Relationship between depression and frailty in older adults : a systematic review and meta-analysis

Abstract

Aim: Depression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta- analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty. Methods: Two authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders. Results: From 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07–47.10, I2 = 94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66–7.35, k = 11), also after adjusting for potential confounders (OR = 2.64; 95%CI: 1.59–4.37, I2 = 55%, k = 4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00–55.30, I2 = 97%). People with depression were at increased odds of having frailty (OR = 4.07, 95%CI 1.93–8.55, k = 8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95–7.08, I2 = 98%, k = 4), whilst in two studies frailty increased the risk of incident depression with an OR = 1.90 (95%CI 1.55–2.32, I2 = 0%).