NIH Public Access: Frailty and Depression in Older Adults: A High-Risk Clinical Population

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Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.
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Am J Geriatr Psychiatry. 2014 November ; 22(11): 1083–1095. doi:10.1016/j.jagp.2013.04.010.
Frailty and depression in older adults: A high-risk clinical

population
Patrick J. Brown, PhD1, Steven P. Roose, MD1, Robert Fieo, PhD2, Xinhua Liu, PhD3, Taina
Rantanen, PhD4, Joel R. Sneed, PhD1,5, Bret R. Rutherford, MD1, D.P. Devanand, MD1, and
Kirsten Avlund, PhD6,7
1Columbia University College of Physicians and Surgeons and New York State Psychiatric
Institute, New York, NY USA 2Sergievsky Center and the Taub Institute, Columbia University
College of Physicians and Surgeons 3Division of Biostatistics, Mailman School of Public Health,
Columbia University, New York, NY USA 4The Finnish Centre for Interdisciplinary Gerontology,
University of Jyväskylä, Finland 5Queens College, City University of New York USA 6Department
of Public Health and Center for Health Ageing, University of Copenhagen, Denmark 7Danish
Aging Research Centre, Universities of Aarhus, Southern Denmark and Copenhagen
Abstract
Objectives—To identify salient characteristics of frailty that increase risk of death in depressed
elders.
Design—Data from the Nordic Research on Ageing Study.
Setting—Research sites in Denmark, Sweden, and Finland.
Participants—Sample included 1027 75-year-old adults, 436 men and 591 women.
Main Outcome Measure—Time of death was obtained, providing a maximum survival time of
11.08 years (initial evaluation took place between 1988-1991).
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 (HR, 1.84; 95% CI, 1.05-3.21) and fatigue (HR,
1.94; 95% CI, 1.11-3.40) associated with faster progression to death in depressed women; none of
the frailty characteristics in the simultaneous model were associated with death in depressed men.
In women, the effect of impaired gait speed on mortality rates nearly doubled when depression
© 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Correspondence: Patrick J. Brown, PhD, Division of Geriatric Psychiatry, Columbia University, New York State Psychiatric Institute,
1051 Riverside Drive, Unit 126, New York, NY 10032, Phone: 212-543-5870, Fax: 212-543-5854, [email protected].
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
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Disclosure: Drs. Brown, Liu, Fieo, Avlund, Rutherford, Rantanen, and Sneed have nothing to disclose. Dr. Roose has served as a
consultant for Medtronics. Dr. Devanand has received research support from Novartis and Eli Lilly, and has served as a consultant to
Bristol Myers Squibb and Sanofi-Aventis. These sponsors had no role in this current manuscript.
Brown et al. Page 2
was present (mortality rates, 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.
Conclusions—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.
Frailty is a syndrome defined by weakness, fatigue, low physical activity, slowed gait, and
unintentional weight loss. These declines across multiple physiologic systems1 develop
incrementally with weakness emerging early in the process and weight loss and fatigue
representing a final pathway towards frailty.1-4 The syndrome, a clinical marker for disease
and/or physiological decline, is associated with greater depressive symptoms and
disability.1, 5, 6 Frailty characteristics are prevalent in the community, with estimates of
prefrailty (1-2 characteristics) or frailty (3+ characteristics) as high as 7% of community
dwelling elders over the age of 65, and 18% of those over the age of 80. Three year follow-
up data2 showed that prefrail elders had more than a 3-fold higher risk of death compared
with non-frail elders; frail elders had a 6-fold higher risk of death. Thus a significant
proportion of community dwelling elderly are at a “tipping point” towards dire outcomes.
Depression is another disease prevalent in older adults associated with disability and
increased mortality; It is estimated that 2.6% of community-dwelling elders suffer from a
mood disorder, a rate believed to be an underestimation due to underdiagnosis, the presence
of subthreshold symptoms, and a lack of high-risk older adults assessed.7 The diagnosis and
treatment of late life depression is complicated by increased risk of comorbid disability,
medical disorders, and cognitive impairment.8-15
There is phenomenological overlap between late life depression and frailty, with symptoms
common to both depression (weight loss, decreased physical activities, low energy) and
frailty (fatigue, decreased leisure activities, weight loss).16 The Cardiovascular Health
Study1 reported that the rate of depressive symptoms increased proportional to the number
of frailty characteristics present.1 Yet despite these associations, there has been little
research focused on this high-risk clinical population.16-21 Therefore, although

characteristics of frailty have been predictive of mortality in nondepressed older adults, it is
not known if these same characteristics are predictive in depressed elders or whether the
presence of depression increases the risk of mortality in these individuals.
Using data from the Nordic Research on Ageing study (NORA22-24), we investigated the
effect of the presence of frailty characteristics on mortality in older adults with differing
degrees of depressive symptomatology. We hypothesized that in the depressed sample low
grip strength and gait speed rather than fatigue and low physical activities (characteristics of
frailty that overlap with symptoms of depression) would predict mortality.

Brown et al. Page 3
Methods
Participants
The purpose of the NORA study was to determine the functional capacity of 75-year-olds
from Glostrup in Denmark, Göteborg in Sweden, and Jyväskylä in Finland.5, 22-24 Data were
obtained in January 2012 for 1204 older adults who were 75 years of age at the time of
evaluation (conducted between 1988 and 1991). The sample used in this study consisted of
1027 older adults. Participants were excluded because of missing baseline depression data or
missing data on all of the four frailty characteristics.
Measures
FRAILTY CHARACTERISTICS
Individuals were coded as having a frailty characteristic if they scored in the bottom 25th
percentile of the total sample of 1027 older adults on that particular assessment.1, 2
Participants were coded as missing if they did not have a value on a frailty assessment.
Missingness was coded for the survival analyses to investigate the potential meaning of
missing data.
Grip strength—Handgrip strength was assessed in kilograms (kg) of force. Men with grip
strength ≤ 36.71 kg and women ≤ 20.90 kg were coded as having the frailty characteristic of
low grip strength. 173 of the 1027 were coded as missing.
Gait speed—Ten-meter walking time was coded as meters per second. Men with gait
speed ≤ 1.43 m/s and women ≤ 1.25 m/s were coded as having the frailty characteristic of
slow gait speed. 145 of the 1027 were coded as missing.
Fatigue—Fatigue was assessed by the Avlund Mob-T Scale that ranges from 0 to 6 with
high scores denoting greater fatigue.25 Participants who scored 4 or greater on the scale
were coded as having the frailty characteristic of fatigue. 188 of the 1027 were coded as
missing.
Physical activity levels—Self-reported physical activity levels ranged from 0-6, with
high scores denoting greater physical activity.26 If participants scored 1 or 2, they were
coded as having the frailty characteristic of low physical activity levels. 75 of the 1027 were
coded as missing.
DEPRESSION
Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression
Scale (CES-D27). The scale ranges from 0 to 60 with high scores indicative of greater
depressive symptomatology. Scores were presented categorically as nondepressed (CES-D ≤
9), mildly depressed (CES-D between 10-15), and depressed (CES-D ≥ 16). A cut-off score
of ≥ 16 correlates with the presence of a depressive disorder.28, 29

