Fatigue In Elderly Patients Research Articles

SOME FACTORS RELATED TO FATIGUE STATUS IN ELDERLY POST-STROKE PATIENTS

Objectives: To identify factors related to fatigue status in elderly post-stroke patients. Methods: A cross-sectional study on 157 patients those ages ≥ 60, diagnosed with stroke (according to the World Health Organization - WHO) and examined or treated as inpatients and outpatients at the National Geriatric Hospital, from July to November 2021. Data were collected using designed tools including characteristics of these patients. Entered data on Redcap and used SPSS version 22.0 for analysis. Results: Relevant factors affecting fatigue in elderly patients after stroke were physical activity daily living, cognitive impairment by Mini-Mental State Examination (MMSE), sleep disturbance by Pittsburgh Sleep Quality Index (PSQI), depression, and malnutrition. Factors that increased the risk of fatigue were age ≥ 60, using medication total, and cognitive decline. Conclusion: Early detection by performing the Fatigue Severity Scale (FSS) test to screen for fatigue in elderly post-stroke patients can provide appropriate treatment that helps improve treatment effectiveness as well as patients' quality of life.

Association between neutrophil-to-lymphocyte ratio and postoperative fatigue in elderly patients with hip fracture

Backgroundand purpose: Postoperative fatigue (POF) is a common and distressing post-operative symptom. This study aimed to explore the relationship between neutrophil-to-lymphocyte ratio (NLR) and POF in elderly patients with hip fracture. MethodElderly patients (age ≥65 years) with acute hip fracture admitted to the Department of Orthopedics of Anqing Municipal Hospital from June 2018 to June 2020 were included. Fatigue was assessed using the Fatigue Severity Scale at the 3-month follow-up postoperatively. Univariate and multivariate analyses were performed to explore the associations between NLR and POF. The diagnostic performance of NLR was analysed using Receiver Operating Characteristic (ROC) curve analysis and the Delong test. ResultA total of 321 elderly patients with hip fractures were included; 120 (37.4 %) of them were diagnosed with POF. Univariate analysis indicated significant differences in NLR, platelet-to-lymphocyte ratio (PLR), education, neutrophil count, lymphocyte count, Hamilton Depression Scale (HAMD) and Insomnia Severity Index (ISI) scores (P < 0.05). Multivariate analysis indicated neutrophil count (odds ratio [OR], 1.46; 95 % confidence interval [CI] 1.27–1.67), lymphocyte count (OR 0.32, 95 % CI 0.19–0.53), NLR (OR1.81, 95 % CI 1.50–2.17) and PLR (OR 1.005, 95 % CI 1.001–1.009) were significantly associated with POF. The areas under the ROC curves (AUCs) of neutrophil count, lymphocyte count, NLR and PLR were 0.712, 0.667, 0.775 and 0.605, respectively. The Delong test indicated that NLR had the best diagnostic performance (p < 0.05). ConclusionNLR independently predicts POF in elderly patients with acute hip fracture.

Pattern of Post COVID Fatigue in Elderly Patients.

The incidence of Long COVID (LC) increases with age but then drops sharply in over 70-year-olds. The prevailing explanation is that different biases in data collection such as reluctance to report symptoms or attributing them to comorbidities may explain this pattern in this age group. Our local data suggested a similar pattern confirming the rarity of LC symptoms especially fatigue in the over 70s. Our data have also showed a different phenotype of post COVID fatigue which is not commonly associated with post exertional symptoms bringing into question the suggestion that bias in collecting data is the main cause. We explore several immunological, metabolic and epigenetic factors associated with aging that may explain such phenomenon.

