Archives of Gerontology and Geriatrics 76 (2018) 196–201

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Archives of Gerontology and Geriatrics

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Association of sarcopenia with depressive symptoms and functional status T

among ambulatory community-dwelling elderly
⁎
Asli Kilavuza, , Reci Meserib, Sumru Savasa, Hatice Simsekc, Sevnaz Sahina,
Derya Hopanci Bicaklid, Fulden Saraca, Mehmet Uyare, Fehmi Akciceka
a
Division of Geriatrics, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey
b
Department of Nutrition and Dietetics, Ege University Faculty of Health Sciences, İzmir, Turkey
c
Department of Public Health, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
d
Division of Medical Oncology, Tulay Aktas Oncology Hospital, Ege University Faculty of Medicine, Izmir, Turkey
e
Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey

A R T I C LE I N FO A B S T R A C T

Keywords: Objective: Sarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is
Depression associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even
Elderly mortality. This study aims to determine the association of sarcopenia with depression and functional status
Functional disability among ambulatory community-dwelling elderly aged 65 years and older.
Sarcopenia
Materials and method: The sample of this cross-sectional study consisted of 28,323 people, aged 65 years and
IADL
older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However,
966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data
were collected by the interviewers at home through face-to-face interview.
Results: The mean age was 72.2 ± 5.8 (65–100) years. The prevalence of functional disability, depressive
symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was
associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/mod-
erate, increased number of chronic diseases, and having at least one physical disability. IADL associated func-
tional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications,
and the BMI.
Conclusion: Sarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive
symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional
disability and depression. Appropriate interventions should also be implemented.

1. Introduction function (strength or performance) (Cruz-Jentoft et al., 2010).

Geriatric syndromes are common in the elderly. They impair the
quality of life, and increase morbidity and mortality (Anpalahan &
Gibson, 2008; Cigolle, Langa, Kabeto, Tian, & Blaum, 2007). Geriatric
syndromes include depression, sarcopenia, and functional disability are
among (Inouye, Studenski, Tinetti, & Kuchel, 2007).
Sarcopenia is defined as the decrease in skeletal muscle mass and
quality due to increasing age (Roubenoff, Heymsfield, Kehayias,
Cannon, & Rosenberg, 1997). The European Working Group on Sarco-
penia in Older People (EWGSOP) recommends that sarcopenia be de-
fined through the presence of both low muscle mass and low muscle
Sarcopenia is associated with the disability in basic activities of
daily living (ADL) (Hairi et al., 2010; Tanimoto et al., 2013) and in-
strumental activities of daily living (IADL) (Baumgartner et al., 1998;
Da Silva, De Oliveira Duarte, Ferreira Santos, Wong, & Lebrao, 2014;
Hairi et al., 2010; Janssen, Heymsfield, & Ross, 2002; Rolland et al.,
2003; Tanimoto et al., 2012).
Depression is associated with several factors such as female gender,
living alone, low income and education levels, poor social support, and
disability on daily work (Lapid & Rummans, 2003; Tiemeier, 2003).
Yesavage et al. reported that physical illness, malnutrition, and poly-
pharmacy were also among the factors that triggered depression

⁎
Corresponding author at: Division of Geriatric Medicine, Department of Internal Medicine, 5th Floor, Ege University School of Medicine, Bornova, Izmir, 35100, Turkey.
E-mail addresses: asli.kilavuz@ege.edu.tr (A. Kilavuz), reci.meseri@ege.edu.tr (R. Meseri), emine.sumru.savas@ege.edu.tr (S. Savas), hatice.simsek@deu.edu.tr (H. Simsek),
sevnaz.sahin@ege.edu.tr (S. Sahin), derya.bicakli@ege.edu.tr (D.H. Bicakli), fulden.sarac@ege.edu.tr (F. Sarac), mehmet.uyar@ege.edu.tr (M. Uyar),
selahattin.fehmi.akcicek@ege.edu.tr (F. Akcicek).

