Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China.
J Gerontol A Biol Sci Med Sci. 2023 Oct 28;78(11):2162-2169. doi: 10.1093/gerona/glad178.
Although previous studies have reported an association between multimorbidity and frailty, its direction and mechanism remain unclear. This study aimed to investigate the direction of this association, as well as the role of depression among older Europeans.
We used a cross-lagged panel design to evaluate the temporal relationship between multimorbidity and frailty and the role of depression. Multimorbidity status was assessed by the self-reporting of 14 chronic diseases. Frailty was assessed based on the frailty phenotype. The European-Depression Scale (EURO-D) was used to assess depression.
There was a bidirectional relationship between frailty and multimorbidity. More severe multimorbidity predicted greater frailty (β = 0.159; p < .001) and vice versa (β = 0.107; p < .001). All paths from multimorbidity to frailty were stronger than the paths from frailty to multimorbidity (b1-a1: β = 0.051; p < .001). Likewise, early multimorbidity change was a significant predictive factor for late frailty change (β = 0.064; p < .001) and vice versa (β = 0.048; p < .001). Depression in Wave 5 (T5) mediated the association between frailty in Wave 4 (T4) and multimorbidity in Wave 6 (T6; indirect effect: β = 0.004; bootstrap 95% confidence interval: 0.003, 0.006).
A positive, bidirectional association was observed between multimorbidity and frailty. Depression may be a potential cause of an increased risk of multimorbidity later in life in frail older adults. Early monitoring of frailty and depression may slow the progression of multimorbidity, thereby interrupting the vicious cycle.
尽管先前的研究报告了多病共存与衰弱之间存在关联，但关联的方向和机制仍不清楚。本研究旨在探讨这种关联的方向，以及老年欧洲人中间抑郁的作用。
我们使用交叉滞后面板设计来评估多病共存与衰弱之间的时间关系以及抑郁的作用。多病共存状况通过自我报告的 14 种慢性疾病来评估。衰弱根据衰弱表型来评估。使用欧洲抑郁量表（EURO-D）来评估抑郁。
衰弱与多病共存之间存在双向关系。更严重的多病共存预示着更大的衰弱（β=0.159；p<0.001），反之亦然（β=0.107；p<0.001）。从多病共存到衰弱的所有路径都强于从衰弱到多病共存的路径（b1-a1：β=0.051；p<0.001）。同样，早期多病共存的变化是晚期衰弱变化的一个显著预测因素（β=0.064；p<0.001），反之亦然（β=0.048；p<0.001）。第 5 波（T5）的抑郁在第 4 波（T4）的衰弱与第 6 波（T6）的多病共存之间起中介作用（间接效应：β=0.004；bootstrap95%置信区间：0.003，0.006）。
观察到多病共存与衰弱之间存在正相关的双向关联。抑郁可能是虚弱的老年患者以后多病共存风险增加的一个潜在原因。早期监测衰弱和抑郁可能会减缓多病共存的进展，从而打破恶性循环。
