Physical frailty in late-life depression: evidence for a depression-frailty subtype?

Frailty is a condition in which there is a reduced reserve capacity of the physiological systems that can lead to serious health problems when exposed to physical and psychosocial stressors. Although the clinical relevance of frailty is increasingly recognized within somatic health care, this concept is hardly applied in mental health care. Possibly the complex relationship and interaction between frailty and psychopathology underlies this. After all, many forms of psychopathology seem to be associated with accelerated biological aging and can actually be seen as a frailty model. In addition, geriatric studies often exclude patients with a psychiatric disorder. Our research shows that frailty, defined according to the biomedical frailty model, can be validly measured in elderly people with a depressive disorder. First, frailty was associated with various biomarkers of aging, such as increased inflammation parameters, shortened telomere length and decreased vitamin D levels. Second, frailty also predicted premature death within a group of depressed elderly. Frailty also appears to be clinically relevant as a predictor for a worse course of depression and may provide an explanation for medically unexplained symptoms in the elderly. Our findings indicate the existence of a so-called "depression-frailty subtype", a group of depressed elderly people with a poor mental and physical prognosis. Integrated somatic and mental health care seems appropriate for this group. Future treatment studies will have to show which interventions can improve the prognosis of these vulnerable groups. This could include a reduction in polypharmacy, more physical activity, nutritional interventions and psychotherapeutic interventions