https://doi.org/10.1016/j.archger.2018.03.003
Received 24 August 2017; Received in revised form 26 February 2018; Accepted 1 March 2018
0167-4943/ © 2018 Elsevier B.V. All rights reserved.
A. Kilavuz et al.
(Yesavage, 1993). Chang et al. have reported a positive association
between sarcopenia and depression in their review (Chang, Hsu, Wu,
Huang, & Han, 2017). Similarly, many studies have shown that de-
pressive disorders were associated with sarcopenia (Hsu et al., 2014;
Kim et al., 2011).
Sarcopenia is associated with physical disability, inactivity, cardi-
ometabolic disease, and even mortality, as well as the depressive dis-
orders that are strongly related to functional impairment and physical
inactivity in elderly (Kim et al., 2011). There may be an association
between sarcopenia, depression and functional status. However, few
studies exist on the association of sarcopenia with functional status and
depressive symptoms in elderly population. This study aimed to de-
termine the association of depression and functional status with sar-
copenia among ambulatory community-dwelling elderly.
2. Methods
2.1. Subjects
This study was conducted in Bornova District, Izmir, between
February and March 2015.
The sample of this cross-sectional study consisted of 28,323 com-
munity-dwelling people aged 65 years and older who were living in an
urban area, the center of Bornova District in Izmir. A multi-stage sample
selection was performed. The prevalence of functional disability and
depression is about 15% in the community-dwelling elderly, whereas
the prevalence of sarcopenia is 10%. As the prevalence of sarcopenia is
lower than the prevalence of functional disability and depression, the
minimum sample size was calculated as 839 elderly people, assuming
sarcopenia prevalence as 10%, at a 2% error and 95% confidence limit.
Twenty percent of this minimum sample size was added for non-
response. The aim was to reach 1007 individuals. The neighborhoods
were stratified based on three different socio-economic characteristics,
and a random neighborhood was selected from each layer. All the el-
derly people on the randomly selected streets were included in the
study. The researchers tried to reach 2430 elderly people, but 222 of
them refused to participate in the study, 965 were not at home, 205 had
moved elsewhere, and 72 were identified to be exitus. As a result, 966
elderly people were reached and screened, and then 861 elderly people
who can walk were included in the study.
The data were collected using a 46-item questionnaire prepared by
the researchers. Sociodemographic characteristics such as age, gender,
marital status, education status, living status, perceived economic si-
tuation, smoking status, alcohol intake, self-reported comorbidities
(e.g., diabetes, arterial hypertension, cancer, heart disease, dementia,
and depression), medications, and presence of disability (visual,
hearing, and physical) were recorded. Body mass index (BMI) values
were calculated by dividing weight (kg) by squared height (m2).
2.2. Determination of depressive symptoms
The severity of depression was evaluated using the Turkish version
of the 15-item Geriatric Depression Scale-Short Form (GDS-SF), which
was standardized in 1997 after its reliability and validity were tested by
Ertan, Eker, and Şar (1997) (Sheikh & Yesavage, 1986). The partici-
pants answered the questions as yes or no. A score of 0–5 was normal. A
score higher than 5 suggested depression.
2.3. Assessment of functional status
2.3.1. Basic activities of daily living
Barthel index was used to assess basic ADL. The individual items
were feeding, moving from wheelchair to bed and returning to wheel-
chair (including sitting up in bed), personal toilet habits (washing face,
combing hair, shaving, and cleaning teeth), getting on and off toilet
(handling clothes, wiping, and flushing), bathing self, walking on level
197
Archives of Gerontology and Geriatrics 76 (2018) 196–201
surface, ascending and descending stairs, dressing (includes tying shoes
and fastening fasteners), controlling bowels, and controlling bladder
(Mahoney & Barthel, 1965). The total score ranged from 0 to 100. A
score of 60 was determined to be the cutoff, and a score higher than 60
was accepted as the ability to function independently (Tuncay &
Mollaoğlu, 2006).
2.3.2. Instrumental activities of daily living
Lawton–Brody index was used for IADL. A 5-score item was used for
men (shopping, medication management, money management, trans-
portation, and telephone), and an 8-score item was used for women
(preparing meals, shopping, medication management, money manage-
ment, transportation, telephone, housekeeping, and laundry). Each
participant received a score of 1 for each item if his/her competence
was at the minimal level or higher. If the total score was ≤6 for elderly
women, they were classified as dependent. The elderly men were
classified as a dependent if their score was between 0 and 3 (Lawton &
Brody, 1969).
2.4. Sarcopenia diagnosis
The EWGSOP criteria were adopted. The diagnosis of sarcopenia
required the documentation of low muscle mass plus either low muscle
strength or low physical performance (Cruz-Jentoft et al., 2010).
2.4.1. Muscle mass measurement
The muscle mass was measured through the calf circumference
(CC). If the CC was lower than 31 cm, muscle mass was classified as low
(Rolland et al., 2003).
2.4.2. Muscle strength measurement
The muscle strength was measured using the Takei T.K.K. Grip D
digital hand grip dynamometer (Takei Scientific Instruments Co. Ltd,
Tokyo, Japan). The highest of the three measured values were taken as
the final strength of the dominant hand. The cutoff points in the
EWGSOP consensus paper were used for the muscle strength (Cruz-
Jentoft et al., 2010). A muscle strength of < 30 kg for men and < 20 kg
for women was classified as low (Lauretani et al., 2003).
2.4.3. Physical performance measurement
The physical performance was assessed using the 6-m walking test.
The International Working Group defined the gait speed less than 1 m/s
to be slow (Cruz-Jentoft et al., 2010).
2.5. Data collection
The data were collected by trained nutrition and dietetic students
(n = 15) at home through face-to-face interviews. Prior to the study,
the researcher provided the students with a standard training on the
data collection forms, measurements and communication skills. After
administering the questionnaire and measurements to each other and
the researchers, they administered them to ten person aged 65 years or
older from outside the study universe as a pilot study.
2.6. Statistical analysis
All statistical analyses were performed using the SPSS software
version 17.0 (SPSS Inc., IL, USA). Continuous variables were presented
as means ± standard deviation, and classified variables were pre-
sented as percentages. The t test or chi-square test (Fisher’s exact test
where necessary) was used to determine the factors that affect de-
pression and functional disability scores in the univariate analyses.
Logistic regression models were established to determine the factors
that affect the presence of depression and functional disability. The
presence of sarcopenia was modeled with variables that were sig-
nificant in univariate analyses. A P value < 0.05 was accepted to be
A. Kilavuz et al. Archives of Gerontology and Geriatrics 76 (2018) 196–201

