with cognitive problems, but the increase in variability in the, albeit small, Group II after controlling for gait speed could not be confirmed. These findings highlight the need for further research, including persons with physical impairments, on the causes of gait variability and, in turn, its role in the risk of falling. Ellen Smulders, PhD Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, the Netherlands Yvonne Schoon, MD Marcel Olde Rikkert, MD Department of Geriatrics, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre Nijmegen, the Netherlands Vivian Weerdesteyn, MD Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, the Netherlands Research, Development, and Education, Sint Maartenskliniek, Nijmegen, the Netherlands ACKNOWLEDGMENTS Conflict of Interest: This study was supported by the Organization for Healthcare Research in the Netherlands. 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: Ellen Smulders: Study design, data analysis, interpretation of data, preparation of letter. Yvonne Schoon: Study concept and design, acquisition of subjects and data, interpretation of data, preparation of data. Marcel Olde Rikkert: Study concept and design, preparation of letter. Vivian Weerdesteyn: Study design, interpretation of data, preparation of letter. Sponsor’s Role: None. REFERENCES 1. Hausdorff JM. Gait variability: Methods, modeling and meaning. J Neuro- eng Rehabil 2005;2:19. 2. Hausdorff JM, Edelberg HK, Mitchell SL et al. Increased gait unsteadiness in community-dwelling elderly fallers. Arch Phys Med Rehabil 1997;78:278– 283. 3. Maki BE. Gait changes in older adults: Predictors of falls or indicators of fear. J Am Geriatr Soc 1997;45:313–320. 4. Menz HB, Lord SR, Fitzpatrick RC. Age-related differences in walking sta- bility. Age Ageing 2003;32:137–142. 5. Reelick MF, van Iersel MB, Kessels RP et al. The influence of fear of falling on gait and balance in older people. Age Ageing 2009;38:435–440. 6. van Kempen J, Schers H, Jacobs A et al. Development of an instrument for the identification of frail elderly as target-population for integrated care. Br J Gen Pract 2012. In press. 7. Beauchet O, Allali G, Annweiler C et al. Gait variability among healthy adults: Low and high stride-to-stride variability are both a reflection of gait stability. Gerontology 2009;55:702–706. 8. Callisaya ML, Blizzard L, Schmidt MD et al. Ageing and gait variability—a population-based study of older people. Age Ageing 2010;39:191–197. INVERSE RELATIONSHIP BETWEEN DEPRESSIVE SYMPTOMS AND ARTERIAL BLOOD PRESSURE IN COMMUNITY-DWELLING OLDEST-OLD BRAZILIANS To the Editor: In Brazil, the average life expectancy for people who are 80 years old is 9.6 years. 1 As in other middle-income countries, the oldest-old (  80) Brazilians are the fastest-growing age group of elderly adults. 1 Hypertension and depression are two common health problems in elderly adults. Hypertension during middle age is an obvious cause of stroke, vascular dementia, myocardial infarction, renal failure, and retinopathy, 2 all of which are well-known causes of depression. 3 Low blood pressure (BP) in elderly adults has been associated with systolic heart failure and chronic diseases associated with malnutrition, such as cancer and dementia. 4 Some studies have found an association between low BP and frailty in the general elderly population, suggesting that BP might be lower with pathological aging, 5 although the relationship between BP and depression is controversial. 6–10 Longitudinal studies have had inconsistency regarding the association between BP and depressive symptoms in the general elderly population, possibly indicating the exis- tence of confounding factors between these variables. 6–8 Some have reported that baseline low BP predicts depres- sive symptoms at follow-up but that the inverse was not true. 7,8 Another study has found the opposite results—that depression is associated with lower BP at follow-up. 6 Another study found that hypertension was associated with depressive symptoms at follow-up. 9 Differences in study design, population age distribu- tion, and health status may have contributed to these divergent findings in different studies. 6–10 Many of the aforementioned studies did not include a representative proportion of very elderly people in their sample, and none evaluated exclusively the oldest old. The relationship between BP and depressive symptoms was investigated in a community-based Brazilian popula- tion aged 80 and older. The total probabilistic sample of this cross-sectional study consisted of 272 older people liv- ing in two Brazilian cities: 155 in Ribeir~ ao Preto (S~ ao Paulo State) and 117 in Caxias do Sul (Rio Grande do Sul State). Data were collected in home interviews and encom- passed sociodemographic characteristics, mean (from two independent measures) systolic and diastolic BP, and the short-form version (15 items) of the Geriatric Depression Scale (GDS). The Ethical Committee of the Ribeir~ ao Preto School of Nursing (S~ ao Paulo University) approved this study, and data were analyzed using SPSS version 18.0 (SPSS, Inc., Chicago, IL). Mean age was 84.7  4.2, 67.6% of participants were female, and mean years of schooling was 3.7  3.8 years. An inverse linear regression line best fit the relationship between diastolic BP and GDS score (coef- ficient of determination (r²) = 0.031, P = 0.004), whereas a quadratic regression curve best represented the relation- ship between systolic BP and GDS score (r²= 0.036, P = .009) (Figure 1). Both associations remained statisti- cally significant even after controlling for age, sex, and schooling (P < .01 for both). JAGS MARCH 2013–VOL. 61, NO. 3 LETTERS TO THE EDITOR 465