Fatigue in older adults: an early indicator of the aging process?

The aim of this paper is to give an overview of research on fatigue in older adults, with a focus on fatigue as an early indicator of the aging process. Fatigue is a strong predictor of functional limitations, disability, mortality, and other adverse outcomes in young-old and old-old populations, between men and women, and in different geographic localities. Several biological, physiological and social explanations are proposed: fatigue may be seen not only as a self-reported indicator of frailty, defined as a physiologic state of increased vulnerability to stressors, which results from decreased physiologic reserves and even dysregulation of multiple physiologic systems, but also this state may be accelerated because of the cumulative impact of social, mental and biological factors throughout life.

[1]  I. Okkes,et al.  Once tired, always tired? Limitations in function over time of tired patients in Dutch general practice , 2007, The European journal of general practice.

[2]  Svend Kreiner,et al.  Functional ability scales for the elderly: A validation study , 1996 .

[3]  Marita Kloseck,et al.  An exploration of the association between frailty and muscle fatigue. , 2008, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[4]  P. Esselman,et al.  Decline in isokinetic force with age: muscle cross-sectional area and specific force , 1997, Pflügers Archiv.

[5]  M. Schroll,et al.  Predicting death from tumour necrosis factor‐alpha and interleukin‐6 in 80‐year‐old people , 2003, Clinical and experimental immunology.

[6]  R. Parse.  The Lived Experience of Feeling Very Tired: A Study Using the Parse Research Method , 2003, Nursing science quarterly.

[7]  Johan Hviid Andersen,et al.  Assessment of fatigue in chronic disease: a bibliographic study of fatigue measurement scales , 2007, Health and quality of life outcomes.

[8]  K. Christensen,et al.  Do childhood and adult socioeconomic circumstances influence health and physical function in middle-age? , 2009, Social science & medicine.

[9]  E. Wouters,et al.  Association of fatigue with an acute phase response in sarcoidosis. , 1999, The European respiratory journal.

[10]  A. Lerdal,et al.  Fatigue in the general population: A translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale , 2005, Scandinavian journal of public health.

[11]  M. Cesari,et al.  C-Reactive protein and lipid parameters in older persons aged 80 years and older , 2009, The journal of nutrition, health & aging.

[12]  L. Ridsdale,et al.  Patients who consult with tiredness: frequency of consultation, perceived causes of tiredness and its association with psychological distress. , 1994, The British journal of general practice : the journal of the Royal College of General Practitioners.

[13]  T. Whiteside,et al.  Natural killer cells and natural killer cell activity in chronic fatigue syndrome. , 1998, The American journal of medicine.

[14]  V. Galea,et al.  Changes in motor unit estimates with aging. , 1996, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[15]  M. Schroll,et al.  Predictors of five-year functional ability in a longitudinal survey of men and women aged 75 to 80. The 1914-population in Glostrup, Denmark , 1997, Aging.

[16]  M. T. Damsgaard,et al.  Social position and health in old age: the relevance of different indicators of social position , 2003, Scandinavian journal of public health.

[17]  Taina Rantanen,et al.  Factors underlying tiredness in older adults , 2007, Aging clinical and experimental research.

[18]  D. Yu,et al.  Fatigue among older people: a review of the research literature. , 2010, International journal of nursing studies.

[19]  S. Berg,et al.  Cognitive function and functional ability in daily life , 1997 .

[20]  M. Schroll,et al.  Tiredness and Onset of Walking Limitations in Older Adults , 2004, Journal of the American Geriatrics Society.

[21]  S. Kreiner,et al.  Functional ability of community dwelling elderly. Criterion-related validity of a new measure of functional ability. , 1992, Journal of clinical epidemiology.

[22]  C. Rice,et al.  Neuromuscular fatigue and aging: Central and peripheral factors , 2002, Muscle & nerve.

[23]  Ellen Gorus,et al.  Handgrip performance in relation to self-perceived fatigue, physical functioning and circulating IL-6 in elderly persons without inflammation , 2007, BMC geriatrics.

[24]  I. Deary,et al.  Oxidative stress, telomere length and biomarkers of physical aging in a cohort aged 79 years from the 1932 Scottish Mental Survey , 2008, Mechanisms of Ageing and Development.

[25]  C. Ciccone.  Chapter 12 – Pharmacology considerations for the aging individual , 2007 .

[26]  I. Kant,et al.  Associations between infections and fatigue in a Dutch working population: Results of the Maastricht Cohort Study on Fatigue at Work , 2004, European Journal of Epidemiology.

[27]  S. Studenski,et al.  Research Agenda for Frailty in Older Adults: Toward a Better Understanding of Physiology and Etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults , 2006, Journal of the American Geriatrics Society.

[28]  C. McHorney,et al.  The MOS 36‐Item Short‐Form Health Survey (SF‐36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs , 1993, Medical care.

[29]  P. Fayers,et al.  Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients , 2007, Breast Cancer Research and Treatment.

[30]  K. Avlund,et al.  Functional ability among elderly people in three service settings: The discriminatory power of a new functional ability scale , 1998, European Journal of Epidemiology.

[31]  P. Nilsson,et al.  Social and biological predictors of early menopause: a model for premature aging , 1997, Journal of internal medicine.

[32]  E. Smets,et al.  The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. , 1995, Journal of psychosomatic research.

[33]  K. Avlund,et al.  Instrumental Activities of Daily Living: The Relationships to Self-rated Memory and Cognitive Performance among 75-year-old Men and Women , 1998 .

[34]  L. Fried,et al.  Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. , 2002, Archives of internal medicine.

[35]  Caroline O'Connell,et al.  Chapter 64 – Fatigue , 2007 .

[36]  C. Shapiro,et al.  Distinguishing sleepiness and fatigue: focus on definition and measurement. , 2006, Sleep medicine reviews.

[37]  M. Schroll,et al.  The relations between musculoskeletal diseases and mobility among old people: are they influenced by socio-economic, psychosocial, and behavioral factors? , 2000 .

[38]  Polypharmacy and older people— , 2005, Zeitschrift fur Gerontologie und Geriatrie.

[39]  K. Schultz-Larsen,et al.  What do 70-ycar-old men and women actually do? And what are they able to do? From the Glostrup survey in 1984 , 1991, Aging.

[40]  Luigi Ferrucci,et al.  Serum IL‐6 Level and the Development of Disability in Older Persons , 1999, Journal of the American Geriatrics Society.

[41]  M. Maurer,et al.  Self-reported lack of energy (anergia) among elders in a multiethnic community. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[42]  Burton H. Singer,et al.  Social Relationships, Gender, and Allostatic Load Across Two Age Cohorts , 2002, Psychosomatic medicine.

[43]  L. Ferrucci,et al.  Fatigue in a representative population of older persons and its association with functional impairment, functional limitation, and disability. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[44]  A. Chaudhuri,et al.  Fatigue and basal ganglia , 2000, Journal of the Neurological Sciences.

[45]  Marianne Schroll,et al.  Tiredness in daily activities among nondisabled old people as determinant of onset of disability. , 2002, Journal of clinical epidemiology.

[46]  W. Frontera,et al.  Chapter 2 – Skeletal muscle function in older people , 2007 .

[47]  J. Bensing,et al.  Distinguishing between chronic and nonchronic fatigue, the role of gender and age. , 1998, Social science & medicine.

[48]  J. Barr.  Chapter 67 – Evaluation of pain in older individuals , 2007 .

[49]  R. Crow,et al.  A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. , 1996, Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer.

[50]  P. Era,et al.  Item bias in self-reported functional ability among 75-year-old men and women in three Nordic localities , 1996, Scandinavian journal of social medicine.

[51]  Paul B. Baltes,et al.  The Berlin Aging Study , 1994, Ageing and Society.

[52]  Pim van der Harst,et al.  Telomere biology in healthy aging and disease , 2009, Pflügers Archiv - European Journal of Physiology.

[53]  L. Radloff.  The CES-D Scale , 1977 .

[54]  F. Ferraù,et al.  Fatigue and aging. , 2003, Critical reviews in oncology/hematology.

[55]  A. Zautra,et al.  Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia , 2007, Pain.

[56]  G. Dinant,et al.  Assessment of vital exhaustion and identification of subjects at increased risk of myocardial infarction in general practice. , 2004, Psychosomatics.

[57]  K. Avlund,et al.  Are Self-ratings of Functional Ability Reliable? , 1995 .

[58]  S. Cummings,et al.  Association between telomere length, specific causes of death, and years of healthy life in health, aging, and body composition, a population-based cohort study. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[59]  L. Fried,et al.  Chronic Cytomegalovirus Infection and Inflammation Are Associated with Prevalent Frailty in Community‐Dwelling Older Women , 2005, Journal of the American Geriatrics Society.

[60]  M. Irwin,et al.  Prospective Association Between C-Reactive Protein and Fatigue in the Coronary Artery Risk Development in Young Adults Study , 2009, Biological Psychiatry.

