Prevalence, Trajectory, and Predictors of Post-stroke Fatigue in Older Adults

Abstract

ObjectiveTo explore the prevalence, trajectories, and predictors of Post-stroke fatigue (PSF) in older adults following a first ischemic stroke. DesignA longitudinal observational cohort study. SettingTwo hospitals. ParticipantsA total of 381 patients aged ≥ 65 years with their first ischemic stroke were included. The mean (SD) age was 71.1 (4.27) years, with 96 patients (25.2%) being women and 285 (74.8%) being men. InterventionsNot applicable. Main Outcome MeasuresPatients were assessed using the Fatigue Severity Scale (FSS) at admission, 3 months, and 12 months. Growth mixture models (GMM) were used to identify distinct fatigue trajectories, and baseline variables were analyzed to determine their association with these trajectories. ResultsThe prevalence of clinical fatigue was 39.11%, 33.33%, and 22.31% at admission, 3 months, and 12 months, respectively. Five distinct fatigue trajectories were identified: persistently low fatigue (class 1, 49.1%), persistently high fatigue (class 2, 21.5%), initial high but early decreasing fatigue (class 3, 15.0%), initial high but late decreasing fatigue (class 4, 8.7%), and increasing-then-decreasing fatigue (class 5, 5.8%). Multinomial logistic regression analysis revealed that several factors were significantly associated with high and persistent fatigue (class 2), including older age, lower social support, decreased physical activity, higher depression and anxiety scores, cognitive impairment, and greater stroke severity. ConclusionThese findings indicate significant variability in the progression of fatigue among stroke survivors. Further research is necessary to determine the outcomes linked to these fatigue trajectory subgroups and to identify the most effective treatment strategies tailored to each specific subgroup.