Table 1
Sociodemographic and clinical characteristics of the participants based on the presence of depressive symptoms and functional disability.

Characteristics Total n (%) Presence of depressive symptoms n (%) Functional disability according to IADL index n (%)

Age (year)
65–74 614 (71.3) 158 (25.7) 99 (16.1)
75–84 218 (25.3) 50 (22.9) 69 (31.7)
85+ 29 (3.4) 9 (31.0) 19 (65.5)
Gender
Women 507 (58.9) 161 (31.8) 157 (31.0)
Men 354 (41.1) 56 (15.8) 30 (8.5)
Education
Illiterate 265 (30.8) 103 (37.5) 123 (44.7)
Literatea 596 (69.2) 114 (37.2) 64 (20.6)
Marital status
Married 570 (66.2) 114 (20) 85 (14.9)
Not marriedb 291 (33.8) 103 (35.4) 102 (35.0)
Living position
Living alone 126 (14.6) 49 (38.9) 52 (13.5)
Living with familyc 735 (85.4) 168 (70.5) 152 (43.1)
Perception of the economic situation
Good–extremely good 115 (13.3) 11 (9.6) 106 (19.1)
Moderate 554 (64.4) 124 (22.4) 64 (33.3)
Poor–extremely poor 192 (22.3) 82 (42.7) 99 (16.1)
Smoking status
No smoking 530 (61.6) 152 (28.7) 145 (27.4)
Smokingd 330 (38.4) 65 (43.5) 42 (25.2)
Alcohol
None 800 (92.9) 208 (26) 186 (23.3)
Present 61 (7.1) 9 (14.8) 1 (1.6)
Number of diseases
0 106 (12.3) 15 (14.2) 12 (11.3)
1+2 504 (58.5) 109 (43.2) 104 (41.2)
3+ 251 (29.2) 93 (37.1) 71 (28.3)
Number of medications
0 130 (15.1) 22 (16.9) 14 (10.8)
1–4 568 (66.0) 144 (53.6) 117 (42.4)
5+ 251 (18.9) 51 (31.3) 56 (34.4)
e
Disability
None 155 (18.0) 24 (15.5) 31 (20.0)
Present 706 (82.0) 193 (27.3) 156 (22.1)
BMI
< 22 52 (6.0) 11 (21.2) 17 (32.7)
≥22 809 (94.0) 205 (25.4) 169 (20.9)
Sarcopenia
Present 40 (4.6) 13 (32.5) 16 (40.0)
None 821 (95.4) 204 (24.8) 171 (20.8)

