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Objectives: Frailty is a common geriatric disorder associated with ADL impairment, hospitalization, and death. Phenomenological evidence suggests that late-life depression (Katz, 2004), particularly vascular depression, may be a risk factor for frailty. This study tests that hypothesis.

Methods: We identified a sample of stroke-free women over the age of 80 from the Health and Retirement Survey. The sample included 984 respondents in 2000 (incidence sample). Of these, 459 were non-frail at baseline and still alive in 2004 (prevalence sample). Frail respondents experienced at least three of the following: wasting, exhaustion, weakness, slowness, and falls. Vascular depression was represented using two dummy variables. The first repre-sented respondents with either high CVB (at least two cerebrovascular risk factors) or probable depression (score ≥ 3 on the 8-item CES-D), and the second represented respondents with both high CVB and probable depression.

Results: At baseline, the prevalence of frailty was 31.5%. Over 4 years the incidence of frailty was 31.8%. After controlling for age, education, ADL and IADL disability, arthritis, pulmonary disorders, cancer, and self-rated health, respondents with either high CVB or probable depression were more likely to be frail at baseline, and those with both were at even higher risk. Of those who were not frail at the 2000 wave, respondents who reported both high CVB and probable depression were more likely to become frail by 2004.

Discussion: These findings suggest that vascular depression is a prodrome for frailty.


Psychiatry and Psychology | Psychology | Social and Behavioral Sciences


This is an Author's Accepted Manuscript, formatted for archiving, of an article published as Paulson, D. and Lichtenberg, P.A. (2013). Vascular depression: an early warning sign of frailty. Aging & Mental Health 7(1): 85-93. [copyright Taylor & Francis], available online at: