The characteristics of fatigue in an older primary care sample
ABSTRACT Primary care studies of younger adults have reported fatigue to be common and etiologically heterogeneous with both physical and psychological associations. This has led to considerable debate about whether fatigue may present independently of psychological disorder. Somatic symptoms in older people have been assumed to be almost entirely physical in origin.
To determine the characteristics of fatigue and its relationship with psychological disorder in older primary care attenders.
Ambulatory primary care patients aged 60 years and over completed self-report questionnaires and psychiatric interview at baseline and at 12 months.
The overall prevalence of fatigue was 27.4% with most, but not all, cases being comorbid with psychological disorder. Psychological disorder (OR, 8.43; 95% CI, 2.98-23.88) was a greater predictor of fatigue than physical illness (OR, 4.74; 95% CI, 1.63-13.85). Neither a tendency for fatigue to evolve into psychological disorder, nor vice versa, was observed longitudinally (overall kappa, 0.68; P<.001).
Fatigue is common in older primary care attenders and is not associated with physical illness alone. Despite the high rate of comorbidity with psychological disorder, independent and longitudinally stable forms of fatigue did present. The overall findings suggest that while fatigue does overlap with psychological phenomena, there may also be distinct forms of fatigue.
Article: Psychiatric disorders in ageing[Show abstract] [Hide abstract]
ABSTRACT: The ageing of the population brings particular challenges to psychiatric practice. Although the clinical presentation of common psychiatric disorders such as mood and psychotic disorders is largely similar to those in younger adults, late life presentations tend to be more complex as co-morbidity with dementia and physical illness is common. Suicide tends to increase with age in most countries. In this chapter we argue that the aetiology of disorders may be best understood within a stress vulnerability model in which neurobiological and psychosocial factors interplay. We further present that management strategies need to be comprehensive, incorporating physical, social, pharmacological, and psychological treatments appropriate to each case. We close with a call for the use of specialised multi-disciplinary services to improve the overall quality of care.03/2012; 10:243-69. DOI:10.1007/7854_2011_124
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ABSTRACT: So far, most studies on the association between pain and fatigue have used cross-sectional data. We analysed the possibilities for a temporal relationship between pain and fatigue in a cohort study of patients presenting with fatigue in primary care. Of 856 recruited patients, 642 (75%) completed postal questionnaires after the consultation, and at one, four, eight and 12 months follow-up, with completion rates ranging from 82% to 88%. Pain was measured using the Short-Form health survey (SF-36) and fatigue using the severity scale of the Checklist Individual Strength (CIS). Longitudinal associations were analysed using generalised estimated equations (GEE). We used three different models assessing possible relationships between the symptoms in time, either in the same intervals or with a time-lag, suggesting either a synchronous or temporal association. The regression coefficients were strongest in the model assessing synchronous change, indicating that a one-point improvement in pain was associated with a 0.25 improvement in fatigue in the same time interval (adjusted for potential confounding). Baseline duration of fatigue and expectations of its future course significantly modified the association in this model, with stronger associations between changes in pain and fatigue found in patients with a shorter duration of fatigue or more positive expectations. The models using a time lag showed a significant but inverse association between changes in pain and subsequent changes in fatigue. The results indicate that changes in pain and fatigue are directly related in time, rather than showing temporal associations.Pain 08/2010; 150(2):351-7. DOI:10.1016/j.pain.2010.05.030 · 5.84 Impact Factor
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ABSTRACT: The objective of the study was to summarize evidence on the course and prognostic factors of fatigue in primary care patients and in the community. Two reviewers independently screened identified citations, discussed eligible studies, and assessed methodological quality of selected studies. Data concerning study population, duration of follow-up, measurement of fatigue, outcome, and prognostic factors were extracted. Studies with populations selected by a specific disease or postpartum condition were excluded. We selected 21 articles reporting on 11 (partly) primary care cohorts and six community cohorts. Follow-up was up to 1 year in primary care and up to 4 years in the community, and in most studies that presented duration of fatigue, participants were chronically fatigued. Because of wide heterogeneity of studies, a qualitative analysis was performed. Recovery of fatigue varied widely, but no differences were found between settings. Sufficient evidence for an association with recovery was found for lower severity of fatigue, and limited evidence was found for good self-reported health, mental health, and psychological attributions. A major deficit in methodological quality of most studies was a potential bias due to low or selective response or loss to follow-up. Most studies on fatigue included patients with long symptom duration at baseline, making it difficult to study prognosis early in the course of fatigue. To provide clear evidence on prognosis in fatigued persons, prognostic studies should use an optimal design including selection of an inception cohort with limited duration of fatigue at baseline, a sufficient sample size, and information on rates and selectivity of response and loss to follow-up.Journal of Psychosomatic Research 05/2008; 64(4):335-49. DOI:10.1016/j.jpsychores.2007.11.001 · 2.84 Impact Factor