Quality of life and fatigue in elderly patients with sarcopenia

Objective: to assess the quality of life (QoL) using general and special questionnaires and to identify the relationship between fatigue and sarcopenia (SP) in elderly and senile people.Patients and methods. The cohort study included 230 patients, including 177 women (77%) and 53 men (23%) over 65 years old (median age 75 [68; 79] years). The presence of SP was determined according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2, 2018). QoL was studied using the general questionnaires EQ-5D, SF-36 and a special questionnaire SarQoL, the level of fatigue – using the FACIT-F questionnaire. To assess the possibility of using the FACIT-F scale for SP screening, its sensitivity, specificity, diagnostic accuracy, positive and negative predictive value were determined, a receiver operating characteristic (ROC) curve (ROC analysis) was constructed, and the area under the ROC curve (AUC) was calculated.Results and discussion. The assessment of QoL using the EQ-5D and SF-36 questionnaires did not reveal significant differences between the groups of patients with and without SP (p&gt;0.05). When analyzing the state of health in the study cohort using the special SarQoL questionnaire, the overall indicator was 63.12±18.83 points, while in patients with SP it was significantly lower than in patients without SP (50.65±14.23 and 75,10±14.46 points, respectively; p&lt;0.001). The mean score for all domains was also lower in the presence of SP than in its absence (p&lt;0.001).The level of fatigue on the FACIT-F scale ranged from 10 to 52 points and averaged 32.5 [29.1; 35.3] points, while in patients with SP the overall score was lower than in elderly people without SP (25.1 [22.13; 29.23] and 39.8 [36.4; 42.4] points respectively; p&lt;0.001). In patients with severe fatigue, SP was diagnosed 4.6 times (95% confidence interval, CI 2.80–7.57) more often than in those without it (p&lt;0.001). Fatigue was associated with senile age, underweight, falls in the previous year, weak muscle strength, low SPPB test scores and an appendicular muscle mass index, CRP &gt;10 mg/L (p&lt;0.05).The possibility of using the FACIT-F questionnaire for screening patients with SP was evaluated. Its sensitivity reached 76%, specificity – 73%, positive predictive value – 53%, and negative predictive value – 88%, diagnostic accuracy – 74%. The area under the ROC-curve (AUC) was 0.726 (95% CI 0.627–0.826; p&lt;0.0001).Conclusion. It has been shown that the general questionnaires EQ-5D and SF-36 do not reflect the true QoL impairment in SP. A significant deterioration in the state of health in elderly people with SP can be identified by a special SarQol questionnaire. The FACIT-F fatigue scale can also be used to screening in SP.

Associated factors of different fatigue dimensions in elderly patients with rheumatoid arthritis

Objective: To investigate the associated factors of different dimensions of fatigue in elderly patients with rheumatoid arthritis (RA). Methods: A cross-sectional analysis was performed in the elderly outpatients with RA (age ≥ 60 years) in the First Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2019. Fatigue was measured by Multidimensional Fatigue Inventory-20 (MFI-20) and 36-item Short Form Health Survey-Vitality (SF-36-VT). Physical fatigue and mental fatigue were subsequently measured by MFI-20 subscales. Results: A total of 104 patients were included. Male-to-female ratio was 1∶3.3. The average age was (68±6) years. The MFI-20 score and SF-36-VT score were 60±14 and 64±20, respectively. The score of physical fatigue measured by MFI-20 was 14±3, and mental fatigue scored 10±4 (P<0.001). Arthralgia, disease activity, disability, insomnia, depression and anxiety were correlated with fatigue assessed by MFI-20 (correlated coefficient: 0.48-0.62). Multivariable regression analysis showed that arthralgia and depression were associated with physical fatigue (Standardized regression coefficients were 0.44 and 0.38, respectively). Insomnia, depression and anxiety were associated factors of mental fatigue (Standardized regression coefficients were 0.20, 0.32 and 0.24, respectively). Conclusions: Elderly patients with RA experiencehigh level of fatigue, mainly presenting as physical fatigue. Arthralgia and depression mainly affect physical fatigue, and arthralgia is a critical factor. Insomnia, depression and anxiety are associated with mental fatigue.

