Tiredness in daily activities among nondisabled old people as determinant of onset of disability

The relationship between self-perceived fatigue, muscle endurance, and circulating markers of inflammation in participants of the Copenhagen aging and Midlife Biobank (CAMB)

BACKGROUND

Fatigue, low muscle endurance, muscle weakness and low-grade inflammation are strongly related to frailty at higher age. When signs of self-perceived fatigue and low muscle endurance are interrelated with low-grade inflammation at midlife, they might be used as early markers for frailty. This study investigated whether the interrelationships among self-perceived fatigue, muscle endurance and inflammation can be observed at midlife.

METHODS

A total of 965 participants of the Copenhagen Aging and Midlife Biobank (aged 52 ± 4 years, 536 males, 426 females) were assessed for self-perceived fatigue (20-item multidimensional fatigue inventory), muscle endurance (grip work), circulating markers of inflammation (hsCRP, IL-6, IL-10, TNF-alpha and IFN-γ), daily physical activity (PAS-2), body composition (%body fat assessed by bio-impedance) and self-reported health status. Participants were categorised (correcting for age and gender) according to high fatigue and/or low muscle endurance, differences in inflammatory profile between fatigue categories were assessed by ANCOVA (corrected for PAS-2, %body fat and presence of inflammatory conditions).

RESULTS

Overall, muscle endurance, fatigue and inflammatory markers were significantly interrelated. Higher levels of hsCRP (p < 0.001), IL-6 (p < 0.001), IL-10 (p = 0.035) and TNF-alpha (p = 0.028) were observed in participants presenting both low muscle endurance and high fatigue. IFN-γ was highest in those with high fatigue but normal muscle endurance (p = 0.015).

CONCLUSIONS

Middle-aged participants with higher fatigue in combination with low muscle endurance show higher levels of inflammation, independently from physical activity, body fat and inflammatory pathology. The underlying mechanisms should be identified and future studies should also investigate whether these individuals show early signs of reduced physiological reserve capacity, which in later life come to full expression by means of frailty.

Defining and Measuring Preclinical Mobility Limitation: An Expert Consensus Exercise Informed by a Scoping Review

BACKGROUND

Early change in function in older adults has been termed preclinical disability (PCD). PCD has been understudied compared to other stages of disability because it is unlikely to receive comparative priority in clinical settings. It has major implications for prevention and population health as it may be the optimal time to intervene to prevent further decline. A standardized approach to research in PCD, including a common definition and measurement approaches, is needed to advance this work.

METHODS

The process to establish how PCD should be defined and measured was undertaken in 2 stages: (1) a scoping review of the literature, which was used to inform (2) a web-enabled consensus meeting with content experts.

RESULTS

The scoping review and the consensus meeting support the use of the term preclinical mobility limitation (PCML) and that it should be measured using both patient-reported and performance-based measures. It was agreed that the definition of PCML should include modification of frequency and/or method of task completion, without overt disability, and that requisite mobility tasks include walking (distance and speed), stairs, and transfers.

CONCLUSIONS

Currently, there are few standardized assessments that can identify PCML. PCML is the term that most clearly describes the stage where people experience a change in routine mobility tasks, without a perception of disability. Further evaluation into the reliability, validity, and responsiveness of outcome measures is needed to advance research on PCML.

Muscle Endurance and Self-Perceived Fatigue Predict Decline in Gait Speed and Activities of Daily Living After 1-Year Follow-Up: Results From the BUTTERFLY Study

BACKGROUND

Fatigue might influence the losses in activities of daily living (ADL). When fatigue parameters are present before the experience of losses in ADL and gait speed, they can be used as early warning signals. This study aimed to explore the predictive value of muscle endurance and fatigue on changes in ADL and gait speed in community-dwelling older adults aged 80 and older.

METHODS

Three hundred twenty four community-dwelling older adults aged 80 and older of the BUTTERFLY study were assessed after 1 year for muscle endurance, self-perceived fatigue, ADL, and gait speed. Exploratory factor analysis (EFA) was performed to explore, whether there is an underlying arrangement of the fatigue parameters. Mediating logistic regression analyses were used to investigate whether muscle endurance mediated by self-perceived fatigue predicts the decline in gait speed and ADL after 1-year follow-up.

RESULTS

EFA indicated a 2-factor model (muscle endurance factor and self-perceived fatigue factor) and had a moderate fit (X2: 374.81, df: 2, comparative fit index; 0.710, Tucker-Lewis index (TLI): 0.961, root mean square error of approximation [90%]: 0.048 [0.00-0.90]). Muscle endurance mediated by self-perceived fatigue had an indirect effect on the prediction of decline in Basal-ADL (-0.27), Instrumental-ADL (-0.25), and gait speed (-0.28) after 1-year follow-up.

CONCLUSION

This study showed that low muscle endurance combined with high self-perceived fatigue can predict changes in ADL after 1-year follow-up. These parameters might be very suitable for use in evaluating intrinsic capacity and can help to reduce the limitations in clinical usage of the vitality domain in the framework of intrinsic capacity.

Structural Basal Ganglia Correlates of Subjective Fatigue in Middle-Aged and Older Adults

OBJECTIVE

Fatigue is among the most common complaints in community-dwelling older adults, yet its etiology is poorly understood. Based on models implicating frontostriatal pathways in fatigue pathogenesis, we hypothesized that smaller basal ganglia volume would be associated with higher levels of subjective fatigue and reduced set-shifting in middle-aged and older adults without dementia or other neurologic conditions.

METHODS

Forty-eight non-demented middle-aged and older adults (M_age = 68.1, SD = 9.4; M_MMSE = 27.3, SD = 1.9) completed the Fatigue Symptom Inventory, set-shifting measures, and structural MRI as part of a clinical evaluation for subjective cognitive complaints. Associations were examined cross-sectionally.

RESULTS

Linear regression analyses showed that smaller normalized basal ganglia volumes were associated with more severe fatigue (β = -.29, P = .041) and poorer Trail Making Test B-A (TMT B-A) performance (β = .30, P = .033) controlling for depression, sleep quality, vascular risk factors, and global cognitive status. Putamen emerged as a key structure linked with both fatigue (r = -.43, P = .003) and TMT B-A (β = .35, P = .021). The link between total basal ganglia volume and reduced TMT B-A was particularly strong in clinically fatigued patients.

CONCLUSION

This study is among the first to show that reduced basal ganglia volume is an important neurostructural correlate of subjective fatigue in physically able middle-aged and older adults without neurological conditions. Findings suggest that fatigue and rapid set-shifting deficits may share common neural underpinnings involving the basal ganglia, and provide a framework for studying the neuropathogenesis and treatment of subjective fatigue.

Validation of the Traditional Chinese Version of the Pittsburgh Fatigability Scale for Older Adults

OBJECTIVES

The Pittsburgh Fatigability Scale (PFS) is a self-administered 10-item tool to measure physical and mental fatigability in older adults. The aim of the current study was to validate the psychometric properties of the traditional Chinese version of PFS (TC-PFS).