Brown et al. Page 4
MORTALITY
Time of death for all participants who died following initial assessment was obtained from
the official register or from hospital records. Death records were last updated in the fall of
2000, providing a maximum follow-up from initial evaluation of 11.08 years (survival:
mean [SD], 10.48 years [.59]; mortality: mean [SD], 5.44 years [2.83]).
Secondary variables (instrumental activities of daily living [IADLs], number of chronic

illnesses, and neuropsychological measures of processing speed30, 31 and executive
function10, 12 [Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale-
Revised32 and Raven’s Progressive Matrices33]) are included in preliminary analyses.
Statistical Analysis
Analysis of variance or χ2 tests were used to detect differences across the three depressed
groups and between men and women for baseline continuous and categorical variables. Post
hoc analyses compared only nondepressed and depressed groups. Nonparametric Kruskal-
Wallis or Mann-Whitney U procedures were used for variables with skewed distributions
across groups. Survival time from baseline was the main outcome, with time observed either
to death or to last follow up. We estimated survival curves using the Kaplan-Meier method
to examine the pattern in survival time and used log rank tests to detect group differences in
the survival curves. An initial omnibus site-stratified Cox proportional hazard model was
conducted examining the relationship between gender, total frailty characteristics, and
depressive symptoms in the total sample, χ25= 80.52, P < .001. This model identified a main
effect of total frailty characteristics, Wald χ21= 7.76, P = .005 (HR, 1.62; 95% CI, 1.15-2.26)
and a gender × depressive symptoms interaction, Wald χ21= 5.95, P = .015 (HR, 1.04; 95%
CI, 1.01-1.07). Given the significant gender × depression interaction, gender-stratified Cox
proportional hazard models were used to examine the effects of frailty characteristics,
depression, and depression by frailty characteristic interactions on survival time. Dummy
coded variables for frailty, missing data, and depression status were used for single predictor
models. For these single predictor models, Bonferroni correction on the false-positive error
rate was used to account for multiple comparisons (α of .05 adjusted for four frailty
characteristics: α = .0125). Multiple predictor models were used to explore the simultaneous
effects of the baseline frailty characteristics in nondepressed and depressed men and women.
Hazard ratios with 95% confidence interval were derived to aid interpretation. Age was not
entered into the models because participants were all 75 years of age at baseline. Education
was not entered because it was coded differently across the three research sites and missing
in most participants. Models were conducted with and without number of chronic baseline
illnesses entered as a covariate.
Results
Frailty and Depression at Baseline—Baseline demographics, frailty characteristics
(total number and values on each individual characteristic), IADLs, number of chronic
illnesses, and neuropsychological variables differed by depressed group (Table 1). Total
number of frailty characteristics increased across groups (H2 = 28.74, P < .001) with the
depressed group having more frailty characteristics than the nondepressed group. Individual

Brown et al. Page 5
frailty characteristics gait speed (F2, 879 = 14.13, P < .001), physical activity level (F2, 949 =
14.73, P < .001), grip strength (F2, 851 = 21.90, P < .001), and levels of fatigue (H2,= 54.05,
P < .001) differed by depression status, with each more impaired in the depressed than the
nondepressed group. Additionally, IADLs (H2 = 71.28, P < .001), number of chronic
illnesses (H2 = 27.85, P < .001), Digit Symbol Substitution Test (F2, 907 = 26.91, P < .001)
and Raven’s Progressive Matrices (F2, 909 = 20.99, P < .001) differed by depression status,
with the depressed group showing greater impairment than the nondepressed group.
Mortality rates were related to depression status in the sample of 1027 elderly, χ22 = 6.93, P
= .03, with the rate in the depressed group (54%) greater than that of the nondepressed group
(45%).
Baseline differences were also observed between men and women (Table 2). Women
presented with greater depressive symptoms, more impairment in IADLs, and worse
performance on Raven’s Progressive Matrices compared with men. There were no gender
differences on number of chronic illnesses or Digit Symbol Substitution Test. More women
had gait impairment, greater fatigue, and lower physical activity levels compared with men;
no gender differences were observed, however, for impaired grip strength (Table 2).
Mortality rates were related to gender, χ22 = 20.68, P < .001; more men died (55%) than did
women (41%).
To investigate the relationship between depression and individual frailty characteristics on