A qualitative research on fatigue cognition and coping experience in elderly patients with chronic obstructive pulmonary disease

Objective To investigate the cognition and coping experience of fatigue in elderly patients with chronic obstructive pulmonary disease (COPD), so as to provide basis and research basis for the preparation of fatigue intervention measures for elderly patients with COPD. Methods Qualitative research interview was used to conduct face-to-face and in-depth communication with 12 elderly patients with COPD under the guidance of pre-prepared interview outline. The 7-step Colaizzi analysis method was used to analyze the transcript of the interview and extract the theme and representative statements. Results Fatigue cognition could be summarized into five themes:fatigue symptoms were often accompanied by drowsiness, fatigue, anxiety, poor sleep, memory loss and other symptoms; there was no definite time point for the appearance of fatigue symptoms; breathing difficulties, limited activities, mental and psychological disorders and deficient social support were the main causes of fatigue; family accidents, seasonal variation, the occurrence of complications and relapses of the malady were the aggravating factors of fatigue symptoms; fatigue affects the patient′s ability to move, social circle and life motivation. Coping experiences could be summarized into three themes: strengthen self-management and ask for help; take the initiative to learn and improve the level of self-care; emotional disorder, negative response. Conclusions There are obvious fatigue symptoms in elderly patients with COPD. Affected by many factors, such as disease factors, self-perceived burden level, family support and social support level, most patients have insufficient fatigue cognition and lack of coping ability. Medical staff should fully understand the fatigue cognition and coping experience of such patients and implement effective intervention programs to improve the coping ability of patients. Key words: Aged; Pulmonary disease, chronic obstructive; Fatigue cognition; Coping experience; Qualitative research

End-of-life care and prognosis of elderly patients with advanced cancer in palliative care unit.

e23011 Background: Prognosis of end-of-life characteristics, which are indicators of palliative care, especially in elderly cancer patients, remains unclear. Methods: We retrospectively analyzed 510 patients who died of advanced cancer at our hospital from August 2011 to August 2016. The patients were divided into two groups: elderly patients (over 80 years old, N = 140) and non-elderly patients (under 80 years old, N = 370). The number of patients (306 male and 204 female) with gastro-esophageal, biliary-pancreatic, colorectal, lung, breast, urological, gynecological, hepatocellular, and other cancers were 114, 98, 82, 84, 25, 36, 20 and 51, respectively. The primary endpoint of the study was to analyze the relationship of end-of-life symptoms, treatment, and chemotherapy with age. The secondary endpoint was to identify the prognostic factors in elderly patients with advanced cancer at the end-of-life. Results: ECOG Performance Status of 0.1 was recorded for 12 patients and 2-4 for 498 patients. The prevalence rate of cancer pain in elderly patients was 19.3%, which was significantly lower than that in non-elderly patients (31.4%). Fatigue in elderly patients was 27.9%, which was significantly lower than that in non-elderly patients (37.6%). Continuous deep sedation usage in elderly patients was 12.9%, which was significantly lower than that in non-elderly patients (28.9%). The mean opioid dose in elderly patients was 23.3mg/day, which was significantly lower than that that in non-elderly patients (43.8mg/day). The rate of more than one line of chemotherapy for elderly patients was 44.4%, which was lower than that for non-elderly patients (65.4%). The rate of use of more than one type of cytotoxic agent in the last regimen for elderly patients was 13.3%, which was lower than that for non-elderly patients (30.8%). Consciousness level was recognized as a significant prognostic factor (HR 1.714, p = 0.048) using multivariate analysis of prognosis in elderly patients at the end-of-life. Conclusions: End-of-life symptoms and the intensity of end-of-life treatment, including chemotherapy, were lesser in elderly patients as compared to non-elderly patients. Consciousness level was a significant prognostic factor in elderly patients at the end-of-life.