METHODS

We recruited 114 community-dwellingolder adults, where 35 were diagnosed with late-life depression (LLD), 26 with mild cognitive impairment (MCI), and 53 were cognitively normal (CN) from a larger community study of older adults. Statistical analyses were done separately for TC-PFS Physical and Mental subscales. Factor analysis was used for reliability, Cronbach's alpha for internal consistency, Pearson's correlation for construct validity, and group comparison for discriminative validity.

RESULTS

Factor analysis revealed a two-factor structure for both the TC-PFS Physical and Mental subscales with high reliability (α = 0.89 and 0.89, respectively). Patients with LLD had the highest PFS scores, with 80.0% and 82.9% classified as having greater physical and mental fatigability. For concurrent validity, we found moderate associations with the vitality and physical functioning subscales of the 36-Item Short Form Health Survey. For convergent validity, TC-PFS showed moderate association with emotional-related psychometrics, particularly for the Physical subscale in those with LLD. In contrast, TC-PFS Mental subscale showed correlations with cognitive function, particularly in the MCI group.

CONCLUSIONS

Our results indicate that the TC-PFS is a valid instrument to measure perceived physical and mental fatigability in older Taiwanese adults.Clinical implications: Perceived fatigability reflects the underlying physical, mental or cognitive function in older adults with or without depression.

Agreement between self-reported and observed functioning in patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia, and the influence of pain and fatigue: a cross-sectional study

Objective: To evaluate the relationship between self-reported and performance-based measures of functioning in rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia (FM), and the influence of pain and fatigue.Method: Self-reported functioning was assessed by the Stanford Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Knee injury and Osteoarthritis Outcome Score. Performance-based measures of task-related physical activity included grip strength and Six-Minute Walk Test (6MWT). Assessment of Motor and Process Skills (AMPS) was used to obtain performance-based measures of activities of daily living (ADL) ability. Pain and fatigue were assessed by 100 mm visual analogue scales. Spearman's rho correlation and regression modelling were applied.Results: Correlations between self-reported functioning and performance-based measures of ADL ability were weak to moderate, and strongest in OA (r = 0.57, p = 0.002), and AMPS ADL ability measures did not enter regression models as explanatory factors for self-reported functioning. Correlations between AMPS ADL ability measures and measures of task-related physical activity were weak, except for a strong correlation between AMPS ADL motor ability and 6MWT in OA (r = 0.63, p = 0.000). The 6MWT was the only performance-based test explaining variance in AMPS motor ability (OA = 42%; FM = 11%). Pain explained variance in self-reported ability and contributed to variance in AMPS ADL motor ability measures in OA.Conclusion: Self-reported and observed measures of functioning assess partly different aspects of functioning, and both approaches may therefore be relevant in a structured assessment of patients with musculoskeletal disorders.

Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review

Mobility is essential to maintaining independence for older adults. This systematic review aimed to summarize evidence about self-reported risk factors for self-reported mobility decline; and to provide an overview of published prognostic models for self-reported mobility decline among community-dwelling older adults. Databases were searched from inception to June 2, 2020. Studies were screened by two independent reviewers who extracted data and assessed study quality. Sixty-one studies (45,187 participants) were included, providing information on 107 risk factors. High-quality evidence and moderate/large effect sizes for the association with mobility decline were found for older age beyond 75 years, the presence of widespread pain, and mobility modifications. Moderate-high quality evidence and small effect sizes were found for a further 21 factors. Three model development studies demonstrated acceptable model performance, limited by high risk of bias. These findings should be considered in intervention development, and in developing a prediction instrument for practical application.

Fatigue and the prediction of negative health outcomes: A systematic review with meta-analysis

INTRODUCTION

Fatigue is a common complaint among older adults. Evidence grows that fatigue is linked to several negative health outcomes. A general overview of fatigue and its relationship with negative health outcomes still lacks in the existing literature. This brings complications for healthcare professionals and researchers to identify fatigue-related health risks. Therefore, this study gives an overview of the prospective predictive value of the main negative health outcomes for fatigue in community-dwelling older adults.

METHODS

PubMed, Web of Knowledge and PsycINFO were systematically screened for prospective studies regarding the relationship between fatigue and negative health outcomes resulting in 4595 articles (last search 5th March 2020). Meta-analyses were conducted in RevMan using Odds ratios (ORs), Hazard ratios (HRs) and relative risk ratios (RR) that were extracted from the included studies. Subgroup-analyses were performed based on (1) gender (male/female), (2) length of follow-up and (3) fatigue level (low, medium and high).

RESULTS

In total, thirty articles were included for this systematic review and meta-analysis encompassing 152 711 participants (age range 40-98 years), providing information on the relationship between fatigue and health outcomes. The results showed that fatigue is related to an increased risk for the occurrence of all studied health outcomes (range OR 1.299-3.094; HR/RR 1.038-1.471); for example, mortality OR 2.14 [1.74-2.63]; HR/RR 1.44 [1.28-1.62]), the development of disabilities in basic activities of daily living (OR 3.22 [2.05-5.38]), or the occurrence of physical decline (OR 1.42 [1.29-1.57]).

CONCLUSION

Overall fatigue increases the risk for developing negative health outcomes. The analyses presented in this study show that fatigue related physical decline occurs earlier than hospitalization, diseases and mortality, suggesting the importance of early interventions.

Brain structural connectomes indicate shared neural circuitry involved in subjective experience of cognitive and physical fatigue in older adults

Cumulative evidence suggests the existence of common processes underlying subjective experience of cognitive and physical fatigue. However, mechanistic understanding of the brain structural connections underlying the experience of fatigue in general, without the influence of clinical conditions, is limited. The purpose of the study was to examine the relationship between structural connectivity and perceived state fatigue in older adults. We enrolled cognitively and physically healthy older individuals (n = 52) and categorized them into three groups (low cognitive/low physical fatigue; low cognitive/high physical fatigue; high cognitive/low physical fatigue; no subjects had high cognitive/high physical fatigue) based on perceived fatigue from cognitive and physical fatigue manipulation tasks. Using sophisticated diffusion tensor imaging processing techniques, we extracted connectome matrices for six different characteristics of whole-brain structural connections for each subject. Tensor network principal component analysis was used to examine group differences in these connectome matrices, and extract principal brain networks for each group. Connected surface area of principal brain networks differentiated the two high fatigue groups from the low cognitive/physical fatigue group (high vs. low physical fatigue, p = 0.046; high vs. low cognitive fatigue, p = 0.036). Greater connected surface area within striatal-frontal-parietal networks was correlated with lower cognitive and physical fatigue, and was predictive of perceived physical and cognitive fatigue measures not used for group categorization (Pittsburgh fatigability physical subscale, R2 = 0.70, p < 0.0001; difference in self-report fatigue before and after gambling tasks, R2 = 0.54, p < 0.0001). There are potentially structural connectomes resilient to both cognitive and physical fatigue in older adults.

