The Significance of Fatigue in the Elderly
The Significance of Fatigue in the Elderly
Abstract & Commentary
By Mary Elina Ferris, MD, Clinical Associate Professor, University of Southern California. Dr. Ferris reports no financial relationship to this field of study.
Synopsis: Mortality rates for community-living older adults followed over 10 years showed higher risk for those who felt tired most of the time.
Source: Hardy SE, Studenski SA. Fatigue predicts mortality in older adults. J Am Geriatr Soc 2008;56:1910-1914.
Persistent unexplained tiredness (also called fatigue) can be a perplexing complaint in the elderly. This study followed 492 patients aged 65 and older from a Medicare HMO and a Veterans' clinic. At the baseline visit they were asked, "Do you feel tired most of the time?" The 43% who answered "yes" were more likely to be female and white, have worse functional and physical status, and have more concurrent conditions.
Over 10 years of follow-up, almost half the participants died, and these were more likely to be those who reported tiredness at their baseline visit. Mortality rates were 59% for those with fatigue and 38% for those without. The difference in survival persisted even after adjustment for chronic conditions, depressive symptoms, and physical performance. The association did not change with age, sex, or race. One subgroup of those who reported no functional limitations did not demonstrate any association between fatigue and survival.
Commentary
The authors speculate that fatigue may be an independent predictor of what they call "subclinical disease, inflammation, or increased work at maintaining homeostasis." The same authors have also found a relationship between a 1-year improvement in gait speed and 8-year survival.1 They suggest that these simple observations could be used as a "vital sign" in the care of the elderly. However, the use of fatigue as a reliable marker is hard to imagine, since the perception of fatigue and how it is described may vary widely among patients of different backgrounds. Fatigue severity was not assessed, nor was the influence of different therapies that may have been utilized over the course of the study. A small group of patients who had no functional impairments was free of the association between fatigue and decreased survival.
While I can criticize this study for the many other variables that were not measured, it does confirm a frequent clinical impression that fatigue is associated with poorer outcomes for our patients. Could it be that the gradual process of reaching the end of life includes a diminution in energy and strength? We may not be able to characterize this observation scientifically, but it remains one of the intuitive measures that physicians may use to assess our patients' chances of ongoing survival.
Reference
1. Hardy SE, et al. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc 2007;55:1727-1734.
Mortality rates for community-living older adults followed over 10 years showed higher risk for those who felt tired most of the time.Subscribe Now for Access
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