The Impact of Age on Quality of Life in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Comparative Analysis From the Prospective Multicenter Randomized ADEBAR trial

BackgroundElderly breast cancer patients are affected by poorer quality of life (QoL) compared to younger patients. Because QoL has a relevant impact on guideline-adherent treatment, elderly breast cancer patients are often undertreated, especially with regard to adjuvant chemotherapy, and overall survival is decreased. Thus, understanding the impact of chemotherapy on QoL in elderly patients is crucial. This study compared QoL in patients aged < 65 years and 65 to 70 years receiving adjuvant chemotherapy as a secondary outcome in the prospective randomized multicenter ADEBAR trial. Patients and MethodsPatients with lymph node–positive breast cancer were prospectively randomized for either sequential anthracycline–taxane or epirubicin/fluorouracil/cyclophosphamid chemotherapy (FEC) therapy. QoL was assessed at baseline (t1), before cycle 4 FEC, and cycle 5 epirubicin/cyclophosphamid–docetaxel (EC-DOC) (t2), 4 weeks after chemotherapy (t3), and 6 weeks after radiation (t4) using the European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Breast Cancer–Specific Module (QLQ-BR23). We compared patients aged < 65 years and 65 to 70 years with respect to QoL and discontinuation of chemotherapy. ResultsA total of 1363 patients were enrolled onto the ADEBAR trial, with 16.7% of the patients aged 65 to 70 years. In elderly patients, Eastern Cooperative Oncology Group performance status was higher and global health status and physical functioning were lower at baseline. Global health status decreased between t1 and t3 by 7 points in patients < 65 years and by 11 points in patients 65 to 70 years, and physical functioning decreased in the same period by 13.4 points in patients aged < 65 years and by 15.9 points in patients 65 to 70 years. In both groups, at t4 global health status exceeded baseline by 6 points, and physical functioning was 1.3 points under baseline in patients < 65 years old and 3 points under baseline in patients 65 to 70 years. There was a trend to more fatigue in elderly patients and to more nausea and vomiting while receiving chemotherapy in younger patients at t3. There was a higher dropout rate in patients aged 65 to 70 years (25.7%) than in patients aged < 65 years (16.2%). ConclusionThere were only small or trivial differences in QoL in patients aged < 65 years versus 65 to 70 years who were receiving adjuvant chemotherapy, although the dropout rate from chemotherapy was notably higher in elderly breast cancer patients.

Recovery of Muscular Performance After Surgical Stress in Elderly Patients

Inflammation is related to muscle wasting in elderly persons. Since surgery is accompanied by an important inflammatory response, the degree of muscle wasting and related symptoms such as weakness and tiredness might exacerbate very rapidly in elderly surgery patients. PubMed and Web of Science were systematically screened for articles reporting the influence of surgery-induced inflammation on muscle performance and/or fatigue in elderly patients. Studies reporting surgery-induced inflammation and changes in muscle performance and/or fatigue, but without analyzing their association were excluded. Although 5 relevant articles were identified including older patients (highest ages reported were 71-92 years), none focused exclusively on elderly patients. Only 2 studies assessed muscle performance, and in none muscle mass was evaluated. Overall, we found evidence that in elderly patients higher surgery-induced inflammation was significantly related to worse muscle performance and fatigue in the first postoperative days as well as after more than one month (especially for fatigue) following the intervention. Pre-operative anti-inflammatory treatment using steroids or glucocorticoids can reduce the surgery-induced inflammatory response and improve the recovery of muscle performance and postoperative fatigue in elderly elective abdominal surgery or arthroplasty patients. We can conclude that to date, only few studies have investigated the association between surgery-induced inflammation and changes in postoperative muscle performance and fatigue in elderly patients. More research is warranted focusing on both the short -and long-term effects of surgical stress on muscle performance in elderly patients as well as the on risks and benefits of peri-operative anti-inflammatory treatment.

