Frailty and Depression in Older Adults: A High-Risk Clinical Population
Frailty and Depression in Older Adults: A High-Risk Clinical Population
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DOI：
10.1016/j.jagp.2013.04.010
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发表时间：
2014-11-01
影响因子：
7.2
通讯作者：
Avlund, Kirsten
中科院分区：
文献类型：
--
作者：
Brown, Patrick J.;Roose, Steven P.;Avlund, Kirsten
目的：探讨老年抑郁症患者的死亡危险性增加的脆弱特征。方法：数据来自北欧老龄化研究，研究地点在丹麦，瑞典和芬兰。参与者为1，027名75岁的成年人（436名男性和591名女性）。获得了死亡时间，提供了11.08年的最长生存时间（初始评价发生在1988年至1991年之间）。结果如下：抑郁的老年人在每个脆弱特征（步态速度，握力，体力活动水平和疲劳）中表现出更大的基线损伤。包括所有四个虚弱特征的同时模型显示出缓慢的步态速度（风险比：1.84; 95%置信区间：1.05-3.21）和疲劳（风险比：1.94; 95%置信区间：1.11-3.40）与抑郁症女性更快进展至死亡相关;在同步模型中，没有一个脆弱的特征与抑郁症患者的死亡有关。在女性中，当存在抑郁症时，步态速度受损对死亡率的影响几乎翻了一番（非抑郁症女性：无步态障碍= 26%;步态缓慢= 40%;抑郁症女性：无步态障碍= 32%;步态缓慢= 58%）。疲劳也观察到类似的模式。结论：虚弱（疲劳和缓慢的步态速度）和抑郁症的特定特征的融合与老年人死亡风险的增加有关;这种关联在老年抑郁症女性中尤其强烈。未来的研究应该调查针对抑郁症，活动能力不足和疲劳的多模式干预是否可以降低死亡率并改善具有虚弱综合征特征的老年抑郁症患者的生活质量。
Objective: To identify salient characteristics of frailty that increase risk of death in depressed elders. Methods: Data were from the Nordic Research on Ageing Study from research sites in Denmark, Sweden, and Finland. Participants were 1,027 adults aged 75 years (436 men and 591 women). Time of death was obtained, providing a maximum survival time of 11.08 years (initial evaluation took place between 1988 and 1991). Results: Depressed elders showed greater baseline impairments in each frailty characteristic (gait speed, grip strength, physical activity levels, and fatigue). Simultaneous models including all four frailty characteristics showed slow gait speed (hazard ratio: 1.84; 95% confidence interval: 1.05-3.21) and fatigue (hazard ratio: 1.94; 95% confidence interval: 1.11-3.40) associated with faster progression to death in depressed women; none of the frailty characteristics in the simultaneous model was associated with death in depressed men. In women, the effect of impaired gait speed on mortality rates nearly doubled when depression was present (nondepressed women: no gait impairment = 26%; slow gait = 40%; depressed women: no gait impairment = 32%; slow gait = 58%). A similar pattern was observed for fatigue. Conclusion: The confluence of specific characteristics of frailty (fatigue and slow gait speed) and depressive illness is associated with an increased risk of death in older adults; this association is particularly strong in older depressed women. Future research should investigate whether multimodal interventions targeting depressive illness, mobility deficits, and fatigue can decrease mortality and improve quality of life in older depressed individuals with characteristics of the syndrome of frailty.