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physical (i.e., balance), nutritive (i.e., weight loss), cognitive (i.e., memory impairments),and sensory (i.e., vision loss) domains; and the biological syndrome model (Fried et al .,2001), in which frailty is modeled as syndrome characterized by weight loss, exhaustion,inactivity, slowness, and weakness (Fried et al ., 2001), akin to geriatric failure-to-thrive(Committee on a National Research Agenda on Aging, 1991). Frailty has also been linked tosacropenia (Frisoli et al ., 2011), vitamin D deficiency (Ensrud et al ., 2010), and relatedhealth conditions. Depending on the index used, the prevalence of frailty among adults 65

years and older is estimated to be 10.9%20.3% (Cigolle et al ., 2009). Frailty is morecommon among women, thosewho are socially isolated (Rockwood et al ., 2004), and thosewho live in socioeconomically disadvantaged communities (Lang et al ., 2009). Support forthe clinical and public health relevance of the frailty construct has been derived from itsutility in predicting functional decline, disability, fracture, and mortality; it has been arguedthat frailty may be a pre-clinical, and potentially reversible, indicator of health status forolder adults (Woods et al ., 2005; Ensrud et al ., 2007).

Parallel to this work on frailty, gerontologists and psychiatrists have characterized variationin the etiology and presentation of depression in later life. In 1994, Gallo and colleaguesdetermined empirically that older adults are less likely to report symptoms of dysphoria butgenerally not other symptoms of depression (i.e., fatigue, guilt, appetite disturbances)relative to younger adults (Gallo et al ., 1994). They later described this phenomenon as

depression without sadness (Gallo & Rabins, 1999) and argued that in the clinical context,Older patients with depression may present with somatic complaints for which a medicaletiology cannot be found or that are disproportionate to the extent of medical illness. Otherinvestigators have noted the difficulty in diagnosing depression in the context of comorbidmedical conditions that are common in later life (Katon & Sullivan, 1990; Birrer & Vemuri,2004), suggesting that one reason for the lower prevalence of depression among older adultsis that this condition is often confused for or conflated with physical decline. One result of this work has been the development of psychiatric assessments designed specifically forolder adults and for those with comorbid neurological conditions, including the GeriatricDepression Scale (GDS) (Yesavage et al ., 1983) and the Cornell Scale for Depression inDementia (Alexopoulos et al ., 1988). Relative to traditional structured diagnostic depressionmeasures (e.g., Schedules for Clinical Assessment in Neuropsychiatry (SCAN), StructuredClinical Interview for DSM (SCID), Diagnostic Interview Schedule (DIS), CompositeInternational Diagnostic Inventory (CIDI)), these instruments emphasize vegetative andfunctional aspects of depression beyond the syndrome criteria set out in the Diagnostic andStatistical Manual of Mental Disorders (i.e., the GDS includes items Do you feel full of energy? Do you enjoy getting up in the morning?).

These conceptualizations of depression in later life share many characteristics with frailty.Depression in later life is predictive of many of the same kinds of out-comes as frailty,including cognitive impairment (Andersen et al ., 2005), disability (Bruce, 2001), fracture(Whooley et al ., 1999), and mortality (Rovner et al ., 1991; Laursen et al ., 2007). However,as yet, there has been relatively little attention paid in the literature as to how these twosyndromes may be related. Because health conditions in later life are often predicted by ashared set of risk factors, Tinetti and colleagues have explicitly called for a unified approachto conceptualizing geriatric syndromes (Tinetti et al ., 1995). Similarly, in a recent editorial,Katz noted that Depending on the definitions [of frailty] used, it is possible to make a casefor each of these conditions [depression and frailty] as a cause, consequence, or comorbidityof the other. It is also possible to argue for their congruence. (Katz, 2004). Despite thesecalls, few studies have rigorously examined the interrelationships between depression andfrailty syndromes.

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The motivations of this paper are to link these parallel bodies of literature by reviewingexisting studies that address the interrelationships between depression and frailty, to suggestconceptual and methodological approaches to synthesize these constructs, and to identifypressing areas in need of additional research in this context.

Methods

Literature searches were conducted in PubMed with the assistance of a research librarianusing combinations of the Medical Subject Heading (MeSH) terms depression,depressive disorder, depressive disorder, major, aging, and the word frailty. Theterm frailty is not currently indexed as a MeSH term, and therefore, searches wereconducted using the related MeSH terms frail elderly, fatigue, mobility limitation,lethargy, disability, atrophy, movement, postural balance, and muscleweakness. The search was restricted to papers published in print or online prior to 1October 2010 and in English. The reference lists of the citations identified in these searches,including review articles, were also examined. General population-based samples are thefocus of this review because these study designs provide the best methodology forunderstanding the natural history of frailty and depression; clinic-based populationsprobably reflect a host of selection factors that make them inappropriate for exploring theseepidemiologic questions (Schwartzbaum et al ., 2003).

Selection of studies

The searches returned 573 unique, empirical research articles, from which a group of fourreviewers selected 133 for full-text abstraction (Supplemental Figure 1). To characterize thestudy population and main findings, the following information was extracted fromeacharticle: author, year of publication, geographic location, study design (i.e., cross-sectional,cohort), sample characteristics (i.e., age, sex, racial/ethnic composition), measure of frailty,the measure of depression or depressive symptoms, and a qualitative summary of the keyfindings. Studies were too varied in their analytic approach and reporting of results to extracta quantitative effect measure or to summarize the results in a formal (e.g., meta-analytic)manner. A handful of studies selected the entire population on thebasis of psychiatric(e.g.,Pijpers et al ., 2009) or frailty status (e.g., Smith Barusch et al ., 1999; Landi et al .,2005). These reports were excluded because all study participants displayed somecharacteristics of frailty or disability, which precluded an examination of the differentialrelationship between depression and frailty. Several other reports were excluded because thestudy sample was selected from a clinic setting, including nursing homes (e.g., Parmelee et al ., 1998; Jongenelis et al .,2004; Onishi et al., 2004) or from a specific patient population(e.g., stroke or cancer patients). Two studies were excluded because they were randomizedcontrolled trials rather than community-based cohorts (Fitzpatrick et al ., 2007; Gitlin et al .,2007). Two independent reviewers examined the abstractions and identified 39 uniquearticles for inclusion in this review.