Chronic Anemia and Fatigue in Elderly Patients: Results of a Randomized, Double‐Blind, Placebo‐Controlled, Crossover Exploratory Study with Epoetin Alfa

To evaluate the effect of epoetin alfa treatment on hemoglobin (Hb), fatigue, quality of life (QOL), and mobility in elderly patients with chronic anemia. An exploratory, 32 week, randomized, double-blind, crossover treatment trial. Sixty-two community-dwelling individuals aged 65 and older with chronic anemia (Hb < or =11.5 g/dL). Subcutaneous epoetin alfa or placebo weekly for 16 weeks (Phase I) with crossover to the opposite treatment (Phase II). Hb and QOL scores from the Functional Assessment of Chronic Illness Therapy (FACIT) measurement system. Mobility was assessed as a secondary outcome using the Timed Up and Go (TUG) test. Of the 62 subjects enrolled, complete data were analyzed for 58 in Phase I and 54 participants in Phase II. Of those enrolled, most were African American (95%) and female (85%) and had multiple comorbidities and a mean age+/-standard deviation of 76.1+/-7.2. Mean baseline Hb was 10.5+/-0.9 g/dL (7.3-11.5). In Phase I, 67% of those taking epoetin alfa, and in Phase II, 69% of those taking epoetin alfa had an increase in Hb of more than 2 g/dL, significantly more than those taking placebo (P<.001). Similarly, elderly participants significantly improved on the fatigue and anemia subscales of the FACIT across phases (all P<.05). No significant differences were found between treatment and placebo on TUG scores. Epoetin alfa was well tolerated. In this trial involving predominantly older African-American women with anemia, a direct relationship existed between increases in Hb during epoetin alfa therapy and improvements in fatigue and QOL.

Chronic Anemia and Fatigue in Elderly Patients: Results of the First Randomized Double-Blind Placebo-Controlled Cross-Over Study with Epoetin Alfa.

Background: Anemia is a common condition among elderly and its prevalence increases with age. Fatigue is well recognized as a prominent feature of chronic anemia and may be especially symptomatic in this population. In order to evaluate the effect of epoetin alfa (EPO) treatment on hemoglobin (Hb), fatigue, and health related quality of life (QOL) in elderly patients (pts) with chronic anemia a 32 week(w) randomized, double-blind, cross-over treatment trial among community-dwelling participants ≥65y was conducted. Pts were ambulatory and had anemia for ≥3 months with inclusion Hb ≤11.5g/dL. Pts with GI bleeding, active cancer, CKD (GFR<30), thrombocytopenia, iron deficiency, hypothyroidism, untreated depression, dementia, or expected survival ≤6months were excluded. Pts were randomized to receive either subcutaneous (sc) placebo or EPO weekly for 16w (Phase 1) and then crossed over to the other treatment (Phase 2). QOL was measured using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) instrument, with specific focus on the Anemia and Fatigue subscales of the instrument. Hb was measured every 4w. Analyses of all efficacy endpoints were based on pts who had who had at least one Phase 1 (58/62) and one Phase 2 (55/58) visit (using analysis of covariance controlling for baseline values).Results: 62 pts, 85% women, and 95% African American with a mean (SD) age of 76.1y (±7.2). Mean baseline Hb was 10.5±0.9 g/dL (7.3–11.5); 75% had anemia of chronic disease and 25% had unexplained anemia. Common baseline comorbidities included hypertension, CHF, osteoarthritis, and Type 2 diabetes. Seven pts did not complete the study. There was 1 death, 1 stroke and 1 DVT on placebo and 1 death and 1 pulmonary embolus on EPO. None of the serious adverse events or deaths were considered treatment-related. Pts receiving EPO had significantly increased Hb compared to placebo at the end of phases 1 and 2 (p<0.0001; Table 1) and, significantly improved scores on the composite FACT-An (p<0.0107, phase 1; p=<0.0001, phase 2), FACT-An anemia subscale (p=0.0017, phase 1; p=0.0003, phase 2) and FACT-An fatigue subscale (p=0.0012, phase 1; p=0.0011, phase 2).Conclusion: A direct relationship exists between increasing Hb during EPO therapy, fatigue scores and corresponding QOL improvements among elderly persons with anemia. EPO was well tolerated in this trial among anemic elderly pts. Improving fatigue may enhance ability to perform daily activities in the elderly.Phase One - No Epo (n=25)Phase One-EPO(n=30)VariableLS meanStd ErrLS MeanStd Errp-value*Difference in LS mean between groupsFatigue Subscale (0–52)36.31.342.41.20.00126.1Anemia Subscale (0–80)56.11.563.11.40.00176.9FACT-An (0–188)138.03.0148.92.80.010710.9Hb (g/dl)10.70.213.20.2<0.00012.4* ANCOVA predicting last phase one study score controlling for baseline Phase 1 scorePhase Two- No EPO (n=30)Phase Two- EPO (n= 25)VariableLS MeanStd ErrLS MeanStd Errp-value**Difference in LS mean between groupsFatigue subscale (0–52)34.21.642.81.80.00118.5Anemia Subscale (0–80)53.21.964.52.10.000311.3FACT-An (0–188)130.63.6153.44.0<0.000122.9Hb (g/dl)10.80.313.30.3<0.00012.5**ANCOVA predicting last phase two study score controlling for baseline (visit 17) score.

