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Prevalence and Predictors of Fatigue in Middle‐aged and Older Adults: Evidence From the Health and Retirement Study

Year: 2010
Type: article
Abstract: To the Editor: Fatigue is associated with adverse health outcomes such as mortality, morbidity, and disability in middle-aged and older adults.1 It is also an important component of the clinical manifestation of the frailty syndrome.2 The most recent evidence regarding the prevalence of fatigue in the U.S. adult population dates back to the 1970s and early 1990s.3,4 For example, a U.S. survey in 1974 showed that 14.3% men and 20.4% women reported suffering from "frequent fatigue,"3 and another study found that 12% of men and 22% of women were considered to have "lack of energy,"4 but the current prevalence of fatigue in the U.S. older adult population is unclear. Therefore, this study set out to determine the prevalence of fatigue in a nationally representative sample of the U.S. middle-aged and older adults in 2004. This study used data from the 2004 wave of the Health and Retirement Study (HRS), a biennial longitudinal survey of a U.S. nationally representative sample of community-dwelling adults aged 51 and older.5 The present study included 17,084 individuals who completed the interview themselves and had complete data on fatigue symptoms. Fatigue is defined as positive response to at least one of two questions: "During the past week, did you feel that everything you did was an effort?" and "you could not get going?" The smoothed (locally weighted least squares, or LOWESS) prevalence of fatigue was plotted according to age to show the unadjusted cross-sectional relationship between age and fatigue prevalence for men and women. The sample represented a population of 74 million U.S. adults aged 51 and older. The mean age of the sample was 64.6, and 55.9% were female. White, black, and Hispanic participants accounted for 81.9%, 9.2%, and 6.5% of the sample, respectively. The prevalence of fatigue was estimated at 31.2% (95% confidence interval=30.0–32.5%). Fatigue was more common in women (33.3%) than in men (28.6%, P<.001), and in minorities (47.5%) than in whites (27.5%, P<.001). Figure 1 illustrates the LOWESS smoothed fatigue prevalence according to age for men and women. The relationship between age and fatigue prevalence appeared to be J-shaped in men and women, with the lowest fatigue prevalence occurring in men aged 60 to 64 and women aged 65 to 69. The prevalence of fatigue appeared to reach its highest level in men and women aged 90 and older. Fatigue prevalence according to sex and age. Locally weighted least squares smoothed fatigue prevalence. Men, n=6,989; women, n=10,095. The prevalence of fatigue in men and women was much higher than that reported in the literature from U.S. and European samples. For example, using the same fatigue definition, a previous study reported prevalence rates of 15% and 29% in a sample of Italian men and women, respectively.6 In addition, using "lack of energy" as the definition of fatigue, another study reported that 12% of men and 22% of women had fatigue.4"Lack of energy" in that study was operationalized as a positive response to "sits around a lot for lack of energy" and having two of six symptoms. Therefore, the higher prevalence of fatigue in this U.S. population might be because of a combination of factors, including differences in populations investigated, a more general measure of fatigue used in the present study, and differences in fatigue prevalence over time. Fatigue prevalence was higher in minorities, which is consistent with the higher levels of unexplained chronic fatigue (UCF) and chronic fatigue syndrome (CFS) found in minorities in a community-based epidemiological study.7 Future research should investigate possible physiological, psychological, and social reasons why these differences exist and how clinical and psychosocial interventions can be designed to address this racial and ethnic fatigue gap. Its cross-sectional study design and descriptive nature limited the present study. Future studies are needed to investigate the risk factors of fatigue over time. In addition, the fatigue questions may not fully capture the complexity of fatigue symptom (the severity, effect, duration, and variations over time), although the subjective nature of fatigue symptoms, the face validity of the questions, and the evidence linking these questions to physical performance suggest that it is a useful brief screening measure for community-living older adults. To the authors' knowledge, the present study is the first large-scale analysis of the symptom of fatigue in the middle-aged and older adult population in the United States. More work is needed to understand the implications of the disparities in fatigue between different racial and ethnic groups, because fatigue may be a pathway through which racial and ethnic health disparities manifest. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Dr. Friedberg and Dr. Meng were supported by National Institutes of Health Grant 1R01NR010229-01. Author Contributions: H. Meng: concept and design, acquisition of data, data analysis, preparation of manuscript. L. Hale: concept and design, preparation of manuscript. F. Friedberg: concept and design, interpretation of data, critical revision of manuscript. Sponsor's Role: Not applicable.
DOI: 10.1111/j.1532-5415.2010.03088.x
Language: English
Field: Medicine
Open Access status: bronze
OpenAlex ID: W1588056972
FWCI: 0.128
Cites: 6
Cited by: 85
Related to: 10