*
Pearson chi-square test; **Fisher's exact test.
a
Literate + primary school + middle school + high school + university and over.
b
Single + widow + divorced.
c
With spouse + with spouse–children + with children–grandchildren.
d
Quit smoking + smoking.
e
One of visual, hearing, physical disability and their combinations.

significant. Depressive symptoms were similar between different age groups

(65–74, 75–84, and > 85 years) (25.7%, 22.9%, and 31.0%;
P = 0.546). However, functional disability in IADL was significantly
3. Results
higher for individuals older than 85 years (65.5%) than for the other
age groups. (65–74 and 75–84 years) (16.1% and 31.7%; P < 0.0001).
A total of 966 individuals were reached, and 861 elderly people
Functional dependency in IADL and depressive symptoms were sig-
meeting the inclusion criteria were included in the study.
nificantly higher in women than in men (P < 0.0001, and
The mean age of the sample population was 72.2 ± 5.8 (65 to 100)
P < 0.0001, respectively) (women: 31.0% and 31.8%; men: 8.5% and
years; 71.3% of the participants were aged between 65 and 74 years,
15.8%, respectively).
and 58.9% of them were women. The mean ages of women and men
The sarcopenic elderly were more dependent in ADL (7.5%) com-
were similar (72.1 ± 6 and 72.41 ± 5.6, respectively, P = 0.28).
pared to the nonsarcopenic elderly (0.7%; P = 0.006). Similarly, ac-
Table 1 shows the sociodemographic and clinical characteristics of the
cording to IADL, functional disability was significantly higher in the
population according to the presence of depressive symptoms and
sarcopenic elderly (n = 16, 40%) than in the nonsarcopenic elderly
functional disability.
(n = 171, 20.8%; P = 0.009).
The prevalence of depressive symptoms was 25.2% among the
Only 9 participants had the ADL disability. Therefore, logistic re-
participants. Also, the prevalence of functional disability in ADL and
gression analysis was conducted only for depression symptoms and
IADL was 1.0% and 21.7%, respectively. The EWGSOP algorithm in-
functional disability in IADL.
dicated 40 participants (n = 40, 4.6%) to be sarcopenic. Fig. 1 shows
Table 2 shows the factors associated with depressive symptoms and
the frequency of participants' diagnosis of sarcopenia according to the
functional disability in IADL according to multivariate analysis. The
EWGSOP.

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A. Kilavuz et al. Archives of Gerontology and Geriatrics 76 (2018) 196–201

Study sample
Subjects ш 65
years
n = 861
Women = 507
Men = 354 Low
(<1 m/sn)
n = 495
Normal CC
ш 31 cm
Gait speed No sarcopenia
n = 584
ш1 m/sn)
Muscle mass

Grip strength
Sarcopenia
Normal
n = 40, 4.6%
30 kg men Low
<30 kg formen Low CC < 31 cm
kg women
<20 kg for women
n = 129

No sarcopenia
n = 237

Fig. 1. Frequency of participants' diagnosis of sarcopenia according to EWGSOP.

rate of functional disability in IADL was 2.9 times higher in the sar-
copenic participants compared to the nonsarcopenic participants
(OR = 2.91, P = 0.02, 95% CI = 1.18–7.17). In addition, depressive
symptom rate was 2.5 times higher in sarcopenic elderly people
(OR = 2.55, P = 0.03, 95% CI = 1.11–5.88).
Age (continuous), gender (reference group; male), education (re-
ference group; university and over), marital status (reference group;
married); the perception of the economic situation (reference group;
extremely good–good); living position (reference group; with spou-
se–children).
4. Discussion
The present study showed that sarcopenia was associated with de-
pression and functional disability in IADL in the elderly. Sarcopenia was
defined by muscle strength, physical performance, and muscle mass,
which was based on the EWGSOP guidelines (Cruz-Jentoft et al., 2010).
Depressive symptoms in the elderly were evaluated using specific
screening scales designed for the elderly people. In population-based
studies, the prevalence of depressive symptoms in the elderly was be-
tween 11.0% and 48.0% (NIH Consensus Conference, 1992). Previous
studies in Turkey found the rate of depressive symptoms to be 29%,

Table 2
Factors associated with depressive symptoms and functional disability.

