Depression in Older Men Increases Future Risk for Functional, Physical Impairment

A recent study in the Journal of the American Medical Association found that nonfrail older men with current or a past history of depression demonstrated greater impairment of functional and physical capacity (2017;18[1]:65-69).

A previous study by the study’s authors, Osvaldo P Almeida, MD, PhD, University of Western Australia (Perth, Australia), and colleagues, showed that the excess mortality associated with depression over a 4-year period is strongly associated with concurrent frailty; these results pointed to the hypothesis that depressive symptoms later in life may lead to a decline in physical and functional capacity. 

To test the hypothesis, Dr Almeida and coauthors conducted a prospective longitudinal study of 1148 men aged 70 to 87 years who were living in a metropolitan community between 2001-2004 and completed a follow-up assessment of physical and functional capacity. 

Outcomes, gathered from 2011-2012, included four measures of physical function (timed up-and-go, timed sit-to-stand, functional reach, step test), the assessment of basic activities of daily living, and instrumental activities of daily living. Information was also collected on depression and frailty using the FRAIL—fatigue, resistance, ambulation, illness, and loss of weight—scale in 2001-2004 and 2011-2012.

At the 2001-2004 assessment, researchers found that men with a history of depression showed significantly worse performance than their counterparts in the timed sit-to-stand and step tests 9 years later. They also had about two times the risk of getting the lowest decile of performance in both tests. 

In addition, the adjusted risk ratio of impaired instrumental activities of daily living was 58% (CI, 95%, 116%) greater for men with than without history of past depression. These associations were particularly strong for men with current depression at the 2001-2004 assessment.

Authors concluded: “From a clinical point of view, these results suggest that the physical and occupational capacity of older men with history of depression should be monitored on a regular basis and that interventions designed to improve physical function should also decrease the risk of frailty…. It seems possible that this deteriorating trajectory could be averted with suitably tailored interventions, such as physical activity.” —Amanda Del Signore