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J Am Geriatr Soc. Author manuscript; available in PMC 2017 April 01. Published in final edited form as: J Am Geriatr Soc. 2016 April ; 64(4): 824–830. doi:10.1111/jgs.14023.

Spousal Associations between Frailty Status and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study Joan Monin, PhD1, Margaret Doyle, MPH1, Becca Levy, PhD1, Richard Schulz, PhD2, Terri Fried, MD3, and Trace Kershaw, PhD1

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1Social

and Behavioral Sciences, Chronic Disease Epidemiology, Yale School of Public Health

2University 3VA

Center for Social and Urban Research, University of Pittsburgh

Connecticut Healthcare System; Geriatrics, Yale School of Medicine

Abstract Objectives—To determine whether older adult spouses’ frailty states and depressive symptoms are interrelated over time. Design—Longitudinal, dyadic path analysis with the Actor Partner Interdependence Model.

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Setting—Data were from baseline (1989–1990), wave 3 (1992–1993), and wave 7 (1996–1997), all waves in which frailty and depressive symptoms were measured, of the Cardiovascular Health Study (CHS), a multi-site, longitudinal, observational study of risk factors for cardiovascular disease in adults 65 years or older. Participants—Each spouse within 1,260 community-dwelling, married couples. Measurements—Frailty was measured using the CHS criteria, categorized as nonfrail, prefrail, or frail. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression scale. Results—Within individuals (actor effects), higher frailty status predicted greater subsequent depressive symptoms, and greater depressive symptoms predicted higher subsequent frailty status. Between spouses (partner effects), an individual’s greater frailty status predicted the spouse’s increased frailty status, and an individual’s greater depressive symptoms predicted the spouse’s increased depressive symptoms.

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Corresponding Author: Joan K. Monin, PhD, Yale School of Public Health, 60 College Street, New Haven, CT 06520, phone: 203 785 2895, fax: 203 785 6980, [email protected]. Alternate Corresponding Author: [email protected] Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Joan Monin was responsible for the design, methods, analysis and preparation of the paper. Margaret Doyle assisted with data management and preparation of the paper. Becca Levy assisted with the design and preparation of the paper. Richard Schulz and Terri Fried assisted with preparation of the paper. Trace Kershaw assisted with design, analysis, and preparation of the paper.

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Conclusion—Frailty and depressive symptoms are interrelated among older adult spouses. For older couples, interventions for preventing or treating frailty and depression that focus on couples may be more effective than those that focus on individuals. Keywords frailty; depression; dyadic analysis

INTRODUCTION

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Frailty is a syndrome that predicts vulnerability to disability, and it affects one in ten older 1 adults. ,2 According to Fried et al (2001), a person is considered frail if he or she has three or more of the following criteria: unintentional weight loss (10 lbs in past year), selfreported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. One or two of these characteristics indicates that a person is prefrail. Frailty has been associated with an increased risk of disability, falls, hospitalization, and a shorter 2 2 lifespan. ,3 Research has also shown that frailty and depression are highly related. ,4 However, when examining frailty and depression, information about social environmental influences is missing. For older married adults, spouses tend to have similar characteristics, engage in shared activities, and live in the same environment, making their health 5 6 interdependent. There is evidence of effective interventions to prevent and treat frailty and 7 depression separately in individuals; however, if spouses’ frailty and depressive symptoms are intertwined, there may be synergistic effects on health when interventions address both frailty and depressive symptoms and are designed for couples.

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Although no research to our knowledge has examined spousal associations in frailty and depressive symptoms, studies have documented spousal associations in instrumental 8 9 activities of daily living , physical activity , and depressive symptoms. It is proposed that one spouse’s frailty influences the other spouse’s depressive symptoms through multiple mechanisms. First, spouses of frail individuals frequently act as caregivers, and caregiving 10 can lead to depression. Second, frail spouses are often depressed which can be 11 contagious. Depressive symptoms may lead to increased frailty through different 12 mechanisms. Depression can reduce the couple’s social activity. ,13 Also, depressed spouses may lack the energy to provide support to their partners exacerbating the partner’s 14 health problems. Multiple relationship theories also suggest that one person’s frailty can impact their partner’s depressive symptoms directly. For example, Inclusion of the Other in the Self theory states that individuals incorporate the characteristics of their partners (e.g., 15 frailty) into their own sense of well-being.

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In this study we first hypothesized that within each individual greater frailty status would predict increases in subsequent frailty status, and greater depressive symptoms would predict increases in subsequent depressive symptoms (H1a and b; actor effects). Second, we hypothesized that an individual’s greater frailty status would predict increases in the spouse’s frailty status; we expected the same for depressive symptoms (H2a and b; partner effects). Third, we hypothesized that within individuals there would be a bidirectional association between frailty and depressive symptoms (H3; actor effects). Fourth, we

J Am Geriatr Soc. Author manuscript; available in PMC 2017 April 01.

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hypothesized a bidirectional association between an individual’s frailty status and the spouse’s depressive symptoms (H4; partner effects). We test our hypotheses using the Actor 16 Partner Interdependence Model (APIM ) that takes into account how couple members’ data is related.

METHODS Data and Sample Characteristics

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Data was from the Cardiovascular Health Study (CHS), a population- based longitudinal study designed to determine risk factors for cardiovascular disease in adults 65 years or older. The CHS recruited participants from four U.S. communities: Forsyth County, NC; Sacramento County, CA; Washington County, MD; and Pittsburgh, PA. Participants underwent annual clinical examinations and structured interviews. The present study includes data from three waves: baseline (1989/1990), wave 3 (1992/1993), and wave 7 (1996/1997). The CHS sample included 5,201 individuals enrolled in 1989/1990, with an additional cohort of 687 African Americans enrolled in 1992/1993. See Fried et al. (1991) 17 for more information about the design and sample. Measures

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Frailty—Frailty was defined using CHS criteria, which include deficits in five areas: low 2 weight, physical inactivity, exhaustion, weakness, and slowness. Low weight was defined as a self-reported or calculated loss of 10% or more in body mass index (BMI) since the previous wave or as a current BMI of

Spousal Associations Between Frailty and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study.

To determine whether older adult spouses' frailty states and depressive symptoms are interrelated over time...
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