Table 2.

Community-based cohort studies of the relationship between frailty and depression

First author	Year	Sample characteristics	Length of follow-up	Measure of frailty	Measure of depression	Main findings
Frailty as determinant, depression as outcome
Kennedy	1991	USA	2 years	Number of medical conditions	CES-D	Poorer health status and use of formal support services were associated with greater persistence of depressive symptoms.
		n = 1577
		82% women		ADL index
		Age range:
		65+ years
		Racial
		composition
		unknown		Use of formal support services
Ormel	2002	Netherlands	2 years	GARS	HADS	Disability had a stronger relationship with worsening depressive symptoms than depression had on worsening disability.
		n = 753
		72% women
		Mean age
		(F): 73 years
		(SD: 7.6)
		Mean age
		(M): 71 years
		(SD: 8.7)
		Racial
		composition
		unknown
Taylor	2004	USA	10 years	ADL and IADL indices	CES-D	Trajectories of increasing disability were significantly associated with trajectories of increasing depressive symptoms.
		n = 3876
		65% women
		Mean age:
		73.2 years
		(SD: 6.4)
		46% White;
		54% Black
Yang	2005	USA	3 years	ADL and IADL indices	CES-D	Onset and persistence of disability were significantly associated with increases in depressive symptoms.
		n = 1300
		63% women		Nagi Physical Performance scale
		Mean age:
		71.1 years
		(SD: 5.1)
		46% White;
		54% Black
		Modified Rosow-Breslau
		Health Scale for the Aged
Schieman	2007	USA	2 years	ADL index	Hopkins	Functional limitations predicted increases in depressive symptoms at follow-up.
		n = 898			Symptom
		50% women			Checklist
		Age: 65+ years
		52% White;
		48% Black
Gayman	2008	USA	3 years	ADL and IADL indices	CES-D	Functional limitations predicted increases in depressive symptoms; depression only weakly predictive of increases in functional limitations.
		n = 1495
		54% women
		Mean age:		Physical mobility
		57 years
		(SD: 17)
		24% White;
		24% Cuban;
		22% non- Cuban Hispanics;
		30% Black
Chang	2009	USA	3 years	ADL index	GDS	Incident disability significantly predicted depressive symptoms at the time of disability onset.
		n = 671
		100% women
		Age: 65+ years
		72% White;				Among those without depression, disability was not significantly associated with depressive symptoms 6 months post-disability onset.
		27% Black
Depression as determinant, frailty as outcome
Buchner	1996	USA	6months	Gait speed	CES-D	Worsening of depressive symptoms was significantly associated with gait slowing.
		n = 152		Lower body strength
		Age range:
		65–85 years
		55% women
		94% White		SF-36
Strawbridge	1998	USA	29 years	Impairments in physical, nutritive, cognitive, and sensory functioning	18-item depressive symptom scale	Depressive symptoms associated with greater likelihood of frailty at follow-up.
		n = 574
		Age range:
		65–102 years
		57% women
		82% White
Vaillant	1998	USA	55 years	Medical examination	IMDDS	Depression was associated with lower likelihood of experiencing no physical limitations at follow-up.
		n = 237
		100% men
		Mean age:		Physical limitations
		75 years
		(SD: 2)
		Racial
		composition
		unknown
Hebert	1999	Canada	3 years	Functional Autonomy Measurement System	GDS	Depression was not significantly predictive of functional decline at follow-up.
		n = 504
		60% women
		Mean age:
		79.9 years
		(SD: 3.9)
		Racial
		composition
		unknown
Rantanen	2000	USA	3 years	Hand grip strength	CES-D	Depressive symptoms were associated with a steeper decline in grip strength over time, particularly among low-weight men.
		n = 2275
		100% men		Body weight
		Age range:
		71–92 years
		100% Asian
Sarkisian	2000	USA	4 years	ADL index	GDS	Depressive symptoms were significantly associated with greater functional decline at follow-up.
