Sad to Say

Over the past year, as the pandemic raged, much was written about the increase in depression, resulting from prolonged isolation, reduced social interactions, and diminished out-of-room time. All of this was necessitated by the need for increased infection control. However, it came with significant consequences including depression.

While depression is common in older adults, it is often underdiagnosed in the frail. Many signs and symptoms of depression and frailty overlap; and most assessments for depression rely on self-report questionnaires. These may not be accurately answered by anyone whose frailty includes cognitive impairment. Since each condition has a significant impact and is treated differently, it is important to assess, diagnose, and treat each condition.

Frailty and Depression

One concept of depression as a disorder of accelerated aging is based on its association with several biomarkers of cellular aging, the onset of chronic diseases, and premature mortality. This makes frailty and depression strongly associated. A recent study, attempting to disentangle the relationship between depression and frailty, published findings that support the need to accurately identify depression and frailty to prevent the most significant adverse outcomes. Clinical management will be more impactful if each condition is assessed appropriately and treatment is specific to the diagnosis. 

In this cohort study of those 75 years and older, the initial findings reported that 40.4% of individuals who were depressed were also frail and that 38.6% of frail individuals were depressed. At intervals, frailty and depression were again assessed to answer their research questions:

  1. Finding: A higher baseline Frailty Index reduced the likelihood of remission of depression but was not associated with the course of depressive symptoms over time.
  2. Finding: A depressive disorder predicted an accelerated frailty increase over time (adding further evidence to the hypothesis that depression is a disorder of accelerated aging.)

A Reciprocal Relationships

Frailty and depression in older adults have a reciprocal relationship. Frailty is highly prevalent among depressed individuals and, over time, depressive disorders accelerate frailty. Frailty in depression interferes with mental and somatic health outcomes. Both conditions need to be identified and treated and likely would benefit from the involvement of a multidisciplinary geriatric care team. 

We can provide clinical guidance into the assessment of frailty. Contact us at patientpattern.com.