Frailty, Lifestyle Behaviors, And Depression In Older Adults: Cross-sectional Study Of 69,178 Uk Biobank Participants

Frailty is a highly prevalent and complex clinical condition in the aging population. Particularly, frailty is negatively associated with increased vulnerability in mental health and is interrelated with the symptoms and risk factors of depression, including lifestyle behaviors. However, the complex association of these interlinked factors has not yet been systematically examined in population-based epidemiological studies. PURPOSE: To examine the associations of frailty and lifestyle behaviors with depression among older adults. METHODS: Data were obtained from 69,178 older adults aged 65 years or older who participated in the baseline survey of the UK Biobank. Frailty status was measured using the five frailty indicators (exhaustion, weight loss, low physical activity (PA), slow walking speed, and low grip strength). Participants were classified into three frailty groups based on the number of indicators met: frail (>2), pre-frail (1-2), and non-frail (0). Depression was defined if participants had sought medical attention for nerves, anxiety, tension, or depression. Lifestyle behaviors included the self-reported time spent in moderate-to-vigorous PA (MVPA), screen-time-based sedentary behavior, and sleep. The associations of frailty and lifestyle behaviors with depression were examined using multivariate logistic regression models. RESULTS: Overall, 29% of participants had depression, of which 7% and 45% were frail and pre-frail, respectively. Significant correlations were observed between frailty and lifestyle behaviors (P’s < .05). In the adjusted model, frailty was significantly associated with an increased risk of depression (Frail: OR = 1.88; Pre-frail: OR = 1.23), and sleep (7-9 hrs/d) was associated with a lower risk of depression (OR = 0.82). However, the statistical significance of MVPA predicting the risk of depression disappeared after adjusting for frailty status, suggesting a possible mediating effect of frailty on the relationship between MVPA and depression. CONCLUSION: Frail and pre-frail older adults have a higher risk of depression than non-frail counterparts; however, this risk could be mediated by the positive effects of MVPA on frailty. Meeting the recommended sleep duration (7-9 hrs/d) can be used as a modifiable behavioral strategy to manage or prevent depression.