The operationalization of fatigue in frailty scales: a systematic review

PURPOSE

To identify the different fatigue items in existing frailty scales.

METHODS

PubMed, Web of Knowledge and PsycINFO were systematically screened for frailty scales. 133 articles were included, describing 158 frailty scales. Fatigue items were extracted and categorized in 4 fatigue constructs: "mood state related tiredness", "general feeling of tiredness", "activity based feeling of tiredness" and "resistance to physical tiredness".

RESULTS

120 fatigue items were identified, of which 100 belonged to the construct "general feeling of tiredness" and only 9 to the construct "resistance to physical tiredness". 49,4% of the frailty scales included at least 1 fatigue item, representing 15 ± 9,3% of all items in these scales. Fatigue items have a significantly higher weight in single domain (dominantly physical frailty scales) versus multi domain frailty scales (21 ± 3.2 versus 10.6 ± 9.8%, p=<0,05).

CONCLUSION

Fatigue is prominently represented in frailty scales, covering a great diversity in fatigue constructs and underlying pathophysiological mechanisms by which fatigue relates to frailty. Although fatigue items were more prevalent and had a higher weight in physical frailty scales, the operationalization of fatigue leaned more towards psychological constructs. This review can be used as a reference for choosing a suitable frailty scale depending on the type of fatigue of interest.

Quality of life among older people with a disability: the role of purpose in life and capabilities

Purpose: Purpose in life and capabilities are two significant individual elements that enhance quality of life among older people. Capabilities refers to the extent to which older people are free to make choices that are important to them. At present, it is not known how purpose in life interacts with capabilities to influence quality of life for those living with a disability. This study examined the extent to which purpose in life and capabilities interacts with health status to affect quality of life, particularly for older people with a disability.Methods: Self-report data from participants in a longitudinal cohort study of older New Zealanders were analyzed. Responses from 452 older people with a disability were compared with 3299 age- and gender-matched older people without a disability on indicators related to health and aging. The associations were tested using hierarchical regression. Mediational impact of purpose in life and capabilities were tested via path analysis.Results: Mental health, physical health, purpose in life, and capabilities accounted for a significant amount of variance in quality of life for older people with a disability. Purpose in life and capabilities were significant unique mediators for older people with a disability.Conclusions: Purpose in life may help older people with a disability to deal with early onset stressors or changes in mental and physical health to maintain overall quality of life. The role of capabilities suggests that the social environment and access to resources and choices are important in ensuring that older people aging with or into a disability achieve quality of life in a socially just environment.Implications for rehabilitationsPurpose in life and capability are unique mediators of the relationship between health status and quality of life.Purpose in life may act as an effective buffering mechanism to deal with disability in later life while capability can empower older people with a disability to achieve quality of life in a just environment.The notion of successful aging with disability should be re-defined as using psychological, social support, and healthcare resources to live a life consistent with personal values in the context of disabilityRather than emphasizing structural factors and physical functioning in activity participation, older people with disability should be supported to decide and pursue their own preferences.Rehabilitation professionals can work flexibly with older people with disability to maximize their resilience, dignity, autonomy and choice, and positive connection to others.

Gender differences in four-year incidence of self-reported and performance-based functional disability: The International Mobility in Aging Study

OBJECTIVES

To examine differences in incidence of functional disability between older women and men.

METHODS

2002 participants (65-74 years) were recruited in 2012 from Canada, Brazil, Colombia, and Albania, and re-assessed in 2016. Three measures of functional disability were used (1) Difficulty in any of five mobility-related Activities of Daily Living (ADL disability); (2) Self-reported difficulty climbing a flight of stairs or walking 400 m (mobility disability); and (3) Poor physical performance. We estimated the adjusted gender-specific incidence risk ratios (IRR) for each outcome in 2016.

RESULTS

In 2016, 1506 participants (52% women) were re-examined, 80% of the surviving cohort. Among those not disabled in 2012, seventy-four (12.9%) men developed ADL disability, while 105 (19.2%) developed mobility disability, and 97 (16.1%) developed poor physical performance. For women, numbers were higher 120 (21.4%) developed ADL disability, 117 (26.5%) developed mobility disability, and 140 (23.0%) developed poor physical performance. Compared to men, women had a higher adjusted incidence of self-reported ADL disability (IRR 1.4; 95% CI 1.04-1.88) and mobility disability (IRR 1.4; 95% CI 1.06-1.77), but not of poor physical performance (IRR 1.03; 95% CI 0.88-1.32).

CONCLUSIONS

Although women have a higher self-reported incidence of ADL and mobility disability than men, there was no significant difference in poor physical performance. Reasons for this discrepancy between self-reported and performance-based measures require further investigation. Understanding gender differences in functional disabilities can provide the basis for interventions to prevent mobility loss and minimize any gender gap.

The Relationship Between Sleep Characteristics and Unmet Physical Activity Need in Older Women

Objective: We examined among older women the association of sleep quality, daytime tiredness, and sleep duration with unmet physical activity need, that is, wishing to be more physically active but perceiving no opportunity for it. Method: Cross-sectional logistic regression analyses among women aged 74 to 86 years (Finnish Twin Study on Aging, third wave, n = 302). Results: Thirty-one participants reported unmet physical activity need. Short sleepers had fivefold and long sleepers threefold odds for unmet physical activity need compared with normative sleepers, while for daytime tiredness the odds were double. Presence of daytime tiredness and unmet physical activity coincided with higher prevalence of chronic diseases, depressive symptoms and walking difficulties, which partly explains the observed associations. Poor sleep quality was not associated with unmet physical activity need. Discussion: Older women with nonoptimal sleep characteristics who perceive unmet physical activity need may benefit from solutions that improve their perceived opportunities for physical activity.

Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care

Background

A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services.

Patients and methods

A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services.

Results

After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052–0.164; P<0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131–0.400; P<0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085–0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395–1.178; P=0.170).

Conclusion

Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.

Leisure-time physical activity and risk of disability incidence: A 12-year prospective cohort study among young elderly of the same age at baseline

Background

To clarify the role of physical activity in preventing disability in Japan, we investigated the association between amount of leisure-time physical activity and incidence of disability among the young elderly.

Methods

In the New Integrated Suburban Seniority Investigation (NISSIN) project conducted from 1996 to 2013, we followed 2888 community-dwelling adults aged 64–65 years with no history of cerebrovascular disease for a median follow-up of 11.6 years. Disabilities were defined as follows based on the classifications of the Japanese long-term care insurance system: 1) support or care levels (support levels 1–2 or care levels 1–5); 2) care levels 2–5; 3) support or care levels with dementia; and 4) care levels 2–5 or death. In addition, we also assessed 5) all-cause mortality.