Results

Cross-sectional s tudies

As shown in Table 1, the majority of population-based cross-sectional studies reported apositive association between depressive symptomatology and frailty status. Six studies didnot report the racial/ethnic composition of the sample, but the all those that did includedprimarily Whites, and three included only Asians. Most studies were primarily composed of or included only women, and only the study conducted by Blyth et al . (2008) includedexclusively men. All but one (Cummings et al ., 2003) of the cross-sectional studies reporteda statistically significant positive association between frailty and depressive



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symptomatology that persisted after adjustment for covariates, whether depression wasexamined as the determinant or consequence of frailty. For example, Hybels et al . (2001)reported that persons with elevated depressive symptoms were over five times as likely tohave activities of daily living (ADL) limitations as persons with-out depression (Hybels et al ., 2001). Several reports examined factors that influenced the depressionfrailtyrelationship, including social support (Newsom and Schulz, 1996; Cummings et al ., 2003),sense of mastery (Jang et al ., 2002), religiosity (Cummings et al ., 2003), and perceived

health (Jang et al ., 2006).

A wide range of metrics were used to index frailty, including traditional disability indices(e.g., ADL/instrumental activities of daily living scales) (Mirowsky and Ross, 1992;Davidson et al ., 1994; Newsom and Schulz, 1996; Prince et al ., 1997; Hybels et al ., 2001;Jang et al ., 2002; Cummings et al ., 2003; Stek et al ., 2004), history or fear of falling(Deshpande et al ., 2008; Wada et al ., 2008), number of medical conditions (Hybels et al .,2001), cognitive functioning (Hajjar et al ., 2009), and specific frailty indices (Blyth et al .,2008; Deshpande et al ., 2008; Chang et al ., 2010; Chen et al ., 2010). Three studiesincorporated objective measures of physical performance (e.g., chair stands, grip strength)(Newsom and Schulz, 1996; Deshpande et al ., 2008; Hajjar et al ., 2009). Two-thirds (10 of 16) of studies used the Centers for Epidemiologic StudiesDepression (CES-D) scale toindex depressive symptomatology (Mirowsky and Ross, 1992; Davidson et al ., 1994;

Newsom and Schulz, 1996; Broe et al ., 1999; Hybels et al ., 2001; Cummings et al ., 2003;Jang et al ., 2006; Deshpande et al ., 2008; Hajjar et al ., 2009; Chen et al ., 2010). No studiesthat met the inclusion criteria used diagnostic instruments. One notable exception to thetraditional regression approach used by these studies was a report by Hajjar and colleagues(2009) that examined the confluence of depressive symptoms, cognitive status, and slownessusing latent variable modeling (Hajjar et al ., 2009); they reported that the clustering of thesecharacteristics was consistent with the notion that they describe a common geriatricsyndrome.

Cohort studies

Table 2 illustrates prospective studies in which depression was studied as a risk factor foronset of frailty, and in which frailty was examined as a risk factor for onset or persistence of depressive symptoms. As shown by the top portion of Table 2, all studies reported a positiveassociation between frailty with onset or worsening of depressive symptomatology atfollow-up (Kennedy et al ., 1991; Ormel et al ., 2002; Taylor and Lynch, 2004; Yang &George, 2005; Han, 2006; Atkinson et al ., 2007; Schieman & Plickert, 2007; Gayman et al .,2008; Chang et al ., 2009). For example, Yang and George (2005) reported that onset andpersistence of frailty were stronger predictors of depressive symptoms than recovery fromfrailty over 6 years (Yang & George, 2005). As displayed in the lower portion of Table 2,most studies reported a significant positive association between depression and risk of frailtyonset, at least in bivariate analyses (Buchner, 1996; Strawbridge et al ., 1998; Vaillant, 1998;Rantanen et al ., 2000; Sarkisian et al ., 2000; Mehta et al ., 2002; Avlund, 2006; Barry et al .,2009). For example, Strawbridge et al . (1998) reported that persons with repeatedly elevateddepressive symptoms were 3.2 times more likely to be frail at follow-up than those with nohistory of depression (Strawbridge et al ., 1998). However, studies were mixed as to whether

depression was an independent risk factor for onset of frailty after accounting for overallhealth status (Hebert et al ., 1999; Ormel et al ., 2002; Avlund et al ., 2006; Gayman et al .,2008; Xue et al ., 2008). For example, Avlund and colleagues reported that depressivesymptoms were not significantly predictive of tiredness at 5-year follow-up after accountingfor comorbidity, physical performance measures, and psychological factors, despite beingsignificantly associated with tiredness at baseline (Avlund et al ., 2006). Hebert andcolleagues did not find a significant association between depression and onset of frailty over



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3 years in even bivariate analyses in their study of adults 75 years and older (Hebert et al .,1999). Similarly, in 2007, Xue and colleagues reported that depression was not associatedwith onset of frailty but did predict frailty-free mortality over a 3-year period.

Three studies explicitly examined the bidirectional relationship between depression andfrailty (Ormel et al ., 2002; Taylor and Lynch, 2004; Gayman et al ., 2008). In 2002, Ormeland colleagues reported that frailty was a stronger predictor of increasing depressive

symptoms than baseline depression was of increasing frailty. Similarly, Gayman et al .(2008) found that although frailty was significantly associated with worsening of depression,depressive symptoms were only weakly predictive of functional decline over a 3-yearperiod. In contrast, Chang et al . (2009) found that incident frailty was strongly associatedwith depressive symptoms at the time of frailty onset, but that frailty did not predictdevelopment of new depressive symptoms 6 months later.

As with the cross-sectional studies, a wide range of indices were used to measure frailtystatus, although four utilized specific syndrome criteria outlined by Fried et al . (2001) (Ostiret al ., 2004; Woods et al ., 2005; Xue et al ., 2008; Park-Lee et al ., 2009). Approximately60% (14 of 23) of studies used the CES-D to index depressive symptomatology; no studiesthat met the inclusion criteria used diagnostic instruments. Six studies did not report theracial/ethnic composition of the sample; of the remainder, most did not include large

samples of racial/ethnic minorities. No-table exceptions were the reports by Schieman andPlickert (2007), Yang and George (2005), Ostir et al .(2004), Gayman et al . (2008), Rantanenet al . (2000), and Taylor and Lynch (2004), which all used cohorts in which at least 40% of the sample was not White. There was some indication of heterogeneity in the associationbetween depression and frailty across racial/ethnic groups; Schieman and Plickert (2007)reported that depressive symptoms were strongly associated with greater functional declineamong Whites but not among Blacks.

Discussion

The primary findings from this review are as follows: (i) most studies report a positive, andpotentially bidirectional, association between depressive symptoms and frailty status; (ii)few studies have examined the potential overlap between depression in late life and frailty,

instead of treating them as independent geriatric syndromes; (iii) existing research is limitedby the methods used to assess depression; (iv) no studies evaluated the role of medicationsto treat depression; and (v) few studies have included enough men or racial/ethnic minoritiesto examine variation in the depressionfrailty relationship across these groups.