mortality, a series of site-stratified gender specific Cox regression models were conducted.
Gait Speed—Cox regression models with depression, gait speed, and missing gait speed
data predicted survival in men (n = 362; χ25 = 46.98, P < .001) and women (n = 442; χ23 =
42.19, P < .001). In men, there was a main effect of gait impairment (Wald χ21= 11.32, P = .
001; HR, 1.85; 95% CI, 1.29-2.64) and a depression by missing gait data interaction (Wald
χ21= 7.29, P = .007; HR, 3.39; 95% CI, 1.40-8.21). In women, there was a main effect of
depression (Wald χ21= 6.33, P = .012; HR, 1.47; 95% CI, 1.09-1.98), gait impairment (Wald
χ21= 15.51, P < .001; HR, 1.99; 95% CI, 1.41-2.81), and missing gait data (Wald χ21= 28.84,
P < .001; HR, 3.07; 95% CI, 2.04-4.63); no interactions were observed. The inclusion of
number of chronic health illnesses as a covariate did not impact the model in men; in
women, its inclusion diminished the effect of depression status on survival.
Grip Strength—Cox regression models with depression, grip strength, and missing grip
strength data predicted survival in men (n = 362; χ25 = 22.59, P < .001) and women (n =
442; χ23 = 30.43, P < .001). In men, there was a depression by missing grip strength data
interaction (Wald χ21= 8.57, P = .003; HR, 3.66; 95% CI, 1.54-8.71). In women, there was a
main effect of grip impairment (Wald χ21= 6.30, P = .012; HR, 1.59; 95% CI, 1.11-2.82),
and missing grip strength data (Wald χ21= 18.70, P < .001; HR, 2.24; 95% CI, 1.55-3.22);
no interactions were observed. The inclusion of the covariate did not impact the model in
men or women.
Fatigue—Cox regression models with depression, fatigue, and missing fatigue data
predicted survival in men (n = 362; χ2 = 39.88, P < .001) and women (n = 442; χ25 3 =
31.69, P < .001). In men, there was a main effect of fatigue (Wald χ21= 8.03, P = .005; HR,

Brown et al. Page 6
1.75; 95% CI, 1.19-2.57) and missing fatigue data (Wald χ21= 7.86, P = .005; HR, 2.95;
95% CI, 1.22-3.10). In women, there was a main effect of fatigue (Wald χ21= 11.61, P = .
001; HR, 1.87; 95% CI, 1.30-2.67) and missing fatigue data (Wald χ21= 17.86, P < .001;
HR, 2.21; 95% CI, 1.53-3.19). No interactions were observed. The inclusion of the covariate
did not impact the model in men or women.
Physical Activity Levels—Cox regression models with depression, physical activity, and
missing physical activity data predicted survival in men (n = 362; χ23 = 37.38, P < .001) and
women (n = 442; χ23 = 33.50, P < .001). In men, there was a main effect of low physical
activity (Wald χ21= 27.69, P < .001; HR, 2.37; 95% CI, 1.72-3.26) and missing physical
activity data (Wald χ21= 12.54, P < .001; HR, 2.64; 95% CI, 1.54-5.53). In women, there
was a main effect of low physical activity (Wald χ21= 19.82, P < .001; HR, 2.11; 95% CI,
1.52-2.93), and missing physical activity data (Wald χ21= 8.05, P = .005; HR, 1.97; 95% CI,
1.23-3.15). The inclusion of the covariate did not impact either model.
Gender, Frailty, and Depression—The survival curves displayed in Figure 1 illustrate

that frailty characteristics, missing data on these frailty characteristics, and depression affect
survival in both men and women. To explore the most salient frailty characteristics in
predicting mortality in both nondepressed and depressed men and women, four multiple-
predictor, site-stratified models were conducted. Each model [nondepressed men (n = 278;
χ28 = 33.95, P < .001), nondepressed women (n = 265; χ28 = 25.20, P = .001), depressed
men (n = 84; χ28 = 31.51, P < .001), and depressed women (n = 177; χ28 = 32.00, P < .001)]
predicted risk of death.
The pattern differed by gender and depression status (Table 3). For nondepressed men low
physical activity, missing physical activity data, and impaired gait speed increased risk of
death after controlling for the effect of all other frailty characteristics. In nondepressed
women only impaired grip strength was predictive of death. In depressed men only missing
fatigue data increased risk of death. In depressed women, however, impaired gait speed and
fatigue were associated with higher risk of death, although the overall effect of fatigue was
not significant due to the lack of effect of missing data on the fatigue assessment. Inclusion
of number of chronic health illnesses as a covariate did not contribute to either depressed
model. In nondepressed men, its inclusion decreased the effect of fatigue and gait
impairment on survival. In the nondepressed women, its inclusion decreased the effect of
low physical activity and fatigue, and increased the effect of gait and grip impairment on
survival.
As depicted in Figure 1A, depression did little to alter the effect of impaired gait speed on
mortality in men (mortality rates, nondepressed men: no gait impairment = 48%; gait
impairment = 75%; depressed men: no gait impairment=45%; gait impairment = 71%). In
women, however, the effect of impaired gait speed on mortality nearly doubled when
depression was present (mortality rates, nondepressed women: no gait impairment = 26%;
gait impairment = 40%; depressed women: no gait impairment=32%; gait impairment =
58%). A similar pattern was observed for fatigue (Figure 1C).

Brown et al. Page 7
Conclusions
The syndrome of frailty and depressive illness are each associated with increased disability
and death, but the confluence of each has rarely been studied.1, 2, 4, 16, 19, 20, 31, 34-41 This
study investigated the relationship between depressive symptoms, characteristics of frailty,