Results

After controlling for sociodemographic, lifestyle, and medical factors, male participants reporting an activity level of 18.1 metabolic equivalent (MET)-hours/week (the median among those with activities) or more had 52% less risk of being classified as support or care levels with dementia compared with the no activity group (hazard ratio 0.48; 95% confidence interval, 0.25–0.94). No significant association was found among women between amount of leisure-time physical activity and incidence of disability.

Conclusion

We identified an inverse dose–response relationship between the amount of leisure-time physical activity and the risk of disability with dementia in men. Therefore, a higher level of physical activity should be recommended to young elderly men to prevent disability with dementia.

•

We examined associations between physical activity and disability incidence.

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We quantified amount of leisure-time physical activity.

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A dose–response relationship was found for the risk of disability with dementia.

Limitations in Activities of Daily Living in Community-Dwelling People Aged 75 and Over: A Systematic Literature Review of Risk and Protective Factors

Background

Most older people wish to age in place, for which functional status or being able to perform activities of daily living (ADLs) is an important precondition. However, along with the substantial growth of the (oldest) old, the number of people who develop limitations in ADLs or have functional decline dramatically increases in this part of the population. Therefore, it is important to gain insight into factors that can contribute to developing intervention strategies at older ages. As a first step, this systematic review was conducted to identify risk and protective factors as predictors for developing limitations in ADLs in community-dwelling people aged 75 and over.

Methods

Four electronic databases (CINAHL (EBSCO), EMBASE, PsycINFO and PubMed) were searched systematically for potentially relevant studies published between January 1998 and March 2016.

Results

After a careful selection process, 6,910 studies were identified and 25 were included. By far most factors were examined in one study only, and most were considered risk factors. Several factors do not seem to be able to predict the development of limitations in ADLs in people aged 75 years and over, and for some factors ambiguous associations were found. The following risk factors were found in at least two studies: higher age, female gender, diabetes, hypertension, and stroke. A high level of physical activity and being married were protective in multiple studies. Notwithstanding the fact that research in people aged 65 years and over is more extensive, risk and protective factors seem to differ between the ‘younger’ and ‘older’ olds.

Conclusion

Only a few risk and protective factors in community-dwelling people aged 75 years and over have been analysed in multiple studies. However, the identified factors could serve both detection and prevention purposes, and implications for future research are given as well.

For whom is a health-promoting intervention effective? Predictive factors for performing activities of daily living independently

BACKGROUND

Health-promoting interventions tailored to support older persons to remain in their homes, so-called "ageing in place" is important for supporting or improving their health. The health-promoting programme "Elderly Persons in the Risk Zone," (EPRZ) was set up for this purpose and has shown positive results for maintaining independence in activities of daily living for older persons 80 years and above at 1- and 2 year follow-ups. The aim of this study was to explore factors for maintaining independence in the EPRZ health-promoting programme.

METHODS

Total of 459 participants in the original trial was included in the analysis; 345 in the programme arm and 114 in the control arm. Thirteen variables, including demographic, health, and programme-specific indicators, were chosen as predictors for independence of activities of daily living. Logistic regression was performed separately for participants in the health promotion programme and in the control arm.

RESULTS

In the programme arm, being younger, living alone and self-rated lack of tiredness in performing mobility activities predicted a positive effect of independence in activities of daily living at 1-year follow-up (odds ratio [OR] 1.18, 1.73, 3.02) and 2-year, (OR 1.13, 2.01, 2.02). In the control arm, being less frail was the only predictor at 1-year follow up (OR 1.6 1.09, 2.4); no variables predicted the outcome at the 2-year follow-up.

CONCLUSIONS

Older persons living alone - as a risk of ill health - should be especially recognized and offered an opportunity to participate in health-promoting programmes such as "Elderly Persons in the Risk Zone". Further, screening for subjective frailty could form an advantageous guiding principle to target the right population when deciding to whom health-promoting intervention should be offered.

TRIAL REGISTRATION

The original clinical trial was registered at ClinicalTrials.gov. Identifier: NCT00877058 , April 6, 2009.

Development and Validation of the State-Trait Inventory of Cognitive Fatigue in Community-Dwelling Older Adults

OBJECTIVE

To develop and validate a subjective measure of cognitive fatigue-the State-Trait Inventory of Cognitive Fatigue-in community-dwelling older adults.

DESIGN

Scale development and test construction.

SETTING

Community-dwelling older adults enrolled in a longitudinal cohort aging study.

PARTICIPANTS

Participants (N=175) were healthy, English-speaking, community-dwelling adults, age ≥65 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

State-Trait Inventory of Cognitive Fatigue total, cognitive fatigue, motivation, mental effort, and boredom summation scores for both state and trait forms.

RESULTS

Principal component analysis yielded the expected 4 components for both state and trait forms: cognitive fatigue, mental effort, motivation, and boredom. All components had good reliability. There was good convergent validity as measured by the strong positive relation between cognitive fatigue and a subjective measure of general fatigue, even after controlling for depressive symptoms. Greater subjective cognitive fatigue was associated with worse performance on measures thought to be more sensitive to aspects of executive functioning.

CONCLUSIONS

This study developed and established the psychometric properties of a new instrument for the subjective measurement of cognitive fatigue for use in community-dwelling older adults. The State-Trait Inventory of Cognitive Fatigue's relatively brief administration time (<10min; mean, 5.6±2.9) and strong psychometric properties support its utility in both research and clinical settings. Future studies should establish the psychometric properties of this scale in other populations and examine its predictive utility for relevant clinical outcomes.

Fatigued, but Not Frail: Perceived Fatigability as a Marker of Impending Decline in Mobility-Intact Older Adults

OBJECTIVES

To evaluate perceived fatigability as a predictor of meaningful functional decline in non-mobility-limited older adults.

DESIGN

Longitudinal analysis of data from the Baltimore Longitudinal Study of Aging (BLSA).

SETTING

National Institute on Aging, Clinical Research Unit, Baltimore, Maryland.

PARTICIPANTS

Men and women aged 60 to 89 participating in the BLSA with concurrent perceived fatigability and functional assessments and follow-up functional assessment within 1 to 3 years (N = 540).

MEASUREMENTS

Perceived fatigability was ascertained using the Borg rating of perceived exertion (RPE) after 5 minutes of treadmill walking at 1.5 miles per hour. Functional assessments included usual and fast gait speed, the Health, Aging and Body Composition physical performance battery (HABC PPB) and reported walking ability. Reported tiredness and energy level were examined as complementary predictors. Covariates included age, age squared, race, follow-up time, and baseline function. Meaningful decline was defined as 0.05 m/s per year for usual gait speed, 0.07 m/s per year for fast gait speed, 0.12 points/year for HABC PPB, and 1 point for walking ability index.

RESULTS

Over a mean 2.1 years, 20-31% of participants declined across functional assessments. Fatigability was associated with a 13-19% greater likelihood of meaningful decline in all measures (P = .002- .02) per 1-unit RPE increase. After considering tiredness and energy level separately, findings were essentially unchanged, and neither was associated with gait speed or physical performance decline. In contrast, each separately predicted decline in reported walking ability independent of fatigability (P = .03 and P < .001, respectively).

