Associação entre fragilidade e sintomas depressivos em idosos institucionalizados

Abstract

The aim of this study was to analyze the presence of depressive symptoms among institutionalized pre-frail and frail older adults and to establish a relationship between these outcomes. This is an analytical cross-sectional study. The sample consisted of 67 older adults of both sexes from four long-term care facilities, located in the city of Rio de Janeiro (RJ). For the assessment, the operational definition of the Frailty phenotype, proposed by Fried, was used, given by 5 components: unintentional weight loss, handgrip strength, gait speed, level of physical activity and self-reported exhaustion. Depressive symptoms were measured using the Geriatric Depression Scale (GDS-30). The Mini Mental State Examination was used as a screening tool for the elderly's global cognition. Descriptive statistics were used to characterize the sample. Data were presented in frequency, mean (±standard deviation), median (minimum and maximum values) and proportion (%). To compare the categorical variables, the chi-square test was performed. The Kolmogorov-Smirnov test was performed to test the normality of continuous and ordinal variables. According to the distribution of normality, the independent T-test and Mann Whitney U-test were used to compare the groups of frail and pre-frail older adults and depressive symptoms between the sexes, according to the conceptual assumptions for parametric and nonparametric tests. A binary logistic regression was performed to test the association between frailty and depressive symptoms. It was observed that 34 (52.2%) of the older adults were frail, while the others were pre-frail. Women were the majority of the sample (64%) and presented a higher frequency of frailty (62.8%, χ²=5.357, p=0.02). However, the presence of depressive symptoms did not differ between sexes (U=420,500, p=0.31). The pre- frail older adults had higher means in the global cognition screening scores (t=2.766, p<0.01) and there was no difference in age between the groups (U=435.000, p=0.11). Depressive symptoms were more frequent in frail older people (61.8%) than in pre-frail (36.4%). The frail older adults had a higher median of depressive symptoms (11, IIQ=10) than the pre-frail older adults (7, IIQ10; U=365.500, p=0.01). It was estimated that frail older adults were 2.8 times more likely to have depressive symptoms (OR=2.8, 95%CI 1.05-7.61, p=0.04). The frail state in the institutionalized older people evaluated in this study was associated with a greater presence of depressive symptoms, with an estimated chance almost 3 times greater in relation to pre-frail older adults. These findings highlight the possibilities of a relationship between frailty and depressive symptoms and demonstrate the importance of a careful evaluation and analysis of this association in institutionalized older people, in view of the potential negative impacts on health and mortality of older adults.