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Fatigue in older adults: an early indicator of the aging process?

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Abstract

The aim of this paper is to give an overview of research on fatigue in older adults, with a focus on fatigue as an early indicator of the aging process. Fatigue is a strong predictor of functional limitations, disability, mortality, and other adverse outcomes in young-old and old-old populations, between men and women, and in different geographic localities. Several biological, physiological and social explanations are proposed: fatigue may be seen not only as a self-reported indicator of frailty, defined as a physiologic state of increased vulnerability to stressors, which results from decreased physiologic reserves and even dysregulation of multiple physiologic systems, but also this state may be accelerated because of the cumulative impact of social, mental and biological factors throughout life.

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References

  1. David A, Pelosi A, McDonald E et al. Tired, weak, or in need of rest: fatigue among general practice attenders. BMJ 1990; 301: 1199–202.

    CAS  PubMed  Google Scholar 

  2. Okkes IM, Oskam K. The probability of specific diagnoses for patients presenting with common symptoms. Fam Pract 2002; 51: 31–6.

    CAS  Google Scholar 

  3. Gialamas A, Beilby JJ, Pratt NL, Rhys H, Marley JE, Roddick JF. Investigating tiredness in Australian general practice. Do pathology tests help in diagnosis? Aust Fam Phys 2003; 32: 663–6.

    Google Scholar 

  4. Renter EGH, Okkes IM, Oskam SK, Lamberts H. Tiredness in Dutch family practice. Data on patients complaining of and/or diagnosed with ‘tiredness’. Fam Pract 2003; 20: 434–40.

    Google Scholar 

  5. Aaronson LS, Pallikkathayil L, Crighton F. A qualitative investigation of fatigue among healthy working adults. West J Nurs Res 2003; 25: 419–33.

    PubMed  Google Scholar 

  6. Chaudhuri A, Behan PO. Fatigue in neurological disorders. Lancet 2004; 363: 978–88.

    PubMed  Google Scholar 

  7. Shen J, Barbera J, Shapiro CM. Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Medicine 2006; 10: 63–76.

    Google Scholar 

  8. National Institute of Aging. Workshop on Unexplained Fatigue in the Elderly. Workshop Summary. National Institute of Aging, 2007.

  9. Yu DSF, Lee DT, Man NW. Fatigue among older people: A review of the research literature. Int J Nurs Stud 2010; 47: 216–28.

    PubMed  Google Scholar 

  10. Lewis G, Wessely S. The epidemiology of fatigue: more questions than answers. J Epidemiol Community Health 1992; 46: 92–7.

    CAS  PubMed  Google Scholar 

  11. Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol Med Sci 2009; 64: 675–81.

    Google Scholar 

  12. Loge JH, Ekeberg Ø, Kaasa S. Fatigue in the general Norwegian population: Normative data and associations. J Psychosom Res 1998; 45: 53–65.

    CAS  PubMed  Google Scholar 

  13. Tiesinga LJ, Dassen TWN, Halfens RJG, van den Heuvel WJA. Factors related to fatigue; priority of interventions to reduce or eliminate fatigue and the exploration of a multidisciplinary research model for further study of fatigue. Int J Nurs Stud 1999; 36: 265–80.

    CAS  PubMed  Google Scholar 

  14. Lerdahl A, Wahl AK, Ruståen T, Hanestad BR, Moum T. Fatigue in the general population: A translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale. Scand J Public Health 2005; 33: 123–30.

    Google Scholar 

  15. Cheng H, Gurland BJ, Maurer MS. Self-reported lack of energy (Anergia) among elders in a multiethnic community. J Gerontol Med Sci 2008; 63A: 707–14.

    Google Scholar 

  16. Goldman SE, Ancoli-Israel S, Broudreau R et al. Sleep problems and associated day time fatigue in community-dwelling older individuals. J Gerontol Med Sci 2008; 63A: 1060–75.

    Google Scholar 

  17. Watt T, Groenvold M, Bjorner JB, Noerholm V, Rasmussen N-A, Bech P. Fatigue in the Danish general population. Influence of sociodemographic factors and disease. J Epidemiol Community Health 2000; 54: 827–33.

    CAS  PubMed  Google Scholar 

  18. Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med 1986; 15: 74–81.

    CAS  PubMed  Google Scholar 

  19. Ridsdale L, Evans A, Jerrett W, Mandalia S, Osler K, Vora H. Patients who consult with tiredness: frequency of consultation, perceived causes of tiredness and its association with psychological distress. Br J Gen Pract 1994; 44: 413–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  20. van Mens-Verhulst J, Bensing J. Distinguishing between chronic and nonchronic fatigue, the role of gender and age. Soc Sci Med 1998; 47: 621–34.