Nocturia. A rarely recognized symptom of sleep apnea and other occult sleep disorders

Nocturia, awakening from sleep to urinate, is a common symptom in a variety of medical disorders and in the elderly. Awakening from sleep as a result of nocturia is thought to be secondary to a sensation of urinary urgency resulting from an overextended bladder. Nocturia-related awakenings cause significant sleep disruption and fatigue in elderly patients and are correlated with an increased number of falls at night. Sleep disorders such as sleep apnea are also common in the elderly and are frequently the source of awakenings from sleep. The high incidence of both nocturia and sleep disorders in the elderly and other groups of patients suggests that sleep disorders may be the source of some awakenings from sleep usually attributed by patients to nocturia. Nocturia secondary to sleep disorders would be causatively different from nocturia secondary to pressure to urinate in common medical disorders and would require different diagnostic procedures and treatment. To determine the frequency of nocturia as a symptom of primary sleep disorders. Eighty consecutive patients, 27 women and 53 men with a mean (+/-SD) age of 58.7+/-14.1 years, undergoing polysomnography (sleep study or PSG) for the evaluation of a suspected sleep disorder and who met the sole criteria of awakening from sleep at least once and urinating voluntarily. Each patient had either a standard PSG recording or a PSG with administration of nasal continuous positive airway pressure. Immediately after each episode of nocturia during the PSG, patients were questioned about the reason they believed they had awakened. The PSG record immediately before awakening from sleep was then reviewed for potential causes of awakening. Patients were also asked on final morning awakening to fill in a questionnaire regarding their awakenings during the prior night. Patient reports were compared with the PSG to determine the accuracy of subjective reports. Patients awakened from sleep and voluntarily urinated a mean (+/- of 1.5+/-0.75 times per night for a total of 121 awakenings for the group. The majority (79.3%) of these awakenings from sleep were found to be directly secondary to sleep apnea, snoring or periodic leg movements in sleep. Patients correctly identified the source of their awakening from sleep on only five(4.9%) occasions and only once was sleep apnea correctly cited by a patient as a source of awakening during the night. Most awakenings from sleep attributed by our patients to pressure to urinate were instead a result of sleep disorders, particularly sleep apnea. The fact that patients do urinate once awake likely contributed to faulty post hoc reasoning and might have limited further inquiry by patients and their physicians in clinical settings into the actual sources of awakening from sleep. Even in those patients with well-known medical reasons for noctruria, Sleep disorders were still found to be the source of almost all awakenings from sleep. Patients were extremely poor judges of the reasons they awoke from sleep. The diagnosis of a sleep disorder should be seriously considered whenever a patient reports frequent awakenings from sleep to urinate.