Presence of depressive symptoms Functional disability according to IADL index

Variable (reference group) P Exp(B) 95% CI P Exp(B) (OR) 95% CI

(OR)
Age (continuous) 0.26 0.98 0.95–1.01 < 0.0001 1.11 1.07–1.15
Gender (men) Women 0.82 0.94 0.56–1.58 0.02 2.14 1.14–4.01
Education (university and over) Illiterate 0.01 2.80 1.23–6.39 < 0.001 7.71 2.45–24.23
Literate 0.27 1.66 0.67–4.09 0.05 3.33 1.00–11.11
Primary 0.76 1.12 0.53–2.40 0.48 1.50 049–4.58
Middle 0.54 1.33 0.53–3.37 0.21 2.26 0.63–8.05
High 0.99 0.99 0.39–2.56 0.53 0.61 0.13–2.83
Marital status (married) Widow 0.19 1.67 0.77–3.61 0.62 1.23 0.54–2.78
Divorced 0.02 3.72 1.26–11.01 0.41 1.72 0.47–6.21
Perception of the economic situation Moderate 0.02 2.22 1.11–4.44 0.45 1.30 0.65–2.58
(good–extremely good) Extremely poor–poor < 0.0001 4.83 2.33–10.02 0.06 2.07 0.98–4.36
Living position (with spouse–children) Alone 0.26 1.66 0.69–3.99 0.16 0.49 0.18–1.32
With spouse 0.11 1.51 0.91–2.51 0.51 0.82 0.46–1.46
With children– 0.91 1.05 0.47–2.35 0.38 1.45 0.63–3.34
grandchildren
Number of diseases (continuous) < 0.0001 1.40 1.18–1.67 0.92 0.99 0.82–1.20
Number of medications (continuous) 0.80 0.99 0.91–1.08 < 0.0001 1.15 1.05–1.26
Ability (none) Present 0.01 2.01 1.21–3.35 0.29 1.34 0.78–2.32
Alcohol (none) Present 0.91 0.95 0.41–2.19 0.25 0.30 0.04–2.40
Smoking (no smoking) Quit smoking 0.12 0.67 0.41–1.11 0.83 1.06 0.60–1.90
Smoking 0.28 1.37 0.77–2.44 0.99 0.99 0.45–2.19
BMI, kg/m2(continuous) 0.02 1.04 1.00–1.07 0.03 1.04 1.00–1.08
Sarcopenia (none) Present 0.03 2.55 1.11–5.88 0.02 2.91 1.18–7.17

OR, Odds ratio; CI, confidence interval.