The results of this review have implications for both the construct validity and measurementof geriatric syndromes. These results underscore the relevance of considering theconsequences of a narrowing between psychological and physical aspects of healththenotion that mental health becomes health (Katz, 1996; Schnittker, 2005)for clinicalcare. In line with the notion that frailty reflects psychological and social elements of healthabove and beyond the burden of chronic medical conditions, the correspondence betweenself-rated health and burden of chronic physical conditions declines with age, whereas thecorrelation between self-rated health and depressive symptoms increases with age

(Schnittker, 2005). Similarly, geriatric failure-to-thrive, although primarily characterized bynutritive and functional decline, also reflects an integration of physical, functional, social,and psychological aspects of health (Rocchiccioli & Sanford, 2009). Despite the 20 yearssince the Institute of Medicine report stating that geriatric failure-to-thrive is oftenaccompanied by dehydration, depressive symptoms , impaired immune function, and lowcholesterol (emphasis added) (Committee on a National Research Agenda on Aging, 1991),empirical investigations of the potential overlap in depressive symptomatology and geriatric



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frailty syndromes remain scant. Consistent with a developmental approach to examining theetiology and consequences of psychopathology, research efforts must reflect the proteannature of the relationship between mental and physical aspects of health, both withinindividuals over the life course and across population groups.

The next implication for research concerns efforts to measure frailty and related geriatricsyndromes in later life. As this review illustrates, there is wide variation in the metrics used

to operationalize frailty, and these measurement differences probably hamper efforts todevelop prevention and intervention programs because of ambiguity about the clinicaltarget. The conceptual development of frailty as a syndrome may be informed by the priorempirical work in psychiatry on alternate presentations of depression in later life (e.g.,depression without sadness, vegetative depression). Latent variable approaches, whichexplicitly account for measurement error in ways that simple sum scores cannot, have beensuccessfully employed to assess depression in later life and frailty (Gallo et al ., 1994;Bandeen-Roche et al ., 2006); this approach is well suited to investigating potential constructoverlap between depression and frailty but has not yet been applied to this measurementproblem. There is also a clear need to understand and explicitly assess how the behavioralsigns of psychopathology (i.e., sleeping disturbances) interrelate with symptoms of frailtyand related geriatric syndromes (i.e., fatigue), both from diagnostic and clinical carestandpoints (Simon et al ., 1999; Dowrick et al ., 2005).

The limitations of the measurement of depression in these studies must be considered. Noneof the studies reviewed used diagnostic instruments to assess depression syndrome, insteadassessing only recent depressive symptoms; as a result, there is probably substantialheterogeneity within cases of depression identified in these reports (Mezuk & Eaton, 2010).The most commonly used scale, the CES-D, has not been extensively validated againstclinical diagnosis, particularly among older adults (Eaton et al ., 2007; Fiske & ORiley,2008), and there is evidence that the underlying factor structure of this scale differs acrossracial/ethnic groups (Guarnacia et al ., 1989). Because instruments such as the CES-D makeno effort to separate symptoms attributable to medical illness or medication side effects fromthose due to psychopathology, they may be particularly inappropriate for examining therelationship between depression and geriatric syndromes that are characterized by non-specific physical complaints (e.g., fatigue, weakness). This measurement strategy hampers

efforts to examine depression as a risk factor for frailty and associated geriatric conditions.Measurement error in depression may produce spurious findings as to the natural history,predictors, and consequences of thiscondition in later life and may have contributed todisparate findings across studies reviewed here.

The apparent link between depression and frailty begs the question of the role thatpsychotropic medications may play in this relationship. No studies included in this reviewconsidered the impact of medications used to treat depression (e.g., antidepressants) in thestudy design or the analytic strategy. Antidepressants have been associated with many of same outcomes as frailty, including osteoporosis (Mezuk et al ., 2008), falls (Ensrud et al .,2002), and fracture (Takkouche et al ., 2007), and studies are needed to determine whetherthese agents potentially mediate the observed associations between depression and frailty.This research also has clear implications for efforts to treat depression in later life; although

selective serotonin reuptake inhibitors are considered a first-line therapy for treatingdepression among older adults, there is a paucity of effectiveness data on these medicationsin this age group (Mottram et al ., 2006). Most trials are of short duration, and therefore, it isdifficult to identify the potential complications from prolonged use or the role of polypharmacy (Fialova & Onder, 2009). Antidepressant classes may also confer differentialfracture risk (Gagne et al ., 2011). Frailty may contribute to withdrawal frompharmacotherapy (Katz et al ., 1994), which emphasizes the need to explore multimodal,



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non-pharmacological interventions for depressed, frail adults (Schulz & Williamson, 1993;Fairhall et al ., 2008), or at least more focused targeting of antidepressant medications thatreflects the patients needs in a holistic manner (Mezuk & Golden, 2009).

Variation in study design may have contributed to differences in findings across studies.Few studies had meaningful numbers of men or racial/ethnic minorities to permit evaluationof whether the associations between depression and frailty vary across these groups; there is

reason to believe that these relationships may differ because the burden of depression islower among men and racial/ethnic minorities relative to women and non-Hispanic Whites,respectively (Breslau et al ., 2006; Needham & Hill, 2010). Also, most studies focused onadults 65 years and older, precluding an investigation of how depressive episodes earlier inthe life course may have contributed to frailty risk; studies that included younger adultswould address this issue. Finally, some studies examined worsening or persistence of depressive symptoms, rather than onset of new symptoms, as an outcome, and thus, it isunclear whether frailty should be thought of as a potential prognostic, rather than etiologic,factor for late-life depression.

Conclusions

This review provides support for the bidirectional relationship between depression and

frailty. Understanding the extent to which depression and frailty reflect plieotropic effects of common risk factors, or are simply variants in expression of the same underlying pathology,is paramount. If depression and frailty are overlapping syndromes, as opposed toetiologically distinct aspects of health, this has implications for the development of tools toappropriately measure and track changes in symptomatology over time. Shifting theparadigm for conceptualizing and measuring depression and frailty is also likely tosignificantly impact approaches to prevention and intervention. The plieotropic risk modelacknowledges that interventions targeted at specific pre-clinical signs or symptoms will beinefficient and calls for comprehensive efforts to reduce morbidity and mortality in later life.Furthering understanding of these relationships may have important implications for thedevelopment of public health and clinical care interventions to reduce disability in later life.

Supplementary Material

Refer to Web version on PubMed Central for supplementary material.

