The contribution of depression and anxiety to frailty in men and women: data from a longitudinal population-based cohort study.

BACKGROUND

Frailty is common in old age and associated with decreased cognition, depression, and anxiety. Since transitioning between frailty states can offer targets for interventions, the aims of the current study were to assess the prevalence of frailty and changes over time as well as the impact of mental health, living environment (rural vs. urban) and sex on frailty transition.

METHODS

683 participants ≥ 65 years were categorized into three frailty stages (robust, pre-frail, frail) according to the Fried frailty phenotype during two consecutive visits (mean assessment interval: 4 years). Aspects of mental health including anxiety and depression (Hospital Anxiety and Depression Scale, HADS) and cognition (mini-mental state examination, MMSE, and number connection test, NCT) were assessed for the purposes of this study.

RESULTS

At visit 1, 35% of participants were classified as robust and 64.1% as pre-frail. More than 40% of participants transitioned between frailty states between visits. For the analysis, frailty status was dichotomized into two categories: robust and pre-frail/frail. A mixed-effect logistic model indicated that the HADS depression subscale was significantly associated with the risk of being pre-frail/frail [odds ratio (OR): 1.28 (95% confidence interval (CI): 1.21-1.36), p < 0.001] and that participants from rural areas were less likely to be pre-frail/frail [OR: 0.57 (95% CI: 0.44-0.75), p = 0.001]. Similar findings were obtained with independent sex-specific models, whereas multivariate logistic regression revealed a positive association between a higher baseline HADS anxiety score and the risk of worsening frailty in females [OR: 1.12 (95% CI: 1.00-1.25), p = 0.05], but not in males.

CONCLUSIONS

Depression and anxiety are two potentially treatable conditions contributing to frailty over time, with anxiety specifically affecting women. As frailty status can change from pre-frail to robust over time, recognizing pre-frailty is paramount to start interventions at this stage with the aim of improving frailty status.