CONCLUSION

Routine assessment of fatigability may help identify older persons vulnerable to greater-than-expected functional decline.

Within-Day Variability of Fatigue and Pain Among African Americans and Non-Hispanic Whites With Osteoarthritis of the Knee

OBJECTIVE

Fatigue is common among persons with osteoarthritis (OA), but little is known about racial/ethnic differences in the prevalence, correlates, or dynamics of fatigue in OA. This research therefore used experience sampling methodology (ESM) to examine fatigue and pain at global and momentary levels among African Americans and non-Hispanic whites with OA.

METHODS

Thirty-nine African Americans and 81 non-Hispanic whites with physician-diagnosed knee OA completed a baseline interview and an ESM protocol assessing fatigue, pain, and mood 4 times daily for 7 days. In addition to analyzing basic group differences, multilevel modeling examined within- versus between-subject patterns and correlates of variability in momentary fatigue, controlling for demographics and other potential confounders.

RESULTS

Both racial groups experienced moderate levels of fatigue; however, there were clear individual differences in both mean fatigue level and variability across momentary assessments. Mean fatigue levels were associated with global pain and depression. Increase in fatigue over the course of the day was much stronger among non-Hispanic whites than African Americans. Momentary fatigue and pain were closely correlated. Mean fatigue predicted variability in mood; at the momentary level, both fatigue and pain were independently associated with mood.

CONCLUSION

Fatigue is a significant factor for both African Americans and non-Hispanic whites with OA, and is negatively related to quality of life. Pain symptoms, at both the momentary level and across individuals, were robust predictors of fatigue. Although overall levels of reported symptoms were similar across these 2 groups, the pattern of fatigue symptoms across the day differed.

Where do community-dwelling older adults with disabilities live? Distribution of disability in the United States of America by household composition and housing type

There is limited research on the living arrangements of older adults with disabilities, especially research that combines household composition and housing characteristics. This paper addresses that gap with two complementary sets of logistic regression models: first, estimating the odds of disability by household composition and housing type and, second, estimating the odds of disability by living arrangement within gender and age sub-groups. Data come from the 2012 American Community Survey (N = 504,371 respondents aged 65 and older), which includes six measures of disability: cognitive, ambulatory, independent living, self-care, vision and hearing. Living alone, with children or with others was associated with higher odds of any disability, compared with living with a spouse only. Compared to those living in a single-family home, living in a mobile home or other temporary structure, or large apartment building was associated with higher odds of disability. Having a disability was associated with lower rates of living with a spouse only, alone, in a single-family home or in a small or mid-sized apartment building and higher rates of all other living arrangements. Sub-group analyses revealed differences in the relationship between living arrangements and disability by gender and age group. This information provides a baseline from which to observe trends in living arrangements and disability for older adults in the United States of America.

Task-Specific Fatigue Among Older Primary Care Patients

OBJECTIVE

Fatigue is a common condition contributing to disability among older patients. We studied self-reported task-specific fatigue and its relation with mobility task performance among community-dwelling primary care patients.

METHOD

Cross-sectional analysis of baseline demographic and health data from a prospective cohort study of 430 primary care patients aged 65 years or older. Fatigue was measured using the Avlund Mobility-Tiredness Scale. Performance tasks included rising from a chair, walking 4 m, and climbing two flights of stairs.

RESULTS

Among demographic and health factors, pain was the only attribute consistently predictive of fatigue status. Self-reported chair rise fatigue and walking fatigue were associated with specific task performance. Stair climb fatigue was not associated with stair climb time.

DISCUSSION

Pain is strongly associated with fatigue while rising from a chair, walking indoors, and climbing stairs. This study supports the validity of self-reported chair rise fatigue and walking fatigue as individual test items.

Self-determination among community-dwelling older persons: explanatory factors

BACKGROUND

Although it is acknowledged that exercising self-determination in daily activities affects older people's health and well-being, few studies have focused on the explanatory factors for self-determination in daily life.

OBJECTIVE

To investigate explanatory factors for self-determination in the context of community-dwelling older persons.

METHOD

This cross-sectional study combined two sets of data that included community-dwelling persons 80 years and older (n = 456). A bivariate logistic regression was performed to analyse the association of self-determination and a set of explanatory factors.

RESULTS

The final bivariate logistic regression model revealed five explanatory factors that were significantly associated with perceiving reduced self-determination: high education (OR = 2.83), frailty (OR = 2.70), poor self-rated health (OR = 2.54), dissatisfaction with physical health (OR = 6.50), and receiving help from public homecare service (OR = 2.46).

CONCLUSION

Several explanatory factors related to the ageing body and environmental aspects were associated with reduced self-determination. To help older people maintain self-determination, healthcare professionals should consider using a person-centred and capability approach to care.

Self-Reported Hindering Health Complaints of Community-Dwelling Older Persons: A Cross-Sectional Study

Purpose

Proactive care for community-dwelling older persons targeting self-reported hindering health complaints might prevent a decline in function. We investigated the spectrum of self-reported hindering complaints of community-dwelling older persons, the association with functional outcomes, and help-seeking behavior for these complaints.

Methods

Within the ISCOPE trial, participants (aged ≥75 years) received the ISCOPE screening questionnaire, including the open-ended question “At the moment, which health complaints limit you the most in your day-to-day life?”. After coding the answers with the ICPC-1-NL, we examined the prevalence and the association between the number and type of complaints and functional outcomes (Groningen Activities Restriction Scale, quality of life measured on Cantril’s Ladder, Mini-Mental State Examination, Geriatric Depression Scale-15, and De Jong Gierveld Loneliness Scale). Electronic patient registers were searched for the most reported complaints.

Results

7285 participants (median age: 81.0 years [IQR 77.8–85.3], 38.6% males) reported 13,524 hindering complaints (median 1, range 0–18); 32.7% reported no complaints. Participants mostly reported problems with walking/standing (22.1%), pain (20.8%) or weakness/tiredness (8.5%). These complaints were mentioned in the electronic patient registers in 28.3%, 91.3% and 55.5%, respectively. Higher numbers of hindering complaints were related to poorer scores on the number of domains with problems, Cantril’s Ladder for quality of life, Groningen Activities Restriction Scale, Geriatric Depression Scale, and De Jong Gierveld Loneliness Scale. Self-reported weakness, problems with walking/standing, visual limitations, cognitive problems, dyspnea and back complaints were associated with poorer scores on the number of domains with problems, Groningen Activities Restriction Scale, MMSE or Geriatric Depression Scale.

Conclusion

One third of the participants reported no hindering complaints. Problems with walking/standing, pain, and weakness/tiredness were most reported, but not always found in electronic patient registers. A higher number of, and specific self-reported hindering complaints, were associated with poorer scores on functional outcomes. It may be helpful for general practitioners to ask about these complaints and their influence on daily life.

