The characteristics of fatigue in an older primary care sample

St. George Hospital, New South Wales, Australia. <>
Journal of Psychosomatic Research (Impact Factor: 2.74). 02/2007; 62(2):153-8. DOI: 10.1016/j.jpsychores.2006.09.011
Source: PubMed


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.

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    • "It can be defined as a pervasive sense of tiredness or lack of energy that is not related exclusively to exertion. It has been estimated that there is an overall prevalence of fatigue of 27% in ambulatory Australians 60 years of age and over (Wijeratne et al. 2007). The cause of fatigue in apparently healthy individuals may not always be determined, even after established etiological factors are excluded. "
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    ABSTRACT: Fatigue syndromes exist on a continuum of severity from mild and transient to the disabling chronic fatigue syndrome, with oxidative stress linked to its pathogenesis. A thermolabile gliadin-combined plant superoxide dismutase (SOD) extract has shown potential in clinical trials as a therapeutic antioxidant. This study investigated the effects of 12 weeks of 500 mg/day of a SOD/gliadin supplement on fatigue. Thirty-eight women aged 50-65 years with self-perceived fatigue entered this randomized, double-blind, placebo-controlled trial. The primary outcome measure was general fatigue determined by the Multidimensional Fatigue Inventory (MFI). Secondary outcome measures included other measures of fatigue from the MFI and blood measures of oxidative stress, antioxidant status and hormones. There were no significant (P>0.05) differences between, or within groups, for decreases in general fatigue (active=1.6%, placebo=4.1%). There were no within or between group differences (P>0.05) in other measures of fatigue (physical fatigue, reduced activity, reduced motivation, mental fatigue and total fatigue score). In regard to the biochemical measures, there were non-significant (P>0.05) differences in increases in plasma SOD activity (active=7.1%, placebo=12.2%), plasma GPx activity (active=2.4%, placebo=0.7%), red blood cell GPx activity (active=9.8%, placebo=4.4%). Markers of oxidative stress were decreased but there were no differences (P>0.05) within or between groups; malondialdehyde (active=4.1%, placebo=1.6%), F-2 isoprostanes (active=14.7%, placebo=22.4%). There was a trend (P=0.08) for a decrease in cortisol in the active group (24.6%), however this was not significantly different from the decrease in the placebo participants (4.1%). DHEA differences were not significant (P<0.05) and declined 1.3% in the active group and 14.4% in the placebo group. In summary, the thermolabile SOD/gliadin supplement had no significant effect on self-perceived fatigue, antioxidants, oxidative stress or hormones in women aged 50-65 years.
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    • "Psychological fatigue symptoms may originate from emotional phenomena or may arise from alterations in neurotransmitter release such as is seen in clinical depression. A recent study of fatigue in primary care patients suggested that psychological disorders were more predictive of fatigue than were physical illnesses [21]. Psychological phenomena not usually treated clinically, including stress and burnout phenomena, have also been associated with increased levels of fatigue. "
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    ABSTRACT: Fatigue is a common and distressing complaint among people with diabetes and likely to hinder the ability to perform daily diabetes self-management tasks. A review of the literature about diabetes-related fatigue was conducted with an eye toward creating a framework for beginning to conduct more focused studies on this subject. A literature search containing the terms diabetes, fatigue, tiredness, and symptoms was conducted to search for literature that addressed diabetes-related fatigue. Diabetes presents many potential pathways for fatigue, but focused studies on this symptom are rare. Furthermore, research on diabetes-related fatigue is limited by fatigue's nonspecific symptoms and because fatigue researchers have yet to agree on standardized definition, measurement, or diagnostic criteria. Additionally, few diabetes randomized clinical trials included measurement of patient-reported outcomes, such as symptoms or health-related quality of life in their study designs, although one that did provided some meaningful finding that symptom-focused education improved self-management practices, Hb(A1c) levels, quality of life, and symptom distress. There is a need to standardize the definition, measurement, and diagnostic criteria of fatigue in diabetes. We present a model that can guide focused studies on fatigue in diabetes. The model capitalizes on the multidimensional phenomena (physiological, psychological, and lifestyle) associated with fatigue in diabetes.
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    • "For example, a study by Avlund et al. (Avlund, Damsgaard, & Schroll, 2001) indicated that older persons (75-year-olds without disabilities ) who reported tiredness had twice the risk of being hospitalized and a user of home help 5 years later compared with those who did not feel tired. Furthermore , fatigue has also been found to significantly increase the risk of mortality (Wijeratne et al., 2007). Fatigue has received more attention in cancer research, and various ways of supporting persons suffering from fatigue have been recommended. "
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    ABSTRACT: The frequency of fatigue among older people (both with and without chronic pain) and its major impact on daily life indicate the urgent need for further research about fatigue, the mechanisms behind it, as well as interventions to alleviate it. Such interventions are necessary to promote health, improve quality of life, and provide opportunities for successful aging.
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