Frailty & late-life depression: a delicate balance

Depression is the most common psychiatric disease worldwide. With demographic balance shifting towards an older population, the number of older adults with a lifetime history of depression or subthreshold depression will be significant over the next decades. Depression is a serious psychiatric disease that affects not only the person suffering from depression, but also the social environment oft he person. The course of late-life depression is characterized by high recurrence and relapse rates. Little is known about the causes of this adverse course of depression in older persons. During the last half of the 20th century, life expectancy rapidly increased and marked the appearance and growth of a vulnerable group of older persons. This shift in age distribution resulted in the introduction of the term frailty. Frailty is a condition conferring vulnerability to poor physical health outcomes, due to a loss of reserve capacity oft he aging body. The associations between late-life depression and frailty are investigated in this thesis. We found that frailty prevalence is much higher in depressed older persons, than in non-depressed older persons and that physical frailty predicts higher severity of depressive symptoms and a chronic course of depression. Frailty can be a useful construct to detect a particularly vulnerable group within depressed older persons that are at risk of a more chronic course of late-life depression. Since frailty is a potentially reversible condition that can be targeted with specific interventions such as exercise, vitamin D supplementation and reduction of polypharmacy, it can guide treatment. Therefore screening for frailty deserves a prominent place in the treatment of late-life depression