟量表（VAS）-疼痛（OR = 1.25；95% CI：1.01-1.55）和严重或非常严重的抑郁症状（OR = 37.36；95% CI：2.68-518.53）与 12 个月随访时的衰弱发生率显著相关。
临床和社会特征都是衰弱的危险因素，但抑郁症状的严重程度对老年抑郁患者衰弱的影响最大。衰弱需要多学科的方法，特别要关注疼痛和抑郁情绪。