Health Promotion Can Postpone Frailty: Results from the RCT Elderly Persons in the Risk Zone

OBJECTIVE

Very old persons (80+) are often described as "frail", implying that they are particularly vulnerable to adverse health outcomes. Elderly Persons in the Risk Zone was designed to determine whether a preventive home visit or multiprofessional senior group meetings could postpone deterioration in frailty if the intervention is carried out when the person is not so frail.

DESIGN AND SAMPLE

The study was a RCT with follow-ups at 1 and 2 years. A total of 459 persons (80+), still living at home, were included. Participants were independent in activities of daily life and cognitively intact.

MEASURES

Frailty was measured in two complementary ways, with the sum of eight frailty indicators and with the Mob-T Scale measuring tiredness in daily activities.

RESULTS

Both interventions showed favorable effects in postponing the progression of frailty measured as tiredness in daily activities for up to 1 year. However, neither of the two interventions was effective in postponing frailty measured with the sum of frailty indicators.

CONCLUSIONS

The results in this study show the potential of health promotion to older persons. The multiprofessional approach, including a broad spectrum of information and knowledge, might have been an important factor contributing to a more positive view of aging.

Associations of Midlife to Late Life Fatigue With Physical Performance and Strength in Early Old Age: Results From a British Prospective Cohort Study

OBJECTIVES

To examine associations of fatigue in midlife and later life with physical performance and strength in early old age.

METHODS

Data on approximately 1800 men and women from the UK Medical Research Council National Survey of Health and Development with data on fatigue at ages 43 and 60 to 64 years were used. Fatigue was defined as perceived tiredness and was assessed prospectively at ages 43 and 60 to 64 years. At both ages, participants were categorized as having no, occasional, or frequent fatigue. Physical performance and strength were measured at age 60 to 64 years using four objective measures: grip strength, standing balance, chair rising, and timed get-up-and-go (TUG) tests.

RESULTS

There were associations between reports of frequent fatigue at both ages and poorer grip strength, chair rise, and TUG performance at 60 to 64 years. Furthermore, individuals reporting frequent fatigue at both ages had weaker grip strength (β = -4.09 kg, 95% confidence interval [CI] = -6.71 to -1.48) and slower chair rise (β = -4.65 repetitions/min, 95% CI = -6.65 to -2.64) and TUG (β = -4.22 cm/s, 95% CI = -12.16 to -2.28) speeds when compared with those who reported no fatigue at both time points. These associations were robust and were maintained after adjustment for a range of covariates including physical activity and health status.

CONCLUSIONS

Reports of frequent fatigue were associated with poorer physical performance in early old age, especially if sustained from midlife to later life. These findings indicate that it is not just fatigue but fatigue sustained across adulthood that has implications for later life functioning.

Self-reported exhaustion associated with physical activity among older adults

AIM

Self-reported exhaustion (SE) is a clinical complaint that is associated with a wide range of chronic diseases. However, the association of SE with physical activity, physical function or cognitive function among the older adult Japanese population is unclear. The present study aimed to determine the prevalence of SE, as well as whether physical function, cognitive function and physical activity were significant covariates.

METHODS

A total of 4607 adults (mean age 71 years) were considered eligible for participation based on the study criteria. SE was evaluated using the Study of Osteoporotic Fracture Index. We also evaluated physical activity, physical function (grip strength, Timed Up & Go) and cognitive function (Mini-Mental State Examination, Trail Making Test part A and B, Symbol Digit Substitution Task).

RESULTS

The prevalence of SE ranged from 40.9% to 55.0%, and significantly increased with age. The results of the multiple logistic regression analyses showed that in the adjusted model of the 65-69 years age group, physical activity, Timed Up & Go and Symbol Digit Substitution Task were independently associated with SE. In the 70-79 years age group, physical activity, Timed Up & Go, Trail Making Test part A and B and Symbol Digit Substitution Task were independently associated with exhaustion. Only physical activity was associated with exhaustion in the ≥80 years age group.

CONCLUSIONS

The prevalence of SE increased with age in the older adult Japanese population. Exhaustion was strongly associated with reduced daily physical activity, especially in those aged ≥80 years. Further studies should be carried out to determine if physical activity causes SE. Geriatr Gerontol Int 2016; 16: 625-630.

Shifting between self-governing and being governed: a qualitative study of older persons' self-determination

Background

Older persons’ right to exercise self-determination in daily life is supported by several laws. Research shows that older persons’ self-determination is not fully respected within the healthcare sector. In order to enable and enhance older persons’ self-determination, extensive knowledge of older persons’ self-determination is needed. The aim of this study was to explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older.

Methods

Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons aged 84–95 years who were beginning to develop dependence in daily activities.

Results

The data analysis revealed the core category, “Self-determination - shifting between self-governing and being governed”. The core category comprised three categories: “Struggling against the aging body”, “Decision-making is relational”, and “Guarding one’s own independence”. Self-determination in daily activities was related to a shifting, which was two-fold, and varied between self-governing and being governed by the aging body, or by others.

Conclusions

The findings imply a need to adopt a person-centered approach where the older persons’ own preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination.

Effects of cognitive task demands on subsequent symptoms and activity in adults with symptomatic osteoarthritis

OBJECTIVE

Adults with osteoarthritis (OA) experience fatigue in daily life that is negatively related to physical activity; however, it is unclear how task demands affect fatigue and occupational performance. We examined effects of a cognitive task on subsequent symptoms and activity.

METHOD

Adults with knee or hip OA completed a standardized cognitive task during a lab visit. Objective physical activity and symptoms were tracked during two home-monitoring periods (i.e., 4-day period before and 5-day period after the lab visit). Multilevel modeling was used to compare pretask with posttask fatigue, pain, and activity levels.

RESULTS

Fatigue increased and pain decreased for 2 days after performing the lab task. The authors found no pretask to posttask changes in activity levels. At posttask, daily fatigue and activity patterns changed relative to baseline.

CONCLUSION

For adults with symptomatic OA, cognitive task demands may be an important contributor to fatigue and pain.

The Relationship between Mechanical Hyperalgesia Assessed by Manual Tender Point Examination and Disease Severity in Patients with Chronic Widespread Pain: A Cross-Sectional Study

The clinical utility of tender point (TP) examination in patients reporting chronic widespread pain (CWP) is the subject of contemporary debate. The objective of this study was to assess the relationship between mechanical hyperalgesia assessed by manual TP examination and clinical disease severity. 271 women with CWP were recruited from a clinical setting. Data collection included patient-reported symptoms, health-related quality of life variables, and observation-based measures of functional ability, muscle strength, 6-minute walk, and pressure pain thresholds measured by cuff algometry. TP examination was conducted according to ACR-guidelines. Relationships between disease variables and TP count (TPC) were analyzed with logistic regression in a continuum model, allowing the TPC to depend on the included disease variables and two regression models carried out for a TPC threshold level, varying between 1 and 17. The threshold analyses indicated a TPC threshold at 8, above which a large number of disease variables became consistently significant explanatory factors, whereas none of the disease variables reached a significance level in the continuum model. These results support the premise that the presence of mechanical hyperalgesia influences symptomatology in CWP and that the severity of clinical expression is related to a threshold of TPs, rather than being part of a continuum.