Ackn owled gment sB. Mezuk is supported by the VCU Building Interdis-ciplinary Research Careers in Womens Health (BIRCWH)Program (K12-HD055881). This project was also supported by award number UL1RR031990 from the NationalCenter for Research Resources and NIH Roadmap for Medical Research, National Institutes of Health. The contentis solely the responsibility of the authors and does not necessarily represent the official views of the National Centerfor Research Resources or the National Institutes of Health.

Supporting information may be found in the online version of this article.

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Lang IA, Hubbard RE, Andrew MK, et al. Neighborhood deprivation, individual socioeconomic status,and frailty in older adults. J Am Geriatr Soc. 2009; 57:17761780. [PubMed: 19754500]

Laursen TM, Munk-Olsen T, Nordentoft M, Mortensen PB. Increased mortality among patientsadmitted with major psychiatric disorders: a register-based study comparing mortality in unipolardepressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia. J ClinPsych. 2007; 68:899907.

Mehta KM, Yaffe K, Covinsky KE. Cognitive impairment, depressive symptoms, and functionaldecline in older people. J Am Geriatr Soc. 2002; 50:10451050. [PubMed: 12110064]

Mezuk, B.; Eaton, WW. Approaches to measuring multi-dimensional constructs across the life course:operationalizing depression over the lifespan. In: Tucker, E.; Viswanathan, M.; Walford, G.,editors. The Handbook of Measurement. SAGE, Inc; London: 2010. p. 239-264.

Mezuk B, Golden SH. A link between depression and bone metabolism: what are the implications fortreatment? Exp Rev Endocrinol Metab. 2009; 4:199202.

Mezuk B, Eaton WW, Golden SH, et al. Depression, antidepressants, and bone mineral density in apopulation-based cohort. J Gerontol A Med Sci Biol Sci. 2008; 63:14101415.

Mirowsky J, Ross C. Age and depression. J Health Soc Behav. 1992; 33(3):187205. [PubMed:1401846]

Mottram P, Wilson K, Strobl J. Antidepressants for depressed elderly. Cochrane Database Syst Rev.2006; 25 CD003491.Needham B, Hill TD. Do gender differences in mental health contribute to gender differences in

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Ormel J, Rijdijk FV, Sullivan M, et al. Temporal and reciprocal relationship between IADL/ADLdisability and depressive symptoms in late life. J Gerontol B Psychol Sci Soc Sci. 2002; 57:338347.

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Taylor MG, Lynch SM. Trajectories of impairment, social support, and depressive symptoms in laterlife. J Gerontol B Psychol Sci Soc Sci. 2004; 59:S238S246. [PubMed: 15294928]

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Key points

Existing research demonstrates a link between depression and frailty in later life.

There is limited research on the depression-frailty relationship among men orracial/ethnic minorities.

(Mis)measurement of depression and frailty may have contributed to conflicting

findings. Future research should explicitly examine how the signs and symptoms of

depression and frailty interrelate, and whether antidepressant medicationscontribute to the depression-frailty relationship.



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T a

b l e 1

C o m m u n i t y - b a s e d c r o s s - s e c t i o n a l s t u d i e s o f t h e r e l a t i o n s h i p b e t w e e n f r a i l t y a n d d e p r e s s i o n

F i r s t a u

t h o r

Y e a r

S a m p l e c h a r a c

t e r i s t

i c s

M e a s u r e o f

f r a i

l t y

M e a s u r e o f

d e p r e s s i o n

M a i n

f i n d

i n g s

F r a i l t y a s d e t e r m i n a n t , d e p r e s s i o n a s o u t c o m e

M i r o w s k y

1 9 9 2

U S A

I A D L i n d e x

C E S - D

P h y s i c a l d y s f u n c t i o n w a s s i g n i f i c a n t l y a s s o c i a t e d

w i t h d e p r e s s i v e s y m p t o m s .

n = 2 8 4 0

A g e r a n g e : 1 8 9 0 y e a r s

G e n d e r & r a c i a l c o m p o s i t i o n u n k n o w n

D a v i d s o n

1 9 9 4

U S A

A D L i n d e x

C E S - D

F u n c t i o n a l l i m i t a t i o n s w e r e s i g n i f i c a n t l y a s s o c i a t e d w i t h

t h e s o m a t i c , b u t n o t n e g a t i v e a f f e c t , p o s i t i v e a f f e c t , o r

i n t e r p e r s o n a l s u b s c a l e s o f t h e C E S D .

n = 3 0 3

A g e r a n g e : 6 5 1 0 2 y e a r s

8 5 % w o m e n

4 7 % W h i t e

N e w s o m

1 9 9 6

U S A

I A D L i n d e x

C E S - D

F u n c t i o n a l i m p a i r m e n t w a s a s s o c i a t e d w i t h d e p r e s s i v e

s y m p t o m s . T h i s r e l a t i o n s h i p w a s p a r t i a l l y m e d i a t e d b y

s o c i a l s u p p o r t .

n = 4 7 3 4

E x e r c i s e t o l e r a n c e

M e a n a g e : 7 2 . 8 y e a r s

U p p e r e x t r e m i t y s t r e n g t h

5 7 % w o m e n

9 5 % W h i t e ; 5 % B l a c k

T i m e d w a l k

B r o e

1 9 9 9

A u s t r a l i a

C E S - D

G a i t s l o w i n g w a s p o s i t i v e l y a s s o c i a t e d w i t h d e p r e s s i v e

s y m p t o m s . A s s o c i a t i o n b e t w e e n c h r o n i c c o n d i t i o n s a n d

d e p r e s s i o n w a s m e d i a t e d b y d i s a b i l i t y .

n = 4 3 4

L i f e S a t i s f a c t i o n I n d e x - A

M e a n a g e : 8 0 . 6 y e a r s ( S D : 4 . 0

)

M e d i c a l / n e u r o l o g i c a l

a s s e s s m e n t

4 6 % w o m e n

R a c i a l c o m p o s i t i o n u n k n o w n

H y b e l s

2 0 0 1

U S A

M o d i f i e d A D L i n d e x

C E S - D

F u n c t i o n a l l i m i t a t i o n s w e r e a s s o c i a t e d w i t h b o t h s u b -

s y n d r o m a l a n d s e v e r e d e p r e s s i o n s y n d r o m e .

n = 4 1 6 2

6 2 % w o m e n

A g e r a n g e : 6 5 1 0 5 y e a r s

W e i g h t e d s u m o f c h r o n i c

h e a l t h c o n d i t i o n s

6 6 % W h i t e ; 3 4 % B l a c k

J a n g

2 0 0 2

U S A

K a t z A D L i n d e x

G D S

D i s a b i l i t y s t a t u s w a s a s s o c i a t e d w i t h d e p r e s s i o n .

n = 4 0 6

T h i s r e l a t i o n s h i p w a s m o d e r a t e d b y s e n s e o f m a s t e r y .

