Changes in Frailty and Depressive Symptoms Among Middle-aged and Older Chinese People: a Nationwide Cohort Study

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2024 Jan 25

PMID 38273230

Authors

Ni Sang

Rong-Chao Liu

Ming-Hui Zhang

Zong-Xiao Lu

Zhen-Gang Wu

Meng-Yao Zhang

Bo-Han Li

Meng Wei

Hai-Feng Pan

Guo Cui Wu

Affiliations

Soon will be listed here.

Abstract

Background And Aims: The older people bears a severe burden of disease due to frailty and depressive symptoms, however, the results of association between the two in the older Chinese people have been conflicting. Therefore, this study aimed to investigate the developmental trajectories and interactions of frailty and depressive symptoms in the Chinese middle-aged and older adults.

Methods: The study used four waves of data from 2011, 2013, 2015 and 2018 in the China Health and Retirement Longitudinal Study (CHARLS) database, focused on middle-aged and older people ≥ 45 years of age, and analyzed using latent growth models and cross-lagged models.

Results: The parallel latent growth model showed that the initial level of depressive symptoms had a significant positive predictive effect on the initial level of frailty. The rate of change in depressive symptoms significantly positively predicted the rate of change in frailty. The initial level of frailty had a significant positive predictive effect on the initial level of depressive symptoms, but a significant negative predictive effect on the rate of change in depressive symptoms. The rate of change in frailty had a significant positive predictive effect on the rate of change in depressive symptoms. The results of the cross-lagged analysis indicated a bidirectional causal association between frailty and depressive symptoms in the total sample population. Results for the total sample population grouped by age and gender were consistent with the total sample.

Conclusions: This study recommends advancing the age of concern for frailty and depressive symptoms to middle-aged adults. Both men and women need early screening and intervention for frailty and depressive symptoms to promote healthy aging.

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References

Lohman M, Dumenci L, Mezuk B . Sex differences in the construct overlap of frailty and depression: evidence from the Health and Retirement Study. J Am Geriatr Soc. 2014; 62(3):500-5. PMC: 4112955. DOI: 10.1111/jgs.12689. View

Ferrucci L, Fabbri E . Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nat Rev Cardiol. 2018; 15(9):505-522. PMC: 6146930. DOI: 10.1038/s41569-018-0064-2. View

Sonnenberg C, Deeg D, van Tilburg T, Vink D, Stek M, Beekman A . Gender differences in the relation between depression and social support in later life. Int Psychogeriatr. 2012; 25(1):61-70. DOI: 10.1017/S1041610212001202. View

Alexopoulos G . Depression in the elderly. Lancet. 2005; 365(9475):1961-70. DOI: 10.1016/S0140-6736(05)66665-2. View

Ji L, Qiao X, Jin Y, Si H, Liu X, Wang C . Age differences in the relationship between frailty and depression among community-dwelling older adults. Geriatr Nurs. 2020; 41(4):485-489. DOI: 10.1016/j.gerinurse.2020.01.021. View

Vaughan L, Corbin A, Goveas J . Depression and frailty in later life: a systematic review. Clin Interv Aging. 2016; 10:1947-58. PMC: 4687619. DOI: 10.2147/CIA.S69632. View

Wang Q, Song D, Lin Q, Tao A, Zhang Y, Li X . The critical role of physical frailty and function on depressive symptoms among community-dwelling older adults in China: A cross-sectional study. Front Psychiatry. 2023; 14:1134427. PMC: 9975574. DOI: 10.3389/fpsyt.2023.1134427. View

Wang X, Shen K . The Reciprocal Relationship between Frailty and Depressive Symptoms among Older Adults in Rural China: A Cross-Lag Analysis. Healthcare (Basel). 2021; 9(5). PMC: 8156888. DOI: 10.3390/healthcare9050593. View

Park C, Ko F . The Science of Frailty: Sex Differences. Clin Geriatr Med. 2021; 37(4):625-638. PMC: 8493788. DOI: 10.1016/j.cger.2021.05.008. View

10.

Ng T, Nyunt M, Feng L, Niti M, Tan B, Chan G . Multi-Domains Lifestyle Interventions Reduces Depressive Symptoms among Frail and Pre-Frail Older Persons: Randomized Controlled Trial. J Nutr Health Aging. 2017; 21(8):918-926. DOI: 10.1007/s12603-016-0867-y. View

11.

Cao L, Zhou Y, Liu H, Shi M, Wei Y, Xia Y . Bidirectional Longitudinal Study of Frailty and Depressive Symptoms Among Older Chinese Adults. Front Aging Neurosci. 2022; 14:791971. PMC: 8866966. DOI: 10.3389/fnagi.2022.791971. View

12.

Rockwood K, Song X, MacKnight C, Bergman H, Hogan D, McDowell I . A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173(5):489-95. PMC: 1188185. DOI: 10.1503/cmaj.050051. View

13.

Hamaker E, Kuiper R, Grasman R . A critique of the cross-lagged panel model. Psychol Methods. 2015; 20(1):102-16. DOI: 10.1037/a0038889. View

14.

Makizako H, Shimada H, Doi T, Yoshida D, Anan Y, Tsutsumimoto K . Physical frailty predicts incident depressive symptoms in elderly people: prospective findings from the Obu Study of Health Promotion for the Elderly. J Am Med Dir Assoc. 2014; 16(3):194-9. DOI: 10.1016/j.jamda.2014.08.017. View

15.

Liu H, Li D, Zhao X, Fang B, Zhang Q, Li T . Longitudinal Impact of Frailty States and Sleep Duration on Subsequent Depressive Symptoms of Older Adults. J Am Geriatr Soc. 2021; 69(4):1003-1011. DOI: 10.1111/jgs.16999. View

16.

Qiu Q, Qian S, Li J, Jia R, Wang Y, Xu Y . Risk factors for depressive symptoms among older Chinese adults: A meta-analysis. J Affect Disord. 2020; 277:341-346. DOI: 10.1016/j.jad.2020.08.036. View

17.

Chen X, Mao G, Leng S . Frailty syndrome: an overview. Clin Interv Aging. 2014; 9:433-41. PMC: 3964027. DOI: 10.2147/CIA.S45300. View

18.

Chen H, Mui A . Factorial validity of the Center for Epidemiologic Studies Depression Scale short form in older population in China. Int Psychogeriatr. 2013; 26(1):49-57. DOI: 10.1017/S1041610213001701. View

19.

Liu X, Dai G, He Q, Ma H, Hu H . Frailty Index and Cardiovascular Disease among Middle-Aged and Older Chinese Adults: A Nationally Representative Cross-Sectional and Follow-Up Study. J Cardiovasc Dev Dis. 2022; 9(7). PMC: 9319589. DOI: 10.3390/jcdd9070228. View

20.

Liu M, Hou T . Response to Kawada (2021) 'Associations between symptoms of pain, insomnia and depression, and frailty in older adults: Comment on Liu et al.'. Int J Nurs Stud. 2021; 123:104072. DOI: 10.1016/j.ijnurstu.2021.104072. View