Fatigue in community-dwelling older adults: A review of definitions, measures, and related factors

Tiredness of Life - Conceptualizing a Complex Phenomenon

A phenomenon referred to as 'tiredness of life' or 'weariness of life' appears in current discussions on the legitimacy of euthanasia for relatively healthy older adults as well as in research on suicidality more broadly. However, a consensus conceptualization of the phenomenon is lacking. In the current paper, we offer such a conceptualization by reviewing and integrating knowledge from terminology, available descriptions, and first qualitative findings. Boredom with life, aversion towards life, meaninglessness, and fatigue are identified as central components of the phenomenon. Per component, we describe how the component was identified, our definition of the component and its foundation in descriptions in the literature, and empirical studies on how the component relates to euthanasia requests and suicidality. Moreover, hypotheses on the structure of the phenomenon are outlined, such as on interactions among and the importance of the different components.

Methodological quality of 100 recent systematic reviews of health-related outcome measurement instruments: an overview of reviews

PURPOSE

Systematic reviews evaluating and comparing the measurement properties of outcome measurement instruments (OMIs) play an important role in OMI selection. Earlier overviews of review quality (2007, 2014) evidenced substantial concerns with regards to alignment to scientific standards. This overview aimed to investigate whether the quality of recent systematic reviews of OMIs lives up to the current scientific standards.

METHODS

One hundred systematic reviews of OMIs published from June 1, 2021 onwards were randomly selected through a systematic literature search performed on March 17, 2022 in MEDLINE and EMBASE. The quality of systematic reviews was appraised by two independent reviewers. An updated data extraction form was informed by the earlier studies, and results were compared to these earlier studies' findings.

RESULTS

A quarter of the reviews had an unclear research question or aim, and in 22% of the reviews the search strategy did not match the aim. Half of the reviews had an incomprehensive search strategy, because relevant search terms were not included. In 63% of the reviews (compared to 41% in 2014 and 30% in 2007) a risk of bias assessment was conducted. In 73% of the reviews (some) measurement properties were evaluated (58% in 2014 and 55% in 2007). In 60% of the reviews the data were (partly) synthesized (42% in 2014 and 7% in 2007); evaluation of measurement properties and data syntheses was not conducted separately for subscales in the majority. Certainty assessments of the quality of the total body of evidence were conducted in only 33% of reviews (not assessed in 2014 and 2007). The majority (58%) did not make any recommendations on which OMI (not) to use.

CONCLUSION

Despite clear improvements in risk of bias assessments, measurement property evaluation and data synthesis, specifying the research question, conducting the search strategy and performing a certainty assessment remain poor. To ensure that systematic reviews of OMIs meet current scientific standards, more consistent conduct and reporting of systematic reviews of OMIs is needed.

Association between nutritional risk and fatigue in frailty conditions for older adult patients: a multicentre cross-sectional survey study

BACKGROUND AND AIMS

Frailty is widespread in the elderly, while there is a bi-directional relationship between frailty and malnutrition. The objectives of this study were to investigate the prevalence and correlation of frailty and nutritional risk in older adult patients and to analyse the factors associated with fatigue which is one indicator of frailty.

METHODS

This cross-sectional multicentre survey study was conducted in five hospitals in the same city from 01 January 2021 to 01 December 2021. We collected information on gender, age, diseases, medication and dietary status. Frailty status was diagnosed using the FRAIL scale, and Nutritional Risk Screening-2002 was used to screen the nutritional risk. Spearman rank correlation was used to analyse the correlation between frailty and nutritional risk. Univariate and multivariate logistic regression analyses were used to analyse the risk factors related to fatigue in all patients and inpatients.

RESULTS

Among 2016 older adult patients, the prevalence of frailty was 15.1% (305/2016), the prevalence of nutritional risk was 16.2% (327/2016) and the overlap prevalence of frailty and nutritional risk was 7.3% (147/2016). Multivariate analysis showed that nutritional risk (OR 3.109, 95% CI 2.384 to 4.056, p<0.001) was an independent risk factor for fatigue in all patients; similar results were found for nutritional risk (OR 2.717, 95% CI 2.068 to 3.571, p<0.001) in hospitalised patients.

CONCLUSIONS

Frailty and nutritional risk are prevalent among older adult patients, and nutritional risk is associated with the occurrence of fatigue in older adult patients and older adult inpatients.

TRIAL REGISTRATION NUMBER

China Clinical Trial Registry (Registered No. ChiCTR-EPC-14005253).

Measurement properties of instruments to measure the fatigue domain of vitality capacity in community-dwelling older people: an umbrella review of systematic reviews and meta-analysis

BACKGROUND

Vitality capacity (VC) is a key domain of intrinsic capacity (IC) and is the underlying biophysiological aspect of IC. Energy and metabolism (E&M) is one of the domains of VC. Fatigue is one of the main characteristics of E&M.

OBJECTIVE

The aims of this umbrella review are (i) to identify the available instruments suitable for measuring fatigue in community-dwelling older adults and (ii) to critically review the measurement properties of the identified instruments.

DESIGN

Umbrella review.

SETTING

Healthcare.