5 2 % w o m e n

I A D L i n d e x


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F i r s t a u

t h o r

Y e a r


t e r i s t

i c s

M e a s u r e o f

f r a i

l t y

M

e a s u r e o f

d e p r e s s

i o n

M a i n

f i n d

i n g s

A g e r a n g e : 6 0 8 4 y e a r s

P h y s i c a l P e r f o r m a n c e S c a l e

9 8 % W h i t e

F u n c t i o n a l H e a l t h S c a l e

C u m m i n g s

2 0 0 3

U S A

A D L a n d I A D L i n d i c e s

C E S - D

F u n c t i o n a l i m p a i r m e n t w a s n o t s i g n i f i c a n t l y a s s o c i a t e d w i t h

d e p r e s s i o n a f t e r a c c o u n t i n g f o r s o c i a l s u p p o r t a n d r e l i g i o s i t y .

n = 5 6 8

8 1 % w o m e n

M e a n a g e : 7 0 . 7 y e a r s ( S D : 6 . 7

)

6 8 % W h i t e ; 3 2 % B l a c k

S t e k

2 0 0 4

N e t h e r l a n d s

G A R S

G D S

F u n c t i o n a l l i m i t a t i o n s w e r e a s s o c i a t e d w i t h e l e v a t e d

d e p r e s s i v e s y m p t o m s .

n = 5 0 0

6 3 % w o m e n

M e a n a g e : 8 5 y e a r s


J a n g

2 0 0 6

U S A

P h y s i c a l P e r f o r m a n c e S c a l e

C E S - D

F u n c t i o n a l d i s a b i l i t y w a s a s s o c i a t e d w i t h d e p r e s s i v e

s y m p t o m s . T h i s a s s o c i a t i o n w a s m e d i a t e d b y h e a l t h

p e r c e p t i o n s .

n = 2 3 0

5 9 % w o m e n

F u n c t i o n a l H e a l t h S c a l e

A g e r a n g e : 6 0 9 2 y e a r s

1 0 0 % A s i a n

W a d a

2 0 0 8

J a p a n

H i s t o r y o f

f a l l i n g

G D S

H i s t o r y o f f a l l i n g w a s p o s i t i v e l y a s s o c i a t e d w i t h d e p r e s s i v e

s y m p t o m s .

n = 1 2 6 1

5 8 % w o m e n

A D L i n d e x

M e a n a g e : 7 5 . 4 y e a r s ( S D : 7 . 2

)

1 0 0 % A s i a n

D e p r e s s i o n a s d e t e r m i n a n t , f r a i l t y a s o u t c o m e

P r i n c e

1 9 9 7

U n i t e d K i n g d o m

O A R S i m p a i r m e n t s c a l e

S H O R T - C A R E

D e p r e s s i o n w a s p o s i t i v e l y a s s o c i a t e d w i t h f u n c t i o n a l

i m p a i r m e n t , d i s a b i l i t y , a n d p h y s i c a l h a n d i c a p .

n = 6 5 4

A g e r a n g e : 6 5 9 8 y e a r s

S H O R T - C A R E

6 1 % w o m e n

L o n d o n H a n d i c a p S c a l e


M o d i f i e d K a t z s c a l e

B l y t h

2 0 0 8

A u s t r a l i a

C a r d i o v a s c u l a r H e a l t h S t u d y G D S

D e p r e s s i o n w a s s i g n i f i c a n t l y a s s o c i a t e d w i t h p a i n . T

h e

a s s o c i a t i o n b e t w e e n p a i n a n d f r a i l t y w a s s i g n i f i c a n t l y


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F i r s t a u

t h o r

Y e a r


t e r i s t

i c s

M e a s u r e o f

f r a i

l t y

M e a s u r e o f

d e p r e s s i o n

M a i n

f i n d

i n g s

F r a i l t y I n d e x

a t t e n u a t e d a f t e r a d j u s t i n g f o r d e p r e s s i o n .

n = 1 7 0 5

1 0 0 % m e n

M e a n a g e : 7 6 . 9 y e a r s ( S D : 5 . 5

)


D e s h p a n d e

2 0 0 8

I t a l y

S A F E

C E S - D

F e a r o f f a l l i n g w a s p o s i t i v e l y a s s o c i a t e d w i t h d e p r e s s i v e

s y m p t o m s , p h y s i c a l w e a k n e s s a n d s l o w n e s s , a n d r e d u c e d

a c t i v i t i e s . D e p r e s s i o n m o d i f i e d t h e r e l a t i o n s h i p b e t w e e n f e a r

o f f a l l i n g a n d a c t i v i t y r e s t r i c t i o n .

n = 8 4 8

5 5 % w o m e n

F I C S I T - 4

M e a n a g e : 7 5 . 9 y e a r s ( S D : 6 . 4

)

R e p e a t e d c h a i r s t a n d


D y n a m o m e t e r

H a j j a r

2 0 0 9

U S A

G a i t s p e e d

C E S - D

T h e c o n f l u e n c e o f d e p r e s s i v e s y m p t o m s , s l o w n e s s , a n d p o o r

e x e c u t i v e f u n c t i o n d e s c r i b e a c o m m o n p h e n o t y p e t h a t i s

a s s o c i a t e d w i t h f u n c t i o n a l d e c l i n e .

n = 5 8 0

6 4 % w o m e n

T r a i l M a k i n g T e s t P a r t B

M e a n a g e : 7 7 . 8 y e a r s ( S D : 0 . 2

)

H o p k i n s V e r b a l L e a r n i n g T e s t

8 0 % W h i t e , 1

4 % B l a c k

C h a n g

2 0 1 0

U S A

C a r d i o v a s c u l a r H e a l t h S t u d y

F r a i l t y I n d e x

G D S

D e p r e s s i v e s y m p t o m s w e r e s i g n i f i c a n t l y a s s o c i a t e d w

i t h

f r a i l t y s t a t u s .

n = 6 2 0

1 0 0 % w o m e n

A g e r a n g e : 7 0 7 9 y e a r s

8 0 % W h i t e ; 2 0 % B l a c k

C h e n

2 0 1 0

T a i w a n

C a r d i o v a s c u l a r H e a l t h

S t u d y F r a i l t y I n d e x

C E S - D

D e p r e s s i v e s y m p t o m s w e r e s i g n i f i c a n t l y a s s o c i a t e d w

i t h

f r a i l t y s t a t u s .