Psychometric properties of the Brief Fatigue Inventory in community-dwelling older adults

OBJECTIVE

To investigate the psychometric properties of the Brief Fatigue Inventory (BFI) in community-dwelling older adults.

DESIGN

Cross-sectional validation study.

SETTING

Community based.

PARTICIPANTS

Subjects (N=302) were nondemented older adults (mean age, 76.44 y; 54% women).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

BFI total, severity, and interference summation scores.

RESULTS

A principal component analysis (PCA) yielded 2 factors, fatigue severity and interference, explaining 65.94% of the variance. Both factors had good reliability, with Cronbach alpha values of .867 for fatigue interference and .818 for fatigue severity. Higher fatigue scores were associated with older age and worse physical and cognitive functions.

CONCLUSIONS

Fatigue is a common and debilitating symptom in the aging population. The current study provides novel findings in validating and establishing a bidimensional factor structure for the BFI in older adults. Severity and interference were differentially related to important health outcomes; therefore, using these subscales in addition to the total BFI score is recommended with older adults. Because of its relatively short administration time and established psychometric properties, the BFI can be successfully incorporated into longitudinal studies and clinical trials.

The Prediction of ADL and IADL Disability Using Six Physical Indicators of Frailty: A Longitudinal Study in the Netherlands

Frailty is a predictor of disability. A proper understanding of the contribution of individual indicators of frailty in the prediction of disability is a requisite for preventive interventions. The aim of this study was to determine the predictive power of the individual physical frailty indicators: gait speed, physical activity, hand grip strength, Body Mass Index (BMI), fatigue, and balance, for ADL and IADL disability. The sample consisted of 505 community-dwelling persons (≥75 years, response rate 35.1%). Respondents first participated between November 2007 and June 2008, and a subset of all respondents participated again one year later (N = 264, 52.3% response rate). ADL and IADL disability were assessed by the Groningen Activity Restriction Scale. BMI was assessed by self-report, and the other physical frailty indicators were assessed with the TUG test (gait speed), the LAPAQ (physical activity), a hand grip strength test, the SFQ (fatigue), and the Four-test balance scale. All six physical frailty indicators were associated with ADL and IADL disability. After controlling for previous disability, sociodemographic characteristics, self-perceived lifestyle, and chronic diseases, only gait speed was predictive of both ADL and IADL disability, whereas there was a small effect of fatigue on IADL disability. Hence, these physical frailty indicators should be included in frailty assessment when predicting future disability.

Epidemiology of restricting fatigue in older adults: the precipitating events project

OBJECTIVES

To estimate the rate of restricting fatigue in community-living older adults and to determine whether the rates differ according to age, sex, race, physical frailty, and depression.

DESIGN

Prospective cohort study.

SETTING

Greater New Haven, Connecticut.

PARTICIPANTS

Nondisabled community-living older men and women aged 70 and older (N = 754).

MEASUREMENTS

Restricting fatigue was defined as staying in bed for at least half the day and/or cutting down on one's usual activities because of fatigue for 3 consecutive months or longer. Physical frailty was defined on the basis of slow gait speed, and depression was assessed using the Center for Epidemiologic Studies Depression Scale.

RESULTS

During a median follow-up of 111 months, the cumulative incidence of restricting fatigue was 31.1% for men and 42.1% for women. The overall incidence rate of restricting fatigue was 6.7 per 1,000 person-months (7.8 for women and 4.4 for men, P < .001), which did not differ according to race. Rates were higher in persons who were physically frail than those who were not (P < .001), in those who were depressed than those who were not (P < .001), and in persons aged 75 to 79 and 80 to 84 than those aged 70 to 74 (both P < .01) but not in those aged 85 and older. Of the 459 episodes of restricting fatigue, the median duration was 3 months, which did not differ according to age, sex, race, physical frailty, or depression.

CONCLUSION

Restricting fatigue is common in community-living older adults. Women, individuals aged 75 to 84, and individuals with physical frailty or depression had higher rates of restricting fatigue than their respective counterparts.

Relationship between fatigue and subsequent physical activity among older adults with symptomatic osteoarthritis

OBJECTIVE

Although it has been well established that fatigue is common among older adults with osteoarthritis (OA), relatively little is known about how fatigue in daily life affects physical activity. The purposes of this study were to examine the relationship between momentary fatigue and subsequent physical activity among people with OA who reported clinically relevant levels of fatigue and to examine moderators of this relationship.

METHODS

People with knee or hip OA and clinically relevant fatigue participated in physical performance assessments, completed questionnaires, and underwent a home monitoring period in which fatigue severity was measured 5 times/day over 5 days (n = 172). Physical activity was concurrently measured via a wrist-worn accelerometer. Multilevel modeling was used to examine the relationship of momentary fatigue and subsequent activity controlling for other factors (e.g., age, body mass index, pain, and depression).

RESULTS

Fatigue was the strongest predictor of reduced subsequent activity. Only functional mobility (Timed Up and Go) moderated the relationship between fatigue and activity. The relationship between fatigue and activity was strongest for people with high functional mobility.

CONCLUSION

Momentary fatigue is a robust and important variable associated with decreased physical activity. Further, the moderating effect of functional mobility suggests this factor should be considered when intervening on fatigue. While people with better functional mobility may benefit from an activity-based treatment approach (such as learning activity pacing techniques to reduce the impact of fatigue on activity), those with worse functional mobility may benefit from treatment focusing on underlying impairments.

Self-reported aging-related fatigue: a concept description and its relevance to physical therapist practice

Fatigue is one of the most common symptoms experienced by older people, both with and without chronic disease. It is unpleasant and distressing and can affect functioning and quality of life. Fatigue also may inhibit an older person from participating optimally in a physical therapy program aimed at rehabilitation or the promotion of better health. However, confusion surrounds the concept of self-reported aging-related fatigue, not only because of the complexity of the problem itself but also because of lack of clarity of definition and the use of the term "fatigue" to describe a range of different concepts. This article aims to provide clarification of the concept in the context of physical therapist clinical practice. The intention is to increase awareness of the issue among physical therapists, promoting their assessment and consideration of the problem when planning health interventions involving functioning, physical activity, and exercise for older people.

One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial: "Continuum of care for frail older people"

Background

The intervention; “Continuum of Care for Frail Older People”, was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person’s own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL).

Methods

The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR).

Results

A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 – 4.68) and (2.04, 95% CI; 1.03 – 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 – 0.98) compared to the control group.

Conclusions

The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.

Trial registration

ClinicalTrials.gov: NCT01260493

Chronic fatigue and affective disorders in older adults: evidence from the 2007 British National Psychiatric Morbidity Survey

BACKGROUND

Although chronic fatigue is common in old age, the association between chronic fatigue and common affective disorders is largely unknown.