		n = 6632
		100% women
		Mean age:
		73 years
		(SD: 4.9)
		Racial
		composition
		unknown
Mehta	2002	USA	2 years	ADL index	CES-D	Depressive symptoms were significantly predictive of incident functional impairment but not worsening functional impairment.
		n = 5697
		64% women
		Mean age:
		77 years
		(SD: 5.5)
		86% White;
		10% Black
Ostir	2004	USA	7 years	Modified Cardiovascular Health Study Frailty Index	CES-D	Positive affect was negatively associated with incidence of frailty.
		n = 1558
		61% women
		Mean age:
		71.9 years
		(SD: 5.7)
		100% Mexican
		American
Woods	2005	USA	3 years		CES-D
		n = 40657		Modified Cardiovascular Health Study Frailty Index		Depressive symptoms were significantly associated with incident frailty.
		100% women
		Age range:
		65–79 years
		86% White;
		6.5% Black
Avlund	2006	Finland & Denmark	5 years	Lower Limb T-Scale	CES-D	Depressive symptoms were significantly associated with feelings of tiredness performing daily activities at baseline but did not predict onset of tiredness at follow-up.
		n = 546
		55% women		Muscle strength
		Age range:		Forced expiratory volume
		75–80 years
		100% White
Avlund	2006	Finland and Denmark	5 years	PADL-H Scale	CES-D	Depressive symptoms were associated with onset of disability, independent from feelings of tiredness.
		n = 419
		61% women
		Mean age:
		75 years
		100% White
Han	2006	USA	2 years	ADL and IADL scales	CES-D	Declines in depressive symptoms were associated with better self-rated health at follow-up among both disabled and non-disabled older people.
		n = 6771
		Age range:
		65+ years
		Gender and racial		Self-rated health
		composition
		unknown
Atkinson	2007	USA	3 years	3MS	CES-D	Depressive symptoms mediated the relationship between cognitive functioning and gait speed change.
		n = 2349
		52% women		CLOX1
		Mean age:		EXIT15
		75.6 years (SD: 2.9)
		63% White;		Gait speed
		37% Black
Xue	2007	USA	3 years	Cardiovascular Health Study Frailty Index	GDS	Depressive symptoms were not significantly associated with incident frailty but were associated with increased frailty-free mortality.
		n = 599
		100% women
		Age: 65+ years
		71% non-Black;
		29% Black
Barry	2009	USA	9 years	ADL index	CES-D	Depressive symptoms predicted degree of mild and severe disability at follow-up.
		n = 754
		65% women
		Age: 70+ years
		>90% White
Park-Lee	2009	USA	4 years	Modified Cardiovascular Health Study Frailty Index	CES-D [Positive affect subscale]	Positive affect was associated with lower incidence of frailty, independent from depressive symptoms.
		n = 954
		100% women
		Mean age:
		81.2 years
		(SD: 3.7)
		87% White

ADLs, activities of daily living (e.g., hygiene, dressing, eating, toileting, basicmobility); IADLs, instrumental activities of daily living (e.g., keeping appointments, using the telephone, traveling, preparing meals, shopping, housework, managing medications, managing finances); GARS, Groningen Activity Restriction Scale; OARS, Older Americans Resources and Services; SAFE, Survey of Activities and Fear of Falling in the Elderly; FICSIT, Frailty and Injuries Cooperative Studies of Intervention Techniques; 3MS, Modified Mini-Mental Status Examination; CLOX1, Executive Clock-Drawing Task; EXIT15, Executive Interview; SF-36, Short-Form Health Survey; PADL-H Scale, Physical Activities of Daily Living—Help Scale; CES-D, Centers for Epidemiologic Studies—Depression Scale; GDS, Geriatric Depression Scale; SHORT-CARE, Comprehensive Assessment and Referral Evaluation—Short Form; DPHS, Depression Homogenous Subscale; DPDS, Depression Diagnostic Subscale; HADS, Hospital Anxiety and Depression Scale; HADS, Hospital Anxiety and Depression Scale; IMDDS, Indicators of Major Depressive Disorder Scale.