n = 2 2 3 8

4 9 % w o m e n

A g e r a n g e : 6 5 1 0 3 y e a r s

1 0 0 % A s i a n

A D L s , a c t i v i t i e s o f d a i l y l i v i n g ( e . g . ,

h y g i e n e , d r e s s i n g , e a t i n g , t o i l e t i n g , b a s i c m o b i l i t y ) ; I A D L s , i n s t r u m e n t a l a c t i v i t i e s o f d a i l y l i v i n g ( e . g . ,

k e e p i n g a p p o i n t m e n t s , u s i n g t h e t e l e p h o n e , t r a v e l i n g , p r e p a r i n g

m e a l s , s h o p p i n g , h o u s e w o r k , m a n a g i n g m e d i c a t i o n s , m a n a g i n g f i n a n c e s ) ; G A R S , G r o n i n g e n A c t i v i t y R e s t r i c t i o n S c a l e ; O A R S , O

l d e r A m e r i c a n s R e s o u r c e s a n d S e r v i c e s ; S A F E , S u r v e y o f A c t i v i t i e s a n d

F e a r o f F a l l i n g i n t h e E l d e r l y ; F I C S I T , F r a i l t y a n d I n j u r i e s C o o p e r a t i v e S t u d i e s o f I n t e r v e n t i o n T e c h n i q u e s ; C E S - D , C e n t e r s f o r E p i d e m i o l o g i c S t u d i e s D e p r e s s i o n S c a l e ; G D S , G e r i a t r i c D e p r e s s i o n

S c a l e ; S H O R T - C A R E , C o m p r e h e n s i v e A s s e s s m e n t a n d R e f e r r a l E v a l u a t i o n S h o r t F o r m .


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T a

b l e 2

C o m m u n i t y - b a s e d c o h o r t s t u d i e s o f t h e r e l a t i o n s h i p b e t w e e n f r a i l t y a n d d e p r e s s i o n

F i r s t a u

t h o r

Y e a r

S a m p l e

c h a r a c

t e r i s t

i c s

L e n g t

h o f

f o l l o w - u p

M e a s u r e o f

f r a i

l t y

M e a s u r e o f

d e p r e s s i o n

M a i n f i n d

i n g s

F r a i l t y a s d e t e r m i n a n t , d e p r e s s i o n a s o u t c o m e

K e n n e d y

1 9 9 1

U S A

2 y e a r s

N u m b e r o f m e d i c a l c o n d i t i o n s

C E S - D

P o o r e r h e a l t h s t a t u s a n d u s e o f f o r m a l s u p p o r t

s e r v i c e s w e r e a s s o c i a t e d w i t h g r e a t e r p e r s i s t e n c e

o f d e p r e s s i v e s y m p t o m s .

n = 1 5 7 7

8 2 % w o m e n

A D L

i n d e x

A g e r a n g e :

6 5 + y e a r s

R a c i a l

c o m p o s i t i o n

u n k n o w n

U s e o f f o r m a l s u p p o r t s e r v i c e s

O r m e l

2 0 0 2

N e t h e r l a n d s

2 y e a r s

G A R S

H A D S

D i s a b i l i t y h a d a s t r o n g e r r e l a t i o n s h i p w i t h

w o r s e n i n g d e p r e s s i v e s y m p t o m s t h a n d e p r e s s i o n

h a d o n w o r s e n i n g d i s a b i l i t y .

n = 7 5 3

7 2 % w o m e n

M e a n a g e

( F ) : 7 3 y e a r s

( S D : 7 . 6

)

M e a n a g e

( M ) : 7 1 y e a r s

( S D : 8 . 7

)

R a c i a l


u n k n o w n

T a y l o r

2 0 0 4

U S A

1 0 y e a r s

A D L

a n d I A D L i n d i c e s

C E S - D

T r a j e c t o r i e s o f i n c r e a s i n g d i s a b i l i t y w e r e

s i g n i f i c a n t l y a s s o c i a t e d w i t h t r a j e c t o r i e s o f

i n c r e a s i n g d e p r e s s i v e s y m p t o m s .

n = 3 8 7 6

6 5 % w o m e n

M e a n a g e :

7 3 . 2 y e a r s

( S D : 6 . 4

)

4 6 % W h i t e ;


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F i r s t a u

t h o r

Y e a r

S a m p l e

c h a r a c

t e r i s t

i c s

L e n g t

h o f

f o l l o w - u p

M e a s u r e o f

f r a i

l t y

M e a s u r e o f

d e p r e s s i o n

M a i n

f i n d

i n g s

5 4 % B l a c k

Y a n g

2 0 0 5

U S A

3 y e a r s


C E S - D

O n s e t a n d p e r s i s t e n c e o f d i s a b i l i t y w e r e

s i g n i f i c a n t l y a s s o c i a t e d w i t h i n c r e a s e s i n

d e p r e s s i v e s y m p t o m s .

n = 1 3 0 0

6 3 % w o m e n

N a g i P h y s i c a l P e r f o r m a n c e s c a l e

M e a n a g e :

7 1 . 1 y e a r s

( S D : 5 . 1

)

4 6 % W h i t e ;

5 4 % B l a c k

M o d i f i e d R o s o w - B r e s l a u

H e a l t h S c a l e f o r t h e A g e d

S c h i e m a n

2 0 0 7

U S A

2 y e a r s

A D L i n d e x

H o p k i n s

F u n c t i o n a l l i m i t a t i o n s p r e d i c t e d i n c r e a s e s i n

d e p r e s s i v e s y m p t o m s a t f o l l o w - u p .

n = 8 9 8

S y m p t o m

5 0 % w o m e n

C h e c k l i s t

A g e : 6 5 + y e a r s

5 2 % W h i t e ;

4 8 % B l a c k

G a y m a n

2 0 0 8

U S A

3 y e a r s


C E S - D

F u n c t i o n a l l i m i t a t i o n s p r e d i c t e d i n c r e a s e s i n

d e p r e s s i v e s y m p t o m s ; d e p r e s s i o n o n l y w e a k l y

p r e d i c t i v e o f i n c r e a s e s i n f u n c t i o n a l l i m i t a t i o n s .

n = 1 4 9 5

5 4 % w o m e n

M e a n a g e :

P h y s i c a l m o b i l i t y

5 7 y e a r s

( S D : 1 7 )

2 4 % W h i t e ;

2 4 % C u b a n ;

2 2 % n o n -

C u b a n H i s p a n i c s ;