and mortality in 75-year old men and women. The results show that 1) the effect of each
frailty characteristic, missing data on each frailty characteristic, and depression status on
progression to death differed between men and women; 2) in depressed men, missing data
on the assessment of gait speed, grip strength, or fatigue resulted in an increased risk of
death; and 3) the combined effect of depression and characteristics of frailty, specifically
fatigue and impaired gait speed, on mortality is particularly deleterious for older women.
The study hypothesis that impaired gait speed and grip strength would be the most salient
characteristics for predicting mortality in the older depressed group was only partially
observed. Low grip strength was only predictive of mortality in women, independent of
depression status, and only when none of the other frailty characteristics were considered.
Subgroup analysis showed that mobility disturbance and fatigue were strongly associated
with increased risk of death in older depressed women. These results are consistent with past
research demonstrating the impact fatigue and worsening mobility have on
prognosis,24, 42-46 although these studies did not account for depression. Frailty
characteristics have been shown to induce a self-perpetuating cycle that develop
incrementally with weakness emerging early in the process and weight loss and fatigue
representing a final pathway towards frailty.1-3 Fatigue, however, is a common symptom in
late life depression and can effect prognosis in elderly people.47 These findings, particularly
those observed in depressed women, emphasize the importance of accounting for the
presence of depression in frailty research; depressed elders may have a different level of
impairment and a different clinical course.
The presence of depressive illness in the context of frailty has until recently21 been largely
ignored.16, 19, 20 The adverse effect of depression on frailty characteristics in this study
however was pervasive, with depressive symptoms associated with increased weakness,
mobility deficits, and fatigue, as well as illness burden, and neuropsychological
impairment.11, 12, 21, 48-51 Although these findings highlight the strength and severity of
these associations, currently the nature of the relationship between the syndrome of frailty
and depressive illness remains unclear. There are a number of possible models to explain the
depressed-frail phenotype. First, the two conditions may be unrelated to each other but
frequently coexist in the elderly (as with cataracts and arthritis). Second, one condition may
be a risk factor for developing the other. In this model it is critical to know whether their
onset is concurrent or whether one generally precedes the other. Third, the relationship
maybe an illusion; two disorders that appear to be distinct are really different manifestations
of the same disorder. For example, there is now evidence to suggest that depression is an
early symptom of Huntington’s disease rather than a separable diagnosis.52 Longitudinal
data need to be examined to test these models.
Research examining the nature of the relationship between depressive illness and the
syndrome of frailty in late life will have treatment implications. Currently, there are multiple
nonpharmacological treatments such as exercise or nutritional interventions53-57 that have

Brown et al. Page 8
been designed to improve strength in lower extremities to improve mobility and decrease
fall potential.4 Questions remain however about the utility of these interventions in
depressed elders, as these studies typically exclude patients with depressive illness and the
overall effectiveness of exercise interventions as a treatment for depression is at best

mixed.58-60 Likewise, although antidepressant medications such as selective serotonin
reuptake inhibitors (SSRIs) have been shown to be effective for the treatment of late life
depression,61 there is currently no evidence that these medications can effectively treat
characteristics of frailty, particularly characteristics such as slowed gait speed that are
strongly associated with mortality. Given these findings, an important direction for future
research would be an investigation of the effectiveness of antidepressant medication on
frailty characteristics in older depressed frail patients, as well as the feasibility and
effectiveness of multimodal interventions (exercise and antidepressant medication) to
improve prognosis in older depressed prefrail and frail individuals. Although side effect
profiles in older depressed patients appear similar to those of younger depressed patients,62
caution must be taken with SSRI use in a prefrail or frail geriatric population as treatment
with these medications is associated with increased risk of falls,63 hyponatremia, and
bleeding.
There are important limitations to this study. The NORA study included 75-year old men
and women from Glostrup in Denmark, Göteborg in Sweden and Jyväskylä in Finland; the
generalizability of these results to other localities may be limited. Also, the use of the CES-
D as a diagnostic tool for depressive illness is suboptimal. The cut-off of ≥ 16 used to denote
depression, however, has been shown to have 100% sensitivity and 88% specificity for
major depressive disorder in elders.27-29 Of note, individuals with missing data on frailty
characteristics do not appear to represent a random sample; we can only hypothesize the
meaning behind the missing data and its relationship to outcome, which is included in
supplemental material online. Additionally, this investigation has limited power to assess
interactions between depression and each of the frailty characteristics in the multiple
predictor models due to sample size constraints. As such, subgroup analyses were used and
interpretation of these results should be made with caution. Future research is needed to
better understand the interrelationships between depression and individual frailty
characteristics and their impact on prognosis.
In conclusion, this study showed that the confluence of characteristics of frailty (fatigue,
slow gait speed) and depressive illness resulted in an increased risk of death in older adults;
specifically, the presence of depression nearly doubled the effect of fatigue and slow gait
speed on mortality rates in older 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.
Supplementary Material
Refer to Web version on PubMed Central for supplementary material.

Brown et al. Page 9
Acknowledgments
This research was supported by grants T32 MH20004. The Nordic Research on Ageing Project was supported by
the Nordea-Foundation, The Danish Medical Research Council, Denmark, Academy of Finland, Ministry of
Education, Ministry of Social Affairs and Health, Social Insurance Institution, and the city of Jyväskylä, Finland.
Dr. Roose has served as a consultant for Medtronics. Dr. Devanand has received research support from Novartis
and Eli Lilly, and has served as a consultant to Bristol Myers Squibb and Sanofi-Aventis. These sponsors had no
role in this current manuscript.
Dr. Brown had full access to all of the data and takes responsibility for the integrity of the data and the accuracy of
the data analysis.
from the National Institute of Mental Health
References
1. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol
A Biol Sci Med Sci. Mar; 2001 56(3):M146–156. [PubMed: 11253156]
2. Bandeen-Roche K, Xue QL, Ferrucci L, et al. Phenotype of frailty: characterization in the women’s
health and aging studies. J Gerontol A Biol Sci Med Sci. Mar; 2006 61(3):262–266. [PubMed:
16567375]
3. Fried LP, Ettinger WH, Lind B, Newman AB, Gardin J, Cardiovascular Health Study Research
Group. Physical disability in older adults: a physiological approach. J Clin Epidemiol. Jul; 1994
47(7):747–760. [PubMed: 7722588]
4. Xue QL, Bandeen-Roche K, Varadhan R, Zhou J, Fried LP. Initial manifestations of frailty criteria
and the development of frailty phenotype in the Women’s Health and Aging Study II. J Gerontol A
Biol Sci Med Sci. Sep; 2008 63(9):984–990. [PubMed: 18840805]
5. Rantanen T, Avlund K, Suominen H, Schroll M, Frandin K, Pertti E. Muscle strength as a predictor
of onset of ADL dependence in people aged 75 years. Aging Clin Exp Res. Jun; 2002 14(3 Suppl):
10–15. [PubMed: 12475129]
6. Rantanen T, Sakari-Rantala R, Heikkinen E. Muscle strength before and mortality after a bone
fracture in older people. Scand J Med Sci Sports. Oct; 2002 12(5):296–300. [PubMed: 12383075]
7. Gum AM, King-Kallimanis B, Kohn R. Prevalence of mood, anxiety, and substance-abuse disorders
for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry. Sep;
2009 17(9):769–781. [PubMed: 19700949]
8. Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. ‘Vascular
depression’ hypothesis. Arch Gen Psychiatry. Oct; 1997 54(10):915–922. [PubMed: 9337771]
9. Alexopoulos GS, Meyers BS, Young RC, Kakuma T, Silbersweig D, Charlson M. Clinically defined
vascular depression. Am J Psychiatry. Apr; 1997 154(4):562–565. [PubMed: 9090349]
10. Sneed JR, Culang ME, Keilp JG, Rutherford BR, Devanand DP, Roose SP. Antidepressant
medication and executive dysfunction: a deleterious interaction in late-life depression. Am J