[61]  C. Cooper,et al.  Developmental origins of midlife grip strength: findings from a birth cohort study. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[62]  J. Guralnik,et al.  Childhood socioeconomic status predicts physical functioning a half century later. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[63]  R. Halfens,et al.  Factors related to fatigue; priority of interventions to reduce or eliminate fatigue and the exploration of a multidisciplinary research model for further study of fatigue. , 1999, International journal of nursing studies.

[64]  J. Ware,et al.  Differential item functioning in the Danish translation of the SF-36. , 1998, Journal of clinical epidemiology.

[65]  K. Avlund,et al.  Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. , 2003, Age and ageing.

[66]  L. Christiansen,et al.  The IL-6 −174G>C polymorphism is associated with cardiovascular diseases and mortality in 80-year-old humans , 2004, Experimental Gerontology.

[67]  G. Lewis,et al.  Cross-cultural differences in the epidemiology of unexplained fatigue syndromes in primary care , 2003, British Journal of Psychiatry.

[68]  R. Brown,et al.  The assessment of fatigue: a practical guide for clinicians and researchers. , 2004, Journal of psychosomatic research.

[69]  I. Okkes,et al.  The probability of specific diagnoses for patients presenting with common symptoms to Dutch family physicians. , 2002, The Journal of family practice.

[70]  Christianna S. Williams,et al.  Restricted Activity among Community-Living Older Persons: Incidence, Precipitants, and Health Care Utilization , 2001, Annals of Internal Medicine.

[71]  A. Chaudhuri,et al.  Fatigue in neurological disorders , 2004, The Lancet.

[72]  C. Cooper,et al.  Birth weight, childhood size, and muscle strength in adult life: evidence from a birth cohort study. , 2002, American journal of epidemiology.

[73]  S. Kreiner,et al.  Construct validation and the Rasch model , 1993, Scandinavian journal of social medicine.

[74]  I. Janszky,et al.  Self-rated health and vital exhaustion, but not depression, is related to inflammation in women with coronary heart disease , 2005, Brain, Behavior, and Immunity.

[75]  M. Schroll,et al.  Changes in Bicycle Ergometer Test Performance and Survival in Men and Women from 50 to 60 and from 70 to 80 Years of Age: Two Longitudinal Studies in the Glostrup (Denmark) Population , 2001, Gerontology.

[76]  M. Chen.  The epidemiology of self-perceived fatigue among adults. , 1986, Preventive medicine.

[77]  A. Mann,et al.  Tired, weak, or in need of rest: fatigue among general practice attenders. , 1990, BMJ.

[78]  L. Pallikkathayil,et al.  A Qualitative Investigation of Fatigue among Healthy Working Adults , 2003, Western journal of nursing research.

[79]  L. Dzurec.  Relationship as an Inherent Component in Healthy Women’s Fatigue , 2002, Western journal of nursing research.

[80]  M. Schroll,et al.  Functional Ability and Oral Health Among Older People: A Longitudinal Study from Age 75 to 80 , 2001, Journal of the American Geriatrics Society.

[81]  M. Schroll,et al.  The Tumor Necrosis Factor Alpha −308G>A Polymorphism Is Associated with Dementia in the Oldest Old , 2004, Journal of the American Geriatrics Society.

[82]  S. Kaasa,et al.  Fatigue in the general Norwegian population: normative data and associations. , 1998, Journal of psychosomatic research.

[83]  P. Schnohr,et al.  Vital exhaustion as a risk factor for ischaemic heart disease and all-cause mortality in a community sample. A prospective study of 4084 men and 5479 women in the Copenhagen City Heart Study. , 2003, International journal of epidemiology.

[84]  E. L. Mortensen,et al.  A WAIS longitudinal study of cognitive development during the life span from ages 50 to 70 , 1993 .

[85]  I. Kant,et al.  Development of the chronic fatigue syndrome in severely fatigued employees: predictors of outcome in the Maastricht cohort study , 2004, Journal of Epidemiology and Community Health.

[86]  M. Schroll,et al.  Tiredness as Determinant of Subsequent Use of Health and Social Services among Nondisabled Elderly People , 2001, Journal of aging and health.

[87]  K. Avlund.  Disability in old age. Longitudinal population-based studies of the disablement process. , 2004, Danish medical bulletin.

[88]  Luigi Ferrucci,et al.  Frailty: an emerging research and clinical paradigm--issues and controversies. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[89]  K. Nair,et al.  Mechanisms of sarcopenia of aging. , 1999, Journal of endocrinological investigation.

[90]  A. Richardson,et al.  Fatigue: a concept analysis. , 1996, International journal of nursing studies.