    PubMed  Google Scholar 

  21. Beutel ME, Weidner K, Schwarz R, Brähler E. Age-related complaints in women and their determinants based on a representative community study. Eur J Obst Gyn Reprod Biol 2004; 117: 204–12.

    CAS  Google Scholar 

  22. Martin P, Bishop A, Poon L, Johnson MA. Influence of personality and health behaviors on fatigue in late and very late life. J Gerontol Psych Sci 2006; 61B: P161–6.

    Google Scholar 

  23. Theou O, Jones GR, Overend TJ, Kloseck M, Vandervoort AA. An exploration of the association between frailty and muscle fatigue. Appl Physiol Nutr Metab 2008; 33: 651–65.

    PubMed  Google Scholar 

  24. Nybo L, Secher NH. Cerebral perturbations provoked by prolonged exercise. Progr Neurobiol 2004; 72: 223–61.

    Google Scholar 

  25. Rubin E. Tiredness (In Danish). In: Salmonsen’s Encyclopedia. Vol. XXIII. Copenhagen: Schultz, 1926: 860–1.

    Google Scholar 

  26. Thage O. Tiredness. In: The Danish National Encyclopedia. Vol. 19. Copenhagen: Gyldendal, 2001: 297–8.

    Google Scholar 

  27. Chaudhuri A, Behan PO. Fatigue and basal ganglia. J Neurol Sci 2000; 179: 34–42.

    CAS  PubMed  Google Scholar 

  28. Tralongo P, Respini D, Ferraù F. Fatigue and aging. Crit Rev Onc Hematol 2003; 48A: S57–64.

    Google Scholar 

  29. Parse RR. The lived experience of feeling very tired: A study using the Parse Research Method. Nursing Science Quarterly 2003; 16: 319–25.

    PubMed  Google Scholar 

  30. O’Conell C, Stokes EK. Fatigue. In Kauffman TL, Barr JO, Moran ML, eds. Geriatric Rehabilitation Manual, Second Ed. Churchill Livingstone Elsevier, 2007: 431–4.

    Google Scholar 

  31. Glaus A, Crow R, Hammond S. A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Eur J Cancer Care 1996; 5: 8–23.

    CAS  Google Scholar 

  32. Ream E, Richardson A. Fatigue: a concept analysis. Int J Nurs Stud 1996; 33: 519–29.

    CAS  PubMed  Google Scholar 

  33. Avlund K, Damsgaard MT, Sakari-Rantala R, Laukkanen P, Schroll M. Tiredness in daily activities among non-disabled old people as determinant of onset of disability. J Clin Epidemiol 2002; 55: 965–73.

    PubMed  Google Scholar 

  34. Avlund K, Rantanen T, Schroll M. Tiredness and subsequent disability in older adults. The role of walking limitations. J Gerontol Med Sci 2006; 61A: 1201–5.

    Google Scholar 

  35. Bjorner JB, Damsgaard MT, Watt T, Groenvold M. Tests of data quality, scaling assumptions, and reliability of the Danish SF-36. J Clin Epidemiol 1998; 51: 1001–11.

    CAS  PubMed  Google Scholar 

  36. Avlund K, Kreiner S, Schultz Larsen K. Functional ability scales for the elderly. A validation study. Eur J Public Health 1996; 6: 35–42.

    Google Scholar 

  37. Smets EMA, Garssen B, Bonke B, de Haes JCJM. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995; 39: 315–25.

    CAS  PubMed  Google Scholar 

  38. Dittner AJ, Wessely SC, Brown RG. The assessment of fatigue. A practical guide for clinicians and researchers. J Psychosom Res 2004; 56: 157–70.

    CAS  PubMed  Google Scholar 

  39. Hjollund NH, Andersen JH, Bech P. Assessment of fatigue in chronic disease: a bibliographic study of fatigue measurement scales. Health and Quality of Life Outcomes 2007; 5: 12 doi:10.1186/1477-7525-5-12.

    PubMed Central  PubMed  Google Scholar 

  40. Avlund K, Schultz Larsen K. What do 70 year old men and women actually do? And what are they able to do? From the Glostrup survey in 1984. Aging Clin Exp Res 1991; 3: 39–49.

    CAS  Google Scholar 

  41. Avlund K. Disability in old age. Longitudinal population-based studies of the disablement process. Dan Med Bull 2004; 51: 315–49.