Geriatr Psychiatry. Feb; 2010 18(2):128–135. [PubMed: 20104069]
11. Sneed JR, Rindskopf D, Steffens DC, Krishnan KR, Roose SP. The vascular depression subtype:
evidence of internal validity. Biol Psychiatry. Sep 15; 2008 64(6):491–497. [PubMed: 18490003]
12. Sneed JR, Roose SP, Keilp JG, Krishnan KR, Alexopoulos GS, Sackeim HA. Response inhibition
predicts poor antidepressant treatment response in very old depressed patients. Am J Geriatr
Psychiatry. Jul; 2007 15(7):553–563. [PubMed: 17586780]
13. de Groot JC, de Leeuw FE, Oudkerk M, Hofman A, Jolles J, Breteler MM. Cerebral white matter
lesions and depressive symptoms in elderly adults. Arch Gen Psychiatry. Nov; 2000 57(11):1071–
1076. [PubMed: 11074873]
14. Taylor WD, Steffens DC, MacFall JR, et al. White matter hyperintensity progression and late-life
depression outcomes. Arch Gen Psychiatry. Nov; 2003 60(11):1090–1096. [PubMed: 14609884]
15. Sheline YI, Pieper CF, Barch DM, et al. Support for the vascular depression hypothesis in late-life
depression: results of a 2-site, prospective, antidepressant treatment trial. Arch Gen Psychiatry.
Mar; 2010 67(3):277–285. [PubMed: 20194828]

Brown et al. Page 10
16. Mezuk B, Edwards L, Lohman M, Choi M, Lapane K. Depression and frailty in later life: a
synthetic review. Int J Geriatr Psychiatry. Oct 7.2011
17. Chang SS, Weiss CO, Xue QL, Fried LP. Patterns of comorbid inflammatory diseases in frail older
women: the Women’s Health and Aging Studies I and II. J Gerontol A Biol Sci Med Sci. Apr;
2010 65(4):407–413. [PubMed: 19933749]
18. Chang SS, Weiss CO, Xue QL, Fried LP. Association between inflammatory-related disease
burden and frailty: Results from the Women’s Health and Aging Studies (WHAS) I and II. Arch
Gerontol Geriatr. Jul 13.2011
19. Mezuk B, Lohman M, Dumenci L, Lapane KL. Are Depression and Frailty Overlapping
Syndromes in Mid- and Late-life? A Latent Variable Analysis. Am J Geriatr Psychiatry. May
16.2012
20. Katz IR. Depression and frailty: the need for multidisciplinary research. Am J Geriatr Psychiatry.
Jan-Feb;2004 12(1):1–6. [PubMed: 14729553]
21. Lakey SL, LaCroix AZ, Gray SL, et al. Antidepressant use, depressive symptoms, and incident
frailty in women aged 65 and older from the Women’s Health Initiative Observational Study. J
Am Geriatr Soc. May; 2012 60(5):854–861. [PubMed: 22568404]
22. Kauppinen M, Davidsen M, Valter S. Design, material and methods in the NORA study. Nordic
Research on Ageing. Aging Clin Exp Res. Jun; 2002 14(3 Suppl):5–9. [PubMed: 12475128]
23. Schroll M, Steen B, Berg S, Heikkinen E, Viidik A. NORA--Nordic research on ageing. Functional
capacity of 75-year-old men and women in three Nordic localities. Dan Med Bull. Nov; 1993
40(5):618–624. [PubMed: 8299404]
24. Avlund K, Rantanen T, Schroll M. Tiredness and subsequent disability in older adults: The role of
walking limitations. J Gerontol A Biol Sci Med Sci. Nov; 2006 61(11):1201–1205. [PubMed:
17167163]
25. Avlund K, Kreiner S, Schultz-Larsen K. Functional ability scales for the elderly. European Journal
of Public Health. 1996; 6:35–42.
26. Grimby G. Physical activity and muscle training in the elderly. Acta Med Scand Suppl. 1986;
711:233–237. [PubMed: 3535411]
27. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general
population. Applied Psychological Measurement. 1977; 1(3):385–401.
28. Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive
symptoms in five psychiatric populations: a validation study. Am J Epidemiol. Sep; 1977 106(3):
203–214. [PubMed: 900119]
29. Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, De Vries MZ, Van Tilburg W. Criterion
validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a
community-based sample of older subjects in The Netherlands. Psychol Med. Jan; 1997 27(1):
231–235. [PubMed: 9122304]
30. Brown PJ, Devanand DP, Liu X, Caccappolo E. Functional impairment in elderly patients with
mild cognitive impairment and mild Alzheimer disease. Arch Gen Psychiatry. Jun; 2011 68(6):
617–626. [PubMed: 21646578]
31. Brown PJ, Liu X, Sneed JR, Pimontel MA, Devanand DP, Roose SP. Speed of Processing and
Depression Affect Function in Older Adults With Mild Cognitive Impairment. Am J Geriatr
Psychiatry. Apr 27.2012
32. W, DA. Manual for the Wechsler Adult Intelligence Scale-Revised. Psychological Corporation;
New York: 1981.
33. Raven, J.; Raven, JC.; Court, JH. Manual for Raven’s Progressive Matrices and Vocabulary Scales.
Harcourt Assessment; San Antonio, TX: 2003. updated 2004
34. Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. N Engl
J Med. Apr 1; 2010 362(13):1173–1180. [PubMed: 20357280]
35. Lin CC, Li CI, Chang CK, et al. Reduced health-related quality of life in elders with frailty: a
cross-sectional study of community-dwelling elders in Taiwan. PLoS One. 2011; 6(7):e21841.
[PubMed: 21747961]
36. Bruce ML. Depression and disability in late life: directions for future research. Am J Geriatr
Psychiatry. 2001; 9(2):102–112. Spring. [PubMed: 11316615]