[91]  R. D'Agostino,et al.  Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study. , 2003, The American journal of medicine.

[92]  M. Hotopf,et al.  The relationship between fatigue and psychiatric disorders: Evidence for the concept of neurasthenia☆ , 2009, Journal of psychosomatic research.

[93]  S. Berg,et al.  Changes in social relations in old age. Are they influenced by functional ability? , 2002, Aging clinical and experimental research.

[94]  M. Schroll,et al.  Tiredness and subsequent disability in older adults: The role of walking limitations. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[95]  N. Salsman,et al.  Educational Attainment, Positive Psychological Mediators, and Resources for Health and Vitality in Older Adults , 2003, Journal of aging and health.

[96]  N. Secher,et al.  Cerebral perturbations provoked by prolonged exercise , 2004, Progress in Neurobiology.

[97]  K. Avlund,et al.  Leisure Activities Among 70-Year-Old Men and Women , 1994 .

[98]  J B Bjorner,et al.  Tests of data quality, scaling assumptions, and reliability of the Danish SF-36. , 1998, Journal of clinical epidemiology.

[99]  The Relationship between Fatigue, Psychological and Immunological Variables in Acute Infectious Illness , 1998, The Australian and New Zealand journal of psychiatry.

[100]  A. Appels.  WHY DO IMMINENT VICTIMS OF A CARDIAC EVENT FEEL SO TIRED? , 1997, International journal of clinical practice.

[101]  H. Stahelin,et al.  Adaptations in Aging , 1995 .

[102]  R. Varadhan,et al.  Initial manifestations of frailty criteria and the development of frailty phenotype in the Women's Health and Aging Study II. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[103]  Meryl S. Cohen.  Chapter 6 – Cardiac considerations in the older patient , 2007 .

[104]  M. Essink‐bot,et al.  A psychometric comparison of health-related quality of life measures in chronic liver disease. , 2001, Journal of clinical epidemiology.

[105]  S. Rubin,et al.  Sleep problems and associated daytime fatigue in community-dwelling older individuals. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[106]  L. Ferrucci,et al.  Phenotype of frailty: characterization in the women's health and aging studies. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[107]  Influence of personality and health behaviors on fatigue in late and very late life. , 2006, The journals of gerontology. Series B, Psychological sciences and social sciences.

[108]  P. Baltes,et al.  The Berlin Aging Study: Trends and Profiles of Psychological Functioning in Very Old Age , 1998 .

[109]  S. Studenski,et al.  Fatigue Predicts Mortality in Older Adults , 2008, Journal of the American Geriatrics Society.

[110]  K. Schultz-Larsen,et al.  Tiredness in daily activities: a subjective measure for the identification of frailty among non-disabled community-living older adults. , 2007, Archives of gerontology and geriatrics.

[111]  E. L. Mortensen,et al.  Brain‐Derived Neurotrophic Factor Predicts Mortality Risk in Older Women , 2009, Journal of the American Geriatrics Society.

[112]  C. Cooper,et al.  Does sarcopenia originate in early life? Findings from the Hertfordshire cohort study. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[113]  J D Williamson,et al.  Association of muscle strength with maximum walking speed in disabled older women. , 1998, American journal of physical medicine & rehabilitation.

[114]  M. Schroll,et al.  Functional ability at age 75: is there an impact of physical inactivity from middle age to early old age? , 2006, Scandinavian journal of medicine & science in sports.

[115]  P. Bech,et al.  The internal and external validity of the Major Depression Inventory in measuring severity of depressive states , 2003, Psychological Medicine.

[116]  J. Woo,et al.  Telomeres and frailty , 2008, Mechanisms of Ageing and Development.

[117]  Susan E. Hardy,et al.  Fatigue and function over 3 years among older adults. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[118]  I. Ruoppila,et al.  Changes in cognitive functioning from 75 to 80 years of age: a 5-year follow-up in two Nordic localities. , 2002, Aging clinical and experimental research.

[119]  A. Appels,et al.  Fatigue and heart disease. The association between 'vital exhaustion' and past, present and future coronary heart disease. , 1989, Journal of psychosomatic research.

[120]  Svend Kreiner,et al.  Monte Carlo tests of the Rasch model based on scalability coefficients. , 2010, The British journal of mathematical and statistical psychology.

[121]  Meryl S. Cohen,et al.  Chapter 7 – Pulmonary considerations in the older patient , 2007 .

[122]  K. Avlund,et al.  Stability and change in physical activity in old age: the role of changes in disability , 2006 .