3 0 %

B l a c k

C h a n g

2 0 0 9

U S A

3 y e a r s

A D L i n d e x

G D S

I n c i d e n t d i s a b i l i t y s i g n i f i c a n t l y p r e d i c t e d

d e p r e s s i v e s y m p t o m s a t t h e t i m e o f d i s a b i l i t y

o n s e t .

n = 6 7 1

1 0 0 % w o m e n


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F i r s t a u

t h o r

Y e a r

S a m p l e

c h a r a c

t e r i s t

i c s

L e n g t

h o f

f o l l o w - u p

M e a s u r e o f

f r a i

l t y

M e a s u r e o f

d e p r e s s i o n

M a i n

f i n d

i n g s

A g e : 6 5 + y e a r s

7 2 % W h i t e ;

A m o n g t h o s e w i t h o u t d e p r e s s i o n ,

d i s a b i l i t y w a s n o t s i g n i f i c a n t l y a s s o c i a t e d w i t h

d e p r e s s i v e s y m p t o m s 6 m o n t h s p o s t - d i s a b i l i t y

o n s e t .

2 7 % B l a c k

D e p r e s s i o n a s d e t e r m i n a n t , f r a i l t y a s o u t c o m e

B u c h n e r

1 9 9 6

U S A

6 m o n t h s

G a i t s p e e d

C E S - D

W o r s e n i n g o f d e p r e s s i v e s y m p t o m s w a s

s i g n i f i c a n t l y a s s o c i a t e d w i t h g a i t s l o w i n g .

n = 1 5 2

L o w e r b o d y s t r e n g t h

A g e r a n g e :

6 5 8 5 y e a r s

5 5 % w o m e n

9 4 % W h i t e

S F - 3 6

S t r a w b r i d g e

1 9 9 8

U S A

2 9 y e a r s

I m p a i r m e n t s i n p h y s i c a l ,

n u t r i t i v e , c o g n i t i v e , a n d

s e n s o r y f u n c t i o n i n g

1 8 - i t e m

d e p r e s s i v e

s y m p t o m

s c a l e

D e p r e s s i v e s y m p t o m s a s s o c i a t e d w i t h g r e a t e r

l i k e l i h o o d o f f r a i l t y a t f o l l o w - u p .

n = 5 7 4

A g e r a n g e :

6 5 1 0 2 y e a r s

5 7 % w o m e n

8 2 % W h i t e

V a i l l a n t

1 9 9 8

U S A

5 5 y e a r s

M e d i c a l e x a m i n a t i o n

I M D D S

D e p r e s s i o n w a s a s s o c i a t e d w i t h l o w e r l i k e l i h o o d

o f e x p e r i e n c i n g n o p h y s i c a l l i m i t a t i o n s a t f o l l o w - u p .

n = 2 3 7

1 0 0 % m e n

M e a n a g e :

P h y s i c a l l i m i t a t i o n s

7 5 y e a r s

( S D : 2 )

R a c i a l


u n k n o w n

H e b e r t

1 9 9 9

C a n a d a

3 y e a r s

F u n c t i o n a l A u t o n o m y

M e a s u r e m e n t S y s t e m

G D S

D e p r e s s i o n w a s n o t s i g n i f i c a n t l y p r e d i c t i v e o f

f u n c t i o n a l d e c l i n e a t f o l l o w - u p .

n = 5 0 4

6 0 % w o m e n

M e a n a g e :

7 9 . 9 y e a r s


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F i r s t a u

t h o r

Y e a r

S a m p l e

c h a r a c

t e r i s t

i c s

L e n g t

h o f

f o l l o w - u p

M e a s u r e o f

f r a i

l t y

M e a s u r e o f

d e p r e s s i o n

M a i n

f i n d

i n g s

( S D : 3 . 9

)

R a c i a l


u n k n o w n

R a n t a n e n

2 0 0 0

U S A

3 y e a r s

H a n d g r i p s t r e n g t h

C E S - D

D e p r e s s i v e s y m p t o m s w e r e a s s o c i a t e d w i t h a

s t e e p e r d e c l i n e i n g r i p s t r e n g t h o v e r t i m e ,

p a r t i c u l a r l y a m o n g l o w - w e i g h t m e n .

n = 2 2 7 5

1 0 0 % m e n

B o d y w e i g h t

A g e r a n g e :

7 1 9 2 y e a r s

1 0 0 % A s i a n

S a r k i s i a n

2 0 0 0

U S A

4 y e a r s

A D L i n d e x

G D S

D e p r e s s i v e s y m p t o m s w e r e s i g n i f i c a n t l y

a s s o c i a t e d w i t h g r e a t e r f u n c t i o n a l d e c l i n e a t

f o l l o w - u p .

n = 6 6 3 2

1 0 0 % w o m e n

M e a n a g e :

7 3 y e a r s

( S D : 4 . 9

)

R a c i a l


u n k n o w n

M e h t a

2 0 0 2

U S A

2 y e a r s

A D L i n d e x

C E S - D

D e p r e s s i v e s y m p t o m s w e r e s i g n i f i c a n t l y p r e d i c t i v e

o f i n c i d e n t f u n c t i o n a l i m p a i r m e n t b u t n o t

w o r s e n i n g f u n c t i o n a l i m p a i r m e n t .

n = 5 6 9 7

6 4 % w o m e n

M e a n a g e :

7 7 y e a r s

( S D : 5 . 5

)

8 6 % W h i t e ;

1 0 % B l a c k

O s t i r

2 0 0 4

U S A

7 y e a r s

M o d i f i e d C a r d i o v a s c u l a r

H e a l t h S t u d y F r a i l t y I n d e x

C E S - D

P o s i t i v e a f f e c t w a s n e g a t i v e l y a s s o c i a t e d w i t h

i n c i d e n c e o f f r a i l t y .

n = 1 5 5 8

6 1 % w o m e n

M e a n a g e :


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F i r s t a u

t h o r

Y e a r

S a m p l e

c h a r a c

t e r i s t

i c s

L e n g t

h o f

f o l l o w - u p

M e a s u r e o f

f r a i

l t y

M e a s u r e o f

d e p r e s s i o n

M a i n

f i n d

i n g s

7 1 . 9 y e a r s

( S D : 5 . 7

)

1 0 0 % M e x i c a n

A m e r i c a n

W o o d s

2 0 0 5

U S A

3 y e a r s

C E S - D

n = 4 0 6 5 7




a s s o c i a t e d w i t h i n c i d e n t f r a i l t y .