37. Chapman DP, Perry GS. Depression as a major component of public health for older adults. Prev
Chronic Dis. Jan.2008 5(1):A22. [PubMed: 18082011]
38. Gallo JJ, Rebok GW, Tennsted S, Wadley VG, Horgas A. Linking depressive symptoms and
functional disability in late life. Aging Ment Health. 2003; 7(14578009):469–480. [PubMed:
14578009]
39. Gurland B, Wilder BE, Berkman C. Depression and disability in the elderly: reciprocal relations
and changes with age. Int J Geriatr Psychiatry. 1988; 3:163–179.
40. Kennedy G. The dynamics of depression and disability. American Journal of Geriatric Psychiatry.
2001; 9(2):99–101. [PubMed: 11316614]
41. Kennedy GJ, Kelman HR, Thomas C. The emergence of depressive symptoms in late life: the
importance of declining health and increasing disability. J Community Health. Apr; 1990 15(2):
93–104. [PubMed: 2141337]
42. Shamliyan T, Talley KM, Ramakrishnan R, Kane RL. Association of frailty with survival: A
systematic literature review. Ageing Res Rev. Mar 12.2012
43. Verghese J, Holtzer R, Lipton RB, Wang C. Mobility stress test approach to predicting frailty,
disability, and mortality in high-functioning older adults. J Am Geriatr Soc. Oct; 2012 60(10):
1901–1905. [PubMed: 23002714]
44. Cheng H, Gurland BJ, Maurer MS. Self-reported lack of energy (anergia) among elders in a
multiethnic community. J Gerontol A Biol Sci Med Sci. Jul; 2008 63(7):707–714. [PubMed:
18693225]
45. White DK, Neogi T, Nevitt MC, et al. Trajectories of Gait Speed Predict Mortality in Well-
Functioning Older Adults: The Health, Aging and Body Composition Study. J Gerontol A Biol Sci
Med Sci. Oct 9.2012
46. Manty M, de Leon CF, Rantanen T, et al. Mobility-related fatigue, walking speed, and muscle
strength in older people. J Gerontol A Biol Sci Med Sci. May; 2012 67(5):523–529. [PubMed:
22016363]
47. Meeks TW, Vahia IV, Lavretsky H, Kulkarni G, Jeste DV. A tune in “a minor” can “b major”: a
review of epidemiology, illness course, and public health implications of subthreshold depression
in older adults. J Affect Disord. Mar; 2011 129(1-3):126–142. [PubMed: 20926139]
48. Brandler TC, Wang C, Oh-Park M, Holtzer R, Verghese J. Depressive Symptoms and Gait
Dysfunction in the Elderly. Am J Geriatr Psychiatry. Mar 17.2011
49. Bruce ML, Seeman TE, Merrill SS, Blazer DG. The impact of depressive symptomatology on
physical disability: MacArthur Studies of Successful Aging. Am J Public Health. Nov; 1994
84(11):1796–1799. [PubMed: 7977920]
50. Glassman AH. Depression and cardiovascular comorbidity. Dialogues Clin Neurosci. 2007; 9(1):
9–17. [PubMed: 17506222]
51. Butters MA, Young JB, Lopez O, et al. Pathways linking late-life depression to persistent cognitive
impairment and dementia. Dialogues Clin Neurosci. 2008; 10(3):345–357. [PubMed: 18979948]
52. Krogias C, Strassburger K, Eyding J, et al. Depression in patients with Huntington disease
correlates with alterations of the brain stem raphe depicted by transcranial sonography. J
Psychiatry Neurosci. May; 2011 36(3):187–194. [PubMed: 21138658]
53. Rolland Y, Dupuy C, Abellan van Kan G, Gillette S, Vellas B. Treatment strategies for sarcopenia
and frailty. Med Clin North Am. May; 2011 95(3):427–438. ix. [PubMed: 21549870]
54. Waters DL, Baumgartner RN, Garry PJ, Vellas B. Advantages of dietary, exercise-related, and
therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clin Interv
Aging. 2010; 5:259–270. [PubMed: 20852673]
55. Binder EF, Schechtman KB, Ehsani AA, et al. Effects of exercise training on frailty in community-
dwelling older adults: results of a randomized, controlled trial. J Am Geriatr Soc. Dec; 2002
50(12):1921–1928. [PubMed: 12473001]
56. Pahor M, Blair SN, Espeland M, et al. Effects of a physical activity intervention on measures of
physical performance: Results of the lifestyle interventions and independence for Elders Pilot
(LIFE-P) study. J Gerontol A Biol Sci Med Sci. Nov; 2006 61(11):1157–1165. [PubMed:
17167156]

57. Rejeski WJ, Miller ME, King AC, et al. Predictors of adherence to physical activity in the Lifestyle
Interventions and Independence for Elders pilot study (LIFE-P). Clin Interv Aging. 2007; 2(3):
485–494. [PubMed: 18044198]
58. Teri L, McCurry SM, Logsdon RG, Gibbons LE, Buchner DM, Larson EB. A randomized
controlled clinical trial of the Seattle Protocol for Activity in older adults. J Am Geriatr Soc. Jul;
2011 59(7):1188–1196. [PubMed: 21718259]
59. Brenes GA, Williamson JD, Messier SP, et al. Treatment of minor depression in older adults: a
pilot study comparing sertraline and exercise. Aging Ment Health. Jan; 2007 11(1):61–68.
[PubMed: 17164159]
60. Forsman AK, Schierenbeck I, Wahlbeck K. Psychosocial interventions for the prevention of
depression in older adults: systematic review and meta-analysis. J Aging Health. Apr; 2011 23(3):
387–416. [PubMed: 20935250]
61. Sneed JR, Rutherford BR, Rindskopf D, Lane DT, Sackeim HA, Roose SP. Design makes a
difference: a meta-analysis of antidepressant response rates in placebo-controlled versus
comparator trials in late-life depression. Am J Geriatr Psychiatry. Jan; 2008 16(1):65–73.
[PubMed: 17998306]
62. Roose, SP.; Sackeim, HA. Late Life Depression. Oxford University Press; New York: 2004.
63. Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes
on falls in elderly persons. Arch Intern Med. Nov 23; 2009 169(21):1952–1960. [PubMed:
19933955]