[123]  Medication for older people--aspects of rational therapy from the general practitioner's point of view. , 2005, Zeitschrift fur Gerontologie und Geriatrie.

[124]  M. Schroll,et al.  CHRONIC DISEASES AND FUNCTIONAL ABILITY IN THREE NORDIC LOCALITIES (NORA 75) : MUSCULOSKELETAL DISEASES, FUNCTIONAL LIMITATIONS AND LOWER LIMB FUNCTIO N , 1997 .

[125]  A. Viidik,et al.  Physical functioning and use of health services in a young and old sample. The influence of fatigue. , 2008, Danish medical bulletin.

[126]  P Bech,et al.  Fatigue in the Danish general population. Influence of sociodemographic factors and disease , 2000, Journal of epidemiology and community health.

[127]  M. Schroll,et al.  Genetic priming of a proinflammatory profile predicts low IQ in octogenarians , 2009, Neurobiology of Aging.

[128]  T. Rantanen,et al.  Muscle strength, disability and mortality , 2003, Scandinavian journal of medicine & science in sports.

[129]  M. Schroll,et al.  The cumulative effect of smoking at age 50, 60, and 70 on functional ability at age 75 , 2004, Scandinavian journal of public health.

[130]  G Lewis,et al.  The epidemiology of fatigue: more questions than answers. , 1992, Journal of epidemiology and community health.

[131]  L. Ferrucci,et al.  Inflammatory markers and physical performance in older persons: the InCHIANTI study. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[132]  Cecilia Fagerström,et al.  Determinants of feeling hindered by health problems in daily living at 60 years and above. , 2008, Scandinavian journal of caring sciences.

[133]  J. Spagnoli,et al.  Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[134]  I. Schultz,et al.  Predicting Return to Work After Low Back Injury Using the Psychosocial Risk for Occupational Disability Instrument: A Validation Study , 2005, Journal of Occupational Rehabilitation.

[135]  L. Ferrucci,et al.  D‐Dimer and Inflammatory Markers as Predictors of Functional Decline in Men and Women with and without Peripheral Arterial Disease , 2005, Journal of the American Geriatrics Society.

[136]  S. Rubin,et al.  Inflammatory Markers and Incident Mobility Limitation in the Elderly , 2004, Journal of the American Geriatrics Society.

[137]  H. Wahl,et al.  Psychological gerontology in Germany: recent findings and social implications , 2003, Ageing and Society.

[138]  C. Sherbourne,et al.  The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. , 1994 .

[139]  C. Cooper,et al.  Developmental origins of midlife physical performance: evidence from a British birth cohort. , 2006, American journal of epidemiology.

[140]  J. Roddick,et al.  Investigating tiredness in Australian general practice. Do pathology tests help in diagnosis? , 2003, Australian family physician.

[141]  A. Luff.  Age‐associated Changes in the Innervation of Muscle Fibers and Changes in the Mechanical Properties of Motor Units , 1998, Annals of the New York Academy of Sciences.

[142]  Joel E Dimsdale,et al.  The relationship between fatigue and cardiac functioning. , 2008, Archives of internal medicine.

[143]  D. Mccluskey,et al.  Aerobic work capacity in patients with chronic fatigue syndrome. , 1990, BMJ.

[144]  M. Schroll,et al.  Maximal isometric muscle strength and functional ability in daily activities among 75‐year‐old men and women , 1994 .

[145]  L. Ferrucci,et al.  Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[146]  M. Mcmurdo,et al.  Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents. , 2004, Age and ageing.

[147]  M. Beutel,et al.  Age-related complaints in women and their determinants based on a representative community study. , 2004, European journal of obstetrics, gynecology, and reproductive biology.

[148]  K. Avlund,et al.  Abdominal syndromes and functional ability in the elderly , 1994, Aging.

[149]  G. Dinant,et al.  Vital exhaustion as a risk indicator for first stroke. , 2004, Psychosomatics.

[150]  Marianne Schroll,et al.  Functional Decline From Age 80 to 85: Influence of Preceding Changes in Tiredness in Daily Activities , 2003, Psychosomatic medicine.

[151]  E. L. Mortensen,et al.  A gender difference in the association between APOE genotype and age-related cognitive decline , 2001, Neurology.

[152]  I. Okkes,et al.  Tiredness in Dutch family practice. Data on patients complaining of and/or diagnosed with "tiredness". , 2003, Family practice.

[153]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[154]  L. Natarajan,et al.  The association between fatigue and inflammatory marker levels in cancer patients: A quantitative review , 2007, Brain, Behavior, and Immunity.