AIMS

To fill this research gap, the present study aims to determine the relationship between chronic fatigue and common psychiatric disorders among older adults aged 65 and older.

METHOD

A national representative sample of 1793 England community-dwelling respondents aged 65 and above was assessed in the 2007 Adult Psychiatric Morbidity Survey (APMS) using the Revised Clinical Interview Schedule to measure chronic fatigue and common psychiatric disorders. Demographic characteristics, medical conditions, and four health-related variables based on the Short Form 12 were also measured.

RESULTS

The prevalence of chronic fatigue was 18.6%. Bivariate analyses revealed that chronic fatigue was more common among women and non-white ethnicities. In addition, chronic fatigue was significantly related to depression, mixed anxiety and depressive disorder, and generalized anxiety disorder after adjusting for demographic variables, medical conditions, and four other health-related variables.

CONCLUSION

The prevalence rate of chronic fatigue in our sample is higher than a previous study. The psychiatric comorbidity of chronic fatigue supports the notion that chronic fatigue has a strong impact on quality of life in old age.

Improving a measure of mobility-related fatigue (the mobility-tiredness scale) by establishing item intensity

OBJECTIVES

To improve the construct validity of self-reported fatigue by establishing a formal hierarchy of scale items and to determine whether such a hierarchy could be maintained across time (aged 75-80), sex, and nationality.

DESIGN

Cohort study.

SETTING

Two Nordic urban locations: Jyväskylä, Finland, and Glostrup, Denmark.

PARTICIPANTS

Baseline (1989/90) consisted of a random sample of citizens of Finland or Denmark born in 1914 (n = 837). At 5-year follow-up, excluding those lost to follow-up and with baseline disability resulted in a sample of n = 690.

MEASUREMENTS

The Mobility-Tiredness (Mob-T) Scale is a six-item scale that requires subjects to self-report on whether they become tired performing mobility-related tasks. Employing item response theory, an attempt was made to enhance construct validity by confirming a hierarchy of mobility-related fatigue.

RESULTS

A formal hierarchy of fatigue tasks, maintained across time, was established using the revised Mob-T Scale. At age 75, the scalability statistics were a homogeneity coefficient (H) of 0.80, Ha T of 3.9% and an H(T) value of 0.66. The corresponding figures at age 80 were 0.75, 6.9% and 0.59. The property of invariant item ordering was maintained across subgroups based on sex and nationality.

CONCLUSION

Establishing a formal hierarchy at age 75 allowed which tasks were most debilitating to be identified more clearly and the individual's "distance" from these tasks to be gauged. Because it was possible to confirm that the item hierarchy was maintained across time (aged 75-80), researchers or clinicians can be more confident that performance over time is the result of real change and has less to do with measurement error.

Fatigability as a function of physical activity energy expenditure in older adults

Increased fatigue is a predictor of morbidity and mortality in older adults. Fatigability defines a change in performance or self-reported fatigue in response to physical activity (PA). However, the relationship of fatigability to PA-related energy expenditure (PAEE) is unknown. Changes in performance, fatigue, and energy expenditure were measured simultaneously in 17 adults (11 females, 74-94 years old) performing eight standardized PA tasks with various energy expenditure requirements in a whole-room indirect calorimeter. Change in performance was objectively measured using a PA movement monitor and change in fatigue was self-reported on a seven-point scale for each task. Performance and perceived fatigability severity scores were calculated as a ratio of change in performance and fatigue, respectively, and PAEE. We found that change in both objective performance and self-reported fatigue were associated with energy expenditure (Spearman rho = -0.72 and -0.68, respectively, p < 0.001) on a task requiring relatively high level of energy expenditure. The performance and perceived fatigability severity scores were significantly correlated (rho = 0.77, p < 0.001) on this task. In summary, results of this proof of concept pilot study show that both perceived and performance fatigability severity scores are related to PAEE-induced fatigue on a task requiring relatively high level of energy expenditure. We conclude that fatigability severity is a valid measure of PAEE-induced fatigue in older adults.

Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis

PURPOSE

Physical activity (PA) is an important behavior when it comes to preventing or slowing down disablement caused by aging and chronic diseases. It remains unclear whether PA can directly prevent or reduce disability in activities of daily living (ADL). This article presents a meta-analysis of the association between PA and the incidence and progression of basic ADL disability (BADL).

METHODS

Electronic literature search and cross-referencing of prospective longitudinal studies of PA and BADL in community dwelling older adults (50+) with baseline and follow-up measurements, multivariate analysis and reporting a point estimate for the association.

RESULTS

Compared with a low PA, a medium/high PA level reduced the risk of incident BADL disability by 0.51 (95% CI: 0.38, 0.68; p<001), based on nine longitudinal studies involving 17,000 participants followed up for 3-10 years. This result was independent of age, length of follow-up, study quality, and differences in demographics, health status, functional limitations, and lifestyle. The risk of progression of BADL disability in older adults with a medium/high PA level compared with those with a low PA level was 0.55 (95% CI: 0.42, 0.71; p<001), based on four studies involving 8500 participants.

DISCUSSION

This is the first meta-analysis to show that being physically active prevents and slows down the disablement process in aging or diseased populations, positioning PA as the most effective preventive strategy in preventing and reducing disability, independence and health care cost in aging societies.

Impact of daytime sleepiness on rehabilitation outcome in the elderly

Daytime sleepiness (DS) is associated with poor health, impaired physical functioning, as well as somatic and psychiatric morbidity. The impact of DS on functional outcome in the elderly is unknown. We investigated whether observed daytime sleepiness in geriatric patients with moderate to severe functional impairment was associated with functional clinical outcomes. We addressed the issue by determining the impact of observed daytime sleepiness, by means of the Essener Questionnaire of Age and Sleepiness (EQAS), on improvement in functional status - measured by the Barthel ADL Index - among disabled geriatric in-patients. We included 129 patients, 28 (22%) were male and 101 (78%) were female. Sleepiness according to EQAS scale was absent in 27 (21%) patients, mild in 71 (55%) patients and moderate to severe in 31 (24%) patients. The three patient groups did not differ in the Barthel ADL Index (BI) on admission or co-morbid conditions. Geriatric treatment was comparable across groups. Improvement in the BI of at least 1 standard deviation (SD) occurred in 23/27 (85%) of subjects without sleepiness, in 53/71 (75%) of subjects with mild to moderate sleepiness and in 15/31 (44%) of subject with severe sleepiness (p < 0.01). BI increased at least 2 SD in 20/27 (74%), 38/71 (54%) and 11/31 (35%) individuals, respectively (p < 0.02). We conclude that the daytime sleepiness predicts a poorer functional recovery rate in older patients during geriatric in-hospital rehabilitation. Furthermore, we found a significant association and a dose response relationship between severity of daytime sleepiness and improvement in Barthel ADL Index.