Figure 1.
Site stratified single predictor Kaplan-Meier survival curves for individual frailty
characteristics in depressed and nondepressed men and women.
Note. Nondepressed = Center for Epidemiologic Studies Depression Scale less than or equal
to 9; Depressed = Center for Epidemiologic Studies Depression Scale greater than or equal
to 16; Gait Speed: No Gait Speed = Walking speed in meters per second in the gender-
specific top 75th percentile; Gait Speed Dysfunction = Walking speed in meters per second
in the gender-specific bottom 25th percentile (men: less than or equal to 1.43 m/s; women:
less than or equal to 1.25 m/s); Grip Strength: No Grip Dysfunction = Grip strength in
kilograms of force in the gender-specific top 75th percentile; Grip Dysfunction = Grip
strength in kilograms of force in the gender-specific bottom 25th percentile (men: less than
or equal to 36.71 kg; Women: less than or equal to 20.90 kg); Fatigue: No Fatigue =
Individuals who scored less than 4 on the fatigue scale (denoting less exhaustion on select
activities) scored in the top 75th percentile. Fatigue: Individuals who scored 4 or greater on
the Fatigue scale (denoting greater Fatigue) scored in the bottom 25th percentile; Physical
Activity Levels: No Physical Activity Dysfunction = Individuals who responded to the

statement: Free time activity over the past year is best described as: moderate physical
activity about 3 hours per week (3), moderate physical activity over 4 hours per week or
intense physical activity up to 4 hours per week (4), active sports at least 3 hours per week
(4), competitive sports (6) were in the top 75th percentile. Physical Activity Dysfunction =
Individuals who responded to the statement Free time activity over the past year is best
described as: mainly sitting in one place (1) or light physical activity (2) were in the bottom
25th percentile.

Table 1
a
Baseline characteristics for nondepressed, mildly depressed, and depressed groups
Nondepressed Mildly Depressed Depressed

Variables (n = 543) (n = 223) (n = 261)
Mean (SD) Mean (SD) Mean (SD)
Sex, No. M/F (% F) 278/265 (49%) 74/149 (67%) b
84/177 (68%)
Mortality, No. Alive/Dead (% Dead) 299/244 (45%) 125/98 (44%) b
120/141 (54%)
CES-D 4.14 (3.07) 12.47 (1.68) b
23.26 (7.26)
τ n = 280 n = 141 n = 156
Number of Chronic Illnesses
1.95 (1.44) 2.31 (1.42) b
2.69 (1.49)
Neuropsychological scores
Digit Symbol n = 493 n = 193 n = 224
30.30 (12.26) 25.81 (10.11) b
24.09 (10.21)
Raven’s Matrices (number correct) n = 489 n = 195 n = 228
17.23 (4.45) 15.99 (4.23) b

14.96 (4.73)
Functioning
τ 1.44 (2.16) 2.01 (2.48) b
IADLs 3.31 (3.44)
Frailty Characteristics
τ n = 389 n = 149 n = 155
Total Frailty Characteristics
Mean .91 (0.99) .91 (1.01) b
1.43 (1.11)
No. ≥ 3 frailty characteristics 27 (7%) 15 (10%) 33 (21%)
(% Frail)
Gait Speed (m/s) n = 479 n = 186 n = 217
Mean 1.63 (0.41) 1.56 (0.38) b
1.45 (0.41)
Frailty, No. Yes/No (% Frail) 163/316 (34%) 64/122 (34%) b
107/110 (49%)
Grip Strength (kg/f) n = 460 n = 187 n = 207
Mean 35.28 (12.57) 29.69 (10.20) b
30.07 (11.75)
70/137 (34%)
τ n = 470 n = 179 n = 190

Fatigue Levels
Mean 1.57 (2.09) 1.75 (1.99) b
2.84 (2.22)
82/108 (43%)
Physical Activity Levels n = 509 n = 207 n = 236
Mean 3.10 (0.91) 2.92 (0.93) b
2.70 (1.01)
101/135 (43%)
Abbreviations: CES-D = Center for Epidemiologic Studies Depression Scale; Nondepressed = CES-D less than or equal to 10; Mildly depressed =
CES-D greater than or equal to 10 but less than 16; and Depressed = CES-D greater than or equal to 16; Digit Symbol = Digit Symbol Substitution
Test of the Wechsler Adult Intelligence Scale-Revised; Raven’s Matrices = Raven’s Progressive Matrices; IADLs = Instrumental Activities of
Daily Living.

a
Data are presented as means (SD) unless otherwise indicated. Neuropsychological scores are raw scores. Analysis of variance F-tests or χ2 tests
were used to detect overall group differences across the three depressed groups for continuous and categorical variables, but only two post hoc
group comparisons (nondepressed vs. depressed) were made. Sample sizes are indicated for variables with missing data.
τ
Nonparametric Kruskal-Wallis tests were used to detect overall and pairwise group differences for variables with skewed distributions.
b
Significant difference in post hoc parametric or nonparametric comparisons between nondepressed and depressed individuals (P ≤ .05).