1 0 0 % w o m e n

A g e r a n g e :

6 5 7 9 y e a r s

8 6 % W h i t e ;

6 . 5 % B l a c k

A v l u n d

2 0 0 6

F i n l a n d &

D e n m a r k

5 y e a r s

L o w e r L i m b T - S c a l e

C E S - D


a s s o c i a t e d w i t h f e e l i n g s o f t i r e d n e s s p e r f o r m i n g

d a i l y a c t i v i t i e s a t b a s e l i n e b u t d i d n o t p r e d i c t o n s e t

o f t i r e d n e s s a t f o l l o w - u p .

n = 5 4 6

5 5 % w o m e n

M u s c l e s t r e n g t h

A g e r a n g e :

F o r c e d e x p i r a t o r y v o l u m e

7 5 8 0 y e a r s

1 0 0 % W h i t e

A v l u n d

2 0 0 6

F i n l a n d a n d

D e n m a r k

5 y e a r s

P A D L - H S c a l e

C E S - D

D e p r e s s i v e s y m p t o m s w e r e a s s o c i a t e d w i t h o n s e t

o f d i s a b i l i t y , i n d e p e n d e n t f r o m f e e l i n g s o f

t i r e d n e s s .

n = 4 1 9

6 1 % w o m e n

M e a n a g e :

7 5 y e a r s

1 0 0 % W h i t e

H a n

2 0 0 6

U S A

2 y e a r s

A D L a n d I A D L s c a l e s

C E S - D

D e c l i n e s i n d e p r e s s i v e s y m p t o m s w e r e a s s o c i a t e d

w i t h b e t t e r s e l f - r a t e d h e a l t h a t f o l l o w - u p a m o n g

b o t h d i s a b l e d a n d n o n - d i s a b l e d o l d e r p e o p l e .

n = 6 7 7 1

A g e r a n g e :

6 5 + y e a r s

G e n d e r a n d r a c i a l

S e l f - r a t e d h e a l t h


u n k n o w n


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F i r s t a u

t h o r

Y e a r

S a m p l e

c h a r a c

t e r i s t

i c s

L e n g t

h o f

f o l l o w - u p

M e a s u r e o f

f r a i

l t y

M e a s u r e o f

d e p r e s s i o n

M a i n

f i n d

i n g s

A t k i n s o n

2 0 0 7

U S A

3 y e a r s

3 M S

C E S - D

D e p r e s s i v e s y m p t o m s m e d i a t e d t h e r e l a t i o n s h i p

b e t w e e n c o g n i t i v e f u n c t i o n i n g a n d g a i t s p e e d

c h a n g e .

n = 2 3 4 9

5 2 % w o m e n

C L O X 1

M e a n a g e :

E X I T 1 5

7 5 . 6 y e a r s ( S D :

2 . 9 )

6 3 % W h i t e ;

G a i t s p e e d

3 7 % B l a c k

X u e

2 0 0 7

U S A

3 y e a r s

C a r d i o v a s c u l a r H e a l t h

S t u d y F r a i l t y I n d e x

G D S

D e p r e s s i v e s y m p t o m s w e r e n o t s i g n i f i c a n t l y

a s s o c i a t e d w i t h i n c i d e n t f r a i l t y b u t w e r e

a s s o c i a t e d w i t h i n c r e a s e d f r a i l t y - f r e e m o r t a l i t y .

n = 5 9 9

1 0 0 % w o m e n

A g e : 6 5 + y e a r s

7 1 % n o n - B l a c k ;

2 9 % B l a c k

B a r r y

2 0 0 9

U S A

9 y e a r s

A D L i n d e x

C E S - D

D e p r e s s i v e s y m p t o m s p r e d i c t e d d e g r e e o f m i l d a n d

s e v e r e d i s a b i l i t y a t f o l l o w - u p .

n = 7 5 4

6 5 % w o m e n

A g e : 7 0 + y e a r s

> 9 0 % W h i t e

P a r k - L e e

2 0 0 9

U S A

4 y e a r s



C E S - D

[ P o s i t i v e

a f f e c t

s u b s c a l e ]

P o s i t i v e a f f e c t w a s a s s o c i a t e d w i t h l o w e r

i n c i d e n c e o f f r a i l t y , i n d e p e n d e n t f r o m d e p r e s s i v e

s y m

p t o m s .

n = 9 5 4

1 0 0 % w o m e n

M e a n a g e :

8 1 . 2 y e a r s

( S D : 3 . 7

)

8 7 % W h i t e

A D L s , a c t i v i t i e s o f d a i l y l i v i n g ( e . g . ,

h y g i e n e , d r e s s i n g , e a t i n g , t o i l e t i n g , b a s i c m o b i l i t y ) ; I A D L s , i n s t r u m e n t a l a c t i v i t i e s o f d a i l y l i v i n g ( e . g . ,

k e e p i n g a p p o i n t m e n t s , u s i n g t h e t e l e p h o n e , t r a v e l i n g , p r e p a r i n g

m e a l s , s h o p p i n g , h o u s e w o r k , m a n a g i n g m e d i c a t i o n s , m a n a g i n g f i n a n c e s ) ; G A R S , G r o n i n g e n A c t i v i t y R e s t r i c t i o n S c a l e ; O A R S , O

l d e r A m e r i c a n s R e s o u r c e s a n d S e r v i c e s ; S A F E , S u r v e y o f A c t i v i t i e s a n d

F e a r o f F a l l i n g i n t h e E l d e r l y ; F I C S I T , F r a i l t y a n d I n j u r i e s C o o p e r a t i v e S t u d i e s o f I n t e r v e n t i o n T e c h n i q u e s ; 3 M S , M o d i f i e d M i n i - M e n t a l S t a t u s E x a m i n a t i o n ; C L O X 1 , E x e c u t i v e C l o c k - D r a w i n g T a s k ;

E X I T 1 5 , E x e c u t i v e I n t e r v i e w ; S F - 3 6 , S

h o r t - F o r m H e a l t h S u r v e y ; P A D L - H S c a l e , P h y s i c a l A c t i v i t i e s o f D a i l y L i v i n g H e l p S c a l e ; C E S - D , C e n t e r s f o r E p i d e m i o l o g i c S t u d i e s D e p r e s s i o n S c a l e ; G D S ,

G e r i a t r i c D e p r e s s i o n S c a l e ; S H O R T - C A R E , C o m p r e h e n s i v e A s s e s s m e n t a n d R e f e r r a l E v a l u a t i o n S h o r t F o r m ; D P H S , D e p r e s s i o n H o m o g e n o u s S u b s c a l e ; D P D S , D e p r e s s i o n D i a g n o s t i c S u b s c a l e ; H A D S ,

H o s p i t a l A n x

Documents

Briana 2012