SUBJECTS

Community-dwelling older adults.

METHODS

PubMed and Web of Knowledge were systematically screened for systematic reviews and meta-analysis reporting on fatigue instruments resulting in 2,263 articles (last search 5 December 2022). The COSMIN checklist was used to appraise psychometric properties and the AMSTAR for assessing methodological quality. Data on fatigue instruments, construct, reference period, assessment method, validated population, reliability, validity, responsiveness and predictive validity on negative health outcomes were extracted.

RESULTS

10 systematic reviews and 1 meta-analysis were included in this study. 70 fatigue instruments were identified in the literature and 21 were originally designed for fatigue. The Fatigue Severity Scale (FSS), Pittsburgh Fatigability Scale (PFS) and Visual Analogue scale (VAS-F), Fatigue Impact Scale (FIS) and the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) presented good psychometric properties.

CONCLUSIONS

The FSS, FIS, FACIT-F, PFS and the VAS-F presented good psychometric properties in various conditions. Therefore, these instruments could be used to quantify trajectories in the domain E&M in the context of VC in community-dwelling older adults.

Possibilities, Patience, and Perseverance: A Preliminary Analysis of the Needs and Experiences of Ten Older Adults Regarding Their Use of Digital Health Technology

The COVID-19 pandemic created the need to use digital health resources (DR), as they sometimes were the only option to receive healthcare or social interaction. The aim of this research is to provide insight into the experiences during the lockdown of older people using DR for health in general and the points of improvement they see. A qualitative study was carried out using semi-structured interviews with older persons by telephone. A total of 10 older adults participated, with a median age of 78 years, the majority having a chronic disease. The most important themes for motivation to use health-related DR were 'urgency' and 'usefulness'. Experiences with DR were related to the themes 'human contact' and 'communication', which were experienced by respondents as facilitated by DR, and 'time and energy', which was two-sided. Additionally, most older persons worried about accessibility of DR by all older persons and the support needed. In conclusion, older persons are convinced of the urgency and the usefulness of digital technology for health and healthcare. Time and energy constraints can be alleviated by using DR on the one hand, but this can also be challenging if older persons are less digitally skilled or lack digital literacy. Good and sustained human support is therefore mandatory.

Comparative responsiveness and minimally important difference of Fatigue Symptom Inventory (FSI) scales and the FSI-3 in trials with cancer survivors

Background

Fatigue is a highly prevalent and disabling symptom in cancer survivors. Although many measures have been developed to assess survivors’ fatigue, their ability to accurately capture change following intervention has rarely been assessed in post-treatment survivors. Ultra-brief fatigue measures are preferable in clinical practice but have limited evidence supporting their use with cancer survivors. We examined the psychometric properties of four Fatigue Symptom Inventory (FSI) measures, including the new FSI-3, in cancer survivors. Examined properties included responsiveness to change and minimally important differences (MIDs).

Methods

We analyzed data from three randomized controlled trials with post-treatment cancer survivors (N = 328). Responsiveness to change was evaluated by comparing standardized response means for survivors who reported their fatigue as being better, the same, or worse at 2–3 months. Responsiveness to intervention was assessed via effect sizes, and MIDs were estimated by using several methods. We also computed area under the curve (AUC) values to assess FSI measures’ discriminative accuracy compared to an established cut-point.

Results

All FSI measures differentiated survivors who reported improvement at 2–3 months from those with stable fatigue, but did not uniformly differentiate worsening fatigue from stable fatigue. Measures showed similar levels of responsiveness to intervention, and MIDs ranged from 0.29 to 2.20 across FSI measures. AUC analyses supported the measures’ ability to detect significant fatigue.

Conclusions

Four FSI scales show similar responsiveness to change, and estimated MIDs can inform assessment of meaningful change in fatigue. The FSI-3 shows promise as an ultra-brief fatigue measure for survivors.

Relationship between Fatigue and Self-Perception of Constipation in Community-Dwelling Older Adults during the COVID-19 Pandemic

Fatigue and constipation are common symptoms among community-dwelling older adults; however, no studies have explored the relationship between both symptoms in said group. Therefore, this study aimed to examine the relationship between fatigue and self-perception of constipation in community-dwelling older adults during the COVID-19 pandemic. A cross-sectional survey was conducted among 97 older people (response rate: 73.2%) between July and November 2021. Backward−forward stepwise linear regression was performed to identify possible predictors of fatigue among the explanatory variable (self-perception of constipation) and possible confounders, which included (a) age, (b) motor fitness scale, (c) economic satisfaction, (d) subjective memory impairment, (e) subjective health, (f) depression, (g) living alone or not, (h) sex, and (i) frequency of exercise. The intercept of the fatigue score was 42.48 points (95% CI = 32.40 to 49.99, p < 0.001). The results showed that the fatigue score in community-dwelling older adults who had self-perception of constipation was significantly lower (i.e., they had higher fatigue; B = −4.49, 95% CI = −6.58 to −2.40, p < 0.001) compared to those who did not have self-perception of constipation. Therefore, there is a need to develop self-management strategies that older people can use to improve the self-perception of constipation.