Table 2
a
Baseline characteristics for men and women in the Nordic Research on Ageing Project
Women Men
Variable (n = 591) (n = 436)
Mean (SD) Mean (SD)
CES-D 12.29 (9.51) b
8.81 (8.06)
Number of Chronic Illnesses n = 350 n = 227
2.24 (1.50) 2.22 (1.44)
Neuropsychological scores
Digit Symbol n = 515 n = 395
28.65 (11.77) 28.05 (11.54)
Raven’s Matrices (number correct) n = 519 n = 393
15.79 (4.30) b
17.21 (4.79)
Functioning
τ 2.33 (2.73) b
IADLs 1.66 (2.67)
Frailty Characteristics
τ n = 382 n = 311
Total Frailty Characteristics
Mean 1.12 (1.05) b
.91 (1.01)
No. ≥ 3 frailty characteristics (% Frail) 52 (14%) 23 (7%)
Gait Speed (m/s) n = 479 n = 377
Mean 1.47 (0.35) b
1.71 (0.44)
Frailty, No. Yes/No (% Frail) 235/270 (49%) 99/278 (26%)
Grip Strength (kg/f) n = 482 n = 372
Mean 25.03 (6.82) b
42.86 (10.04)
τ n = 463 n = 376
Fatigue Levels
Mean 2.00 (2.14) b
1.77 (2.18)
Physical Activity Levels n = 542 n = 410
Mean 2.89 (0.88) b

3.06 (1.04)
Abbreviations: CES-D = Center for Epidemiologic Studies Depression Scale; Digit Symbol = Digit Symbol Substitution Test of the Wechsler
Adult Intelligence Scale-Revised; Raven’s Matrices = Raven’s Progressive Matrices; IADLs = Instrumental Activities of Daily Living.
a
Data are presented as means (SD) unless otherwise indicated. Neuropsychological scores are raw scores. Sample sizes are indicated for variables
with missing data. Independent sample t-tests or χ2 tests were used to detect gender differences for continuous or categorical variables.
τ
Nonparametric Mann-Whitney U tests were used to detect gender differences for variables with skewed distributions.
b
Significant difference between men and women (P ≤ .05).

NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Table 3
Site stratified proportional hazards models with multiple predictors of frailty characteristics for depressed and nondepressed men and women.
Nondepressed Depressed
(n=543) (n=261)
Brown et al.
Men Women Men Women

(n=278) (n=265) (n=84) (n=177)
Wald Hazard ratio p Wald Hazard ratio p Wald Hazard ratio p Wald Hazard ratio p
Frailty Predictors χ2 (95% CI) Value χ2 (95% CI) Value χ2 (95% CI) Value χ2 (95% CI) Value
Low Physical Activities 10.48 0.005 1.25 0.535 1.81 0.404 3.66 0.160
Yes vs. No 7.27 1.76 (1.17, 2.65) 0.007 1.13 1.34 (0.78, 2.28) 0.287 1.61 1.68 (0.76, 3.74) 0.204 2.86 1.56 (0.93, 2.61) 0.091
Missing vs. No 4.85 2.80 (1.12, 7.01) 0.028 0.01 0.95 (0.36, 2.50) 0.917 0.09 1.25 (0.29, 5.46) 0.765 0.19 0.81 (0.32, 2.05) 0.662
Fatigue 4.90 0.086 3.67 0.160 6.46 0.040 5.62 0.060
Yes vs. No 3.82 1.51 (1.00, 2.28) 0.051 2.73 1.54 (0.92, 2.56) 0.098 1.02 1.48 (0.69, 3.15) 0.313 5.40 1.94 (1.11, 3.40) 0.020
Missing vs. No 2.24 1.46 (0.89, 2.41) 0.134 1.96 1.52 (0.85, 2.74) 0.161 6.29 2.90 (1.26, 6.67) 0.012 2.81 1.66 (0.92, 3.00) 0.094
Slow Gait Speed 5.99 0.050 1.89 0.388 2.17 0.338 6.69 0.035
Yes vs. No 4.96 1.54 (1.05, 2.26) 0.026 1.04 1.30 (0.79, 2.14) 0.307 1.01 1.52 (0.67, 3.45) 0.315 4.59 1.84 (1.05, 3.21) 0.032
Missing vs. No 1.92 1.71 (0.80, 3.64) 0.166 1.38 1.85 (0.66, 5.18) 0.240 1.95 2.67 (0.67, 10.59) 0.163 5.47 2.71 (1.18, 6.26) 0.019
Low Grip Strength 2.34 0.310 4.92 0.085 0.64 0.725 1.60 0.452
Yes vs. No 0.01 1.02 (0.65, 1.59) 0.934 4.64 1.83 (1.06, 3.18) 0.031 0.63 1.35 (0.64, 2.81) 0.429 0.43 1.19 (0.70, 2.02) 0.513
Missing vs. No 2.19 0.55 (0.25, 1.22) 0.139 0.85 1.52 (0.63, 3.69) 0.355 0.05 1.15 (0.33, 4.02) 0.827 1.46 1.59 (0.75, 3.36) 0.228
Cox proportional hazard models were used to explore the simultaneous effects of the baseline frailty characteristics in separate models for nondepressed and depressed men and women. Wald χ2 values are
listed; (df = 2 for the overall effect of each frailty characteristic, df= 1 for each subgroup comparison); Hazard ratios (and 95% CI) are for multiple predictor models with the inclusion of other frailty
characteristics as covariates.

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Am J Geriatr Psychiatry. 2014 November ; 22(11): 1083–1095. doi:10.1016/j.jagp.2013.04.010.

Frailty and depression in older adults: A high-risk clinical

Design—Data from the Nordic Research on Ageing Study.

Setting—Research sites in Denmark, Sweden, and Finland.

Results—Depressed elders showed greater baseline impairments in each frailty characteristic

research focused on this high-risk clinical population.16-21 Therefore, although

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Secondary variables (instrumental activities of daily living [IADLs], number of chronic

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

To investigate the relationship between depression and individual frailty characteristics on

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Gender, Frailty, and Depression—The survival curves displayed in Figure 1 illustrate

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

study investigated the relationship between depressive symptoms, characteristics of frailty,

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

overall effectiveness of exercise interventions as a treatment for depression is at best

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

from the National Institute of Mental Health

medication and executive dysfunction: a deleterious interaction in late-life depression. Am J

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Nondepressed Mildly Depressed Depressed

17.23 (4.45) 15.99 (4.23) b

τ n = 470 n = 179 n = 190

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Mean 2.89 (0.88) b

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

Men Women Men Women

Am J Geriatr Psychiatry. Author manuscript; available in PMC 2015 November 01.

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