    PubMed  Google Scholar 

  42. Avlund K, Davidsen M, Schroll M, Gause Nilsson I, Laukkanen P, Heikkinen E. Self reported functional ability in three Nordic localities. A comparative study of Activities of Daily Living among 75 year old men and women in Glostrup, Gothenburg and Jyväskylä. Int J Health Sci 1994; 5: 119–28.

    Google Scholar 

  43. Avlund K, Kreiner S, Schultz Larsen K. Construct validation and the Rasch model: Functional ability of healthy elderly people. Scand J Soc Med 1993; 21: 233–46.

    CAS  PubMed  Google Scholar 

  44. Avlund K, Era P, Davidsen M, Gause Nilsson I. Item bias in self reported functional ability among 75 year old men and women in three Nordic localities. Scand J Soc Med 1996; 24: 206–17.

    CAS  PubMed  Google Scholar 

  45. Christensen KB, Kreiner S. Monte Carlo tests of the Rasch model based on scalability coefficients. Br J Math Stat Psychol 2010; 63: 101–11.

    PubMed  Google Scholar 

  46. Avlund K, Thudium D, Davidsen M, Fuglsang Sørensen B. Are self ratings of functional ability reliable? Scand J Occup Ther 1995; 2: 10–6.

    Google Scholar 

  47. Avlund K, Holstein BE. Functional ability among elderly people in three service settings. The discriminatory power of a new functional ability scale. Eur J Epidemiol 1998; 14: 783–90.

    CAS  PubMed  Google Scholar 

  48. Avlund K, Schroll M, Davidsen M, Løvborg B, Rantanen T. Maximal isometric muscle strength and functional ability in daily activities among 75 year old men and women. Scand J Med Sci Sports 1994; 4: 32–40.

    Google Scholar 

  49. Smets EMA, Garssen B, Cull A, de Haes JCJM. Application of the Muldimentional Fatigue Inventory (MFI-20) in cancer patients receiving radiotherapy. Br J Cancer 1996; 73: 241–5.

    CAS  PubMed Central  PubMed  Google Scholar 

  50. Ünal G, de Boer JB, Borsboom JJM, Bouwer JT, Essink-Bot M-L, de Man RA. A psychometric comparison of health-related quality of life measures in chronic liver disease. J Clin Epidemiol 2001; 54: 587–96.

    PubMed  Google Scholar 

  51. McHorney CA, Ware JE, Raczek AB. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993; 31: 247–63.

    CAS  PubMed  Google Scholar 

  52. McHorney CA, Ware JE, Lu JF, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994; 32: 40–66.

    CAS  PubMed  Google Scholar 

  53. Bjorner JB, Kreiner S, Ware J, Damsgaard MT, Watt T, Bech P. Differential item functioning in the Danish translation of the SF-36. J Clin Epidemiol 1998; 51: 1189–202.

    CAS  PubMed  Google Scholar 

  54. Schultz-Larsen K, Avlund K. Tiredness in daily activities: A subjective measure for the identification of frailty among non-disabled community-living older adults. Arch Gerontol Geriatr 2007; 44: 83–93.

    PubMed  Google Scholar 

  55. Avlund K, Sakari-Rantala R, Rantanen T, Pedersen AN, Frändin K, Schroll M. Tiredness and onset of walking limitations in older adults. Letter to the editor. J Am Geriatr Soc 2004; 52: 1963–5.

    PubMed  Google Scholar 

  56. Avlund K, Damsgaard MT, Schroll M. Tiredness as determinant of subsequent use of health and social services among nondisabled elderly people. J Aging Health 2001; 13: 267–86.

    CAS  PubMed  Google Scholar 

  57. Avlund K, Holm-Pedersen P, Schroll M. Functional ability and oral health among older people: A longitudinal study from age 75 to 80. J Am Geriatr Soc 2001; 49: 954–62.

    CAS  PubMed  Google Scholar 

  58. Avlund K, Pedersen AN, Schroll M. Functional decline from age 80 to 85. Influence of preceding changes in tiredness in daily activities. Psychosom Med 2003; 65: 771–7.

    PubMed  Google Scholar 

  59. Avlund K, Vass M, Hendriksen C. Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. Age Ageing 2003; 32: 579–84.

    PubMed  Google Scholar 

  60. Avlund K, Mehlsen M, Thomsen DK, Viidik A, Zachariae R. Physical functioning and use of health services at one-year follow-up in a young and old sample. The influence of fatigue. Dan Med Bull 2008; 55: 147–51.

    PubMed  Google Scholar 

  61. Fagerstrom C, Persson H, Holst G