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11.0%, and 56.6% using different scales. (Dişçigil, Gemalmaz, Başak,
Gürel, & Tekin, 2005). The rate of depressive symptoms was 25.2% in
the present study, in accordance with the literature.
Many risk factors directly influence depression: female gender,
living alone, low income and less education, poor social support, and
disability on daily work, and others (Lapid & Rummans, 2003;
Tiemeier, 2003). In the present study, depression was related to many
risk factors in the elderly suggested by some studies, which might be
explained by the perception of poor economic situation (Magni,
Marchetti, Moreshi, Merskey, & Luchini, 1993; Papadopoulos et al.,
2005), less education (Forsell, 2000; Harlow, Goldberg, & Comstock,
1991; Magni et al., 1993; Roberts, Shema, Kaplan, & Strawbridge,
2000), be divorced (Wilson, Chen, Taylor, McCracken, & Copeland,
1999), comorbidities (Gomez & Gomez, 1993), physical ability
(Bekaroğlu, Uluutku, Tanrıöver, & Kırkpınar, 1991), obesity (Carpenter,
Hasin, Allison, & Faith, 2000; Heo, Pietrobelli, Fontaine, Sirey, & Faith,
2006; Istvan, Zavela, & Weidner, 1992; Li et al., 2004), and sarcopenia
(Hsu et al., 2014; Kim et al., 2011).
In the present study, depressive symptoms were 2.5 times more
prevalent in the sarcopenic participants compared to the nonsarcopenic
participants. A study on elderly Koreans examined the relationship
between depression and body composition, and showed that depressive
men had lower BMI and lower skeletal muscle mass compared to those
without depression. Although causal mechanisms were not established,
a positive correlation was found between sarcopenia and depression,
which was in accordance with the existing results (Kim et al., 2011).
Another study showed that depression was significantly associated
with sarcopenia among elderly men in Southern Taiwan (Hsu et al.,
2014). This finding supports the results of the present study.
In the present study, functional evaluation for disability revealed
that only nine subjects were disabled according to the Barthel ADL
Index. Thus, the analysis was performed using Lawton–Brody IADL
index results.
In parallel with the results of the present study, some previous
studies showed that functional dependency was related to many risk
factors, such as female gender, less education, perception of poor eco-
nomic situation (Beland & Zunzunegui, 1999; Cho et al., 1998; Jiang,
Tang, Meng, & Fatatsuka, 2002; Rantanen et al., 2000; Stuck et al.,
1999), increasing age (Ford et al., 1988; Konno, Katsumata, Arai &
Tamashiro, 2004), polypharmacy (Bahat et al., 2014; Jyrkkä, Enlund,
Korhonen, Sulkava, & Hartikainen, 2009), obesity (Hairi et al., 2010),
and sarcopenia (Baumgartner et al., 1998; Da Silva et al., 2014; Hairi
et al., 2010; Janssen et al., 2002; Rolland et al., 2003; Tanimoto et al.,
2012; Tanimoto et al., 2013).
The present study showed that sarcopenia was associated with
functional dependency in IADL, and several previous studies supported
this finding. A study conducted by the American Geriatric Society on
subjects older than 60 years of age showed that reduced skeletal muscle
mass was significantly associated with functional impairment and dis-
ability in the elderly Americans (particularly in women) (Janssen et al.,
2002).
Roland et al. reported that a statistically insignificant relation was
found between sarcopenia and functional disability in elderly women
diagnosed with sarcopenia. However, this subgroup of women had four
times more difficulty in performing three or more activities of IADL
compared to those without sarcopenia. This result confirmed the con-
cern about the key role of muscle loss in the development of functional
impairment. The present study found a significant relation between
functional disability and low IADL score in the elderly (Rolland et al.,
2003).
Hairi et al. reported that sarcopenia was found to be associated with
lower ADL and IADL index scores in community-dwelling elderly men
(Hairi et al., 2010), in line with the present study.
Previous studies on community-dwelling elderly showed that sar-
copenic elderly had higher levels of functional disability (Da Silva et al.,
2014; Tanimoto et al., 2012; Tanimoto et al., 2013). The present study
200
Archives of Gerontology and Geriatrics 76 (2018) 196–201
reached a similar conclusion by evaluating the presence of sarcopenia
and functional status using the IADL index.
Finally, in a study on the epidemiology of sarcopenia among the
elderly, sarcopenic men had at least three disabilities on IADL, and si-
milar results were observed for sarcopenic women (Baumgartner et al.,
1998). These results were also in accordance with the present study.
In conclusion, previous studies also found an association between
sarcopenia, depression, and functional disability, similar to the present
study. This study indicated that functional disability and depression
increased as the level of sarcopenia increased in the elderly.
To sum up, sarcopenia is a common risk factor for functional dis-
ability in IADL, as well as being related to depressive symptoms.
The major limitation of this study was its cross-sectional design,
which provided a weak evidence of causality. Another limitation was
that the relation between depression and sarcopenia was not fully es-
tablished due to the use of GDS-short form, which evaluates depressive
symptoms at a single point of time instead of making a diagnosis of
depression. The variation in gender, age groups, participant composi-
tions, and methods used to confirm sarcopenia in the reported studies
caused limitations in interstudy comparison of results.
Being population based, using probability sampling method and
having a high response rate were key points in this study, which pre-
vented sampling bias. Another strength of this study was the use of the
EWGSOP criteria to describe sarcopenia, similar to the majority of the
recent studies. Data collection by pre-trained interviewers and weekly
data control assured standardized data, which was also a strength of
this study. The data can be used to identify the relationship between
sarcopenia and depressive symptoms or functional status.
5. Conclusions and recommendations
In patients with sarcopenia, functional disability in IADL and de-
pressive symptoms were 2.9- and 2.5 times higher in ambulatory
community-dwelling elderly, respectively. Sarcopenia is significant as-
sociated with depressive symptoms and increased functional disability
in ambulatory community-dwelling elderly. Therefore, elderly people
at a high risk of sarcopenia should be screened for functional disability
and depression.
Conflicts of interest
There are no financial or personal conflicts of interest associated
with the study. All authors declared that they had no conflicts of in-
terest.
Disclosure
The funding played no role in study design, collection, analysis,
interpretation of data, writing of manuscript, or the decision to submit
for publication.
Ethical standards
The research protocol was approved by the ethics committee of
Medical Faculty of Ege University on December 12, 2014. All partici-
pants signed the informed consent form.
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