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Peer-reviewedCC BY 4.0PLOS One

Depressive symptoms are associated with the incidence of frailty in older adults with cardiometabolic diseases: Interaction between depression and diabetes

  • Fumino Kobayashi1
  • Yoshiaki Tamura2
  • Yuji Murao3
  • Kenji Toyoshima4
  • Kazuhito Oba5
  • Remi Kodera
  • Ai Iizuka
  • Yuko Chiba
  • Ayumi Toba
  • Takumi Hirata
  • Yumi Shindo
  • Joji Ishikawa
1 more authors
  • Atsushi Araki
5 affiliations
  1. 1Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
  2. 2Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
  3. 3Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
  4. 4Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
  5. 5Center for Cultivating and Enlightenment for Healthy Longevity, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Abstract

Background: Older adults with diabetes are prone to frailty and increased mortality. Aim: In this longitudinal study, we examined the association between depressive symptoms and the incidence of frailty in older people with cardiometabolic diseases. We also investigated whether comorbidities modified the association between depressive symptoms and incident frailty in this patient population. Methods: We analyzed longitudinal data from 431 outpatients aged 65 years or older with cardiometabolic diseases who visited a frailty clinic from 2015 to 2023. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS)-15. The outcome during follow-up (median, 2.9 years) was incident frailty, as defined by the modified Cardiovascular Health Study (mCHS) criteria or the Kihon Checklist (KCL). Hazard ratios (HRs) and 95% confidence intervals (CIs) for incident frailty were estimated using multivariable Cox regression models. Results: Depressive symptoms (GDS-15 ≥ 5) were independently associated with incident mCHS- and KCL-defined frailty across all models. The fully adjusted HRs for incident mCHS- and KCL-defined frailty were 1.92 and 2.05, respectively. Stratified analyses demonstrated consistent associations between depressive symptoms and incident frailty in participants with diabetes and hyperglycemia. Significant interactions between depressive symptoms and diabetes were observed for both mCHS- and KCL-defined frailty, whereas no significant interactions were observed for cognitive impairment or physical inactivity. Conclusion: Depressive symptoms were independently associated with incident frailty, as defined by both the mCHS and KCL criteria, in older outpatients attending a frailty clinic for cardiometabolic diseases. A significant interaction between depressive symptoms and diabetes was observed, suggesting that patients with coexisting depressive symptoms and diabetes may represent a high-risk group for incident frailty. Further studies are needed to determine whether interventions targeting depressive symptoms and diabetes management can reduce the risk of incident frailty.

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Cite

BibTeXRIS
BibTeX
@article{kobayashi2026depressive,
  title = {{Depressive symptoms are associated with the incidence of frailty in older adults with cardiometabolic diseases: Interaction between depression and diabetes}},
  author = {Fumino Kobayashi and Yoshiaki Tamura and Yuji Murao and Kenji Toyoshima and Kazuhito Oba and Remi Kodera and Ai Iizuka and Yuko Chiba and Ayumi Toba and Takumi Hirata and Yumi Shindo and Joji Ishikawa and Atsushi Araki},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0360802},
  url = {https://doi.org/10.1371/journal.pone.0360802},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Depressive symptoms are associated with the incidence of frailty in older adults with cardiometabolic diseases: Interaction between depression and diabetes
AU  - Fumino Kobayashi
AU  - Yoshiaki Tamura
AU  - Yuji Murao
AU  - Kenji Toyoshima
AU  - Kazuhito Oba
AU  - Remi Kodera
AU  - Ai Iizuka
AU  - Yuko Chiba
AU  - Ayumi Toba
AU  - Takumi Hirata
AU  - Yumi Shindo
AU  - Joji Ishikawa
AU  - Atsushi Araki
PY  - 2026
DA  - 2026/10/26
JO  - PLOS One
DO  - 10.1371/journal.pone.0360802
UR  - https://doi.org/10.1371/journal.pone.0360802
AB  - Background: Older adults with diabetes are prone to frailty and increased mortality. Aim: In this longitudinal study, we examined the association between depressive symptoms and the incidence of frailty in older people with cardiometabolic diseases. We also investigated whether comorbidities modified the association between depressive symptoms and incident frailty in this patient population. Methods: We analyzed longitudinal data from 431 outpatients aged 65 years or older with cardiometabolic diseases who visited a frailty clinic from 2015 to 2023. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS)-15. The outcome during follow-up (median, 2.9 years) was incident frailty, as defined by the modified Cardiovascular Health Study (mCHS) criteria or the Kihon Checklist (KCL). Hazard ratios (HRs) and 95% confidence intervals (CIs) for incident frailty were estimated using multivariable Cox regression models. Results: Depressive symptoms (GDS-15 ≥ 5) were independently associated with incident mCHS- and KCL-defined frailty across all models. The fully adjusted HRs for incident mCHS- and KCL-defined frailty were 1.92 and 2.05, respectively. Stratified analyses demonstrated consistent associations between depressive symptoms and incident frailty in participants with diabetes and hyperglycemia. Significant interactions between depressive symptoms and diabetes were observed for both mCHS- and KCL-defined frailty, whereas no significant interactions were observed for cognitive impairment or physical inactivity. Conclusion: Depressive symptoms were independently associated with incident frailty, as defined by both the mCHS and KCL criteria, in older outpatients attending a frailty clinic for cardiometabolic diseases. A significant interaction between depressive symptoms and diabetes was observed, suggesting that patients with coexisting depressive symptoms and diabetes may represent a high-risk group for incident frailty. Further studies are needed to determine whether interventions targeting depressive symptoms and diabetes management can reduce the risk of incident frailty.
SN  - 1932-6203
ER  -