Depressive symptoms are associated with the incidence of frailty in older adults with cardiometabolic diseases: Interaction between depression and diabetes

BACKGROUND: Older adults with diabetes are prone to frailty and increased mortality. AIM: In this longitudinal study, we examined the association between depressive symptoms and the incidence of frailty in older people with cardiometabolic diseases. We also investigated whether comorbidities modified the association between depressive symptoms and incident frailty in this patient population. METHODS: We analyzed longitudinal data from 431 outpatients aged 65 years or older with cardiometabolic diseases who visited a frailty clinic from 2015 to 2023. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS)-15. The outcome during follow-up (median, 2.9 years) was incident frailty, as defined by the modified Cardiovascular Health Study (mCHS) criteria or the Kihon Checklist (KCL). Hazard ratios (HRs) and 95% confidence intervals (CIs) for incident frailty were estimated using multivariable Cox regression models. RESULTS: Depressive symptoms (GDS-15 ≥ 5) were independently associated with incident mCHS- and KCL-defined frailty across all models. The fully adjusted HRs for incident mCHS- and KCL-defined frailty were 1.92 and 2.05, respectively. Stratified analyses demonstrated consistent associations between depressive symptoms and incident frailty in participants with diabetes and hyperglycemia. Significant interactions between depressive symptoms and diabetes were observed for both mCHS- and KCL-defined frailty, whereas no significant interactions were observed for cognitive impairment or physical inactivity. CONCLUSION: Depressive symptoms were independently associated with incident frailty, as defined by both the mCHS and KCL criteria, in older outpatients attending a frailty clinic for cardiometabolic diseases. A significant interaction between depressive symptoms and diabetes was observed, suggesting that patients with coexisting depressive symptoms and diabetes may represent a high-risk group for incident frailty. Further studies are needed to determine whether interventions targeting depressive symptoms and diabetes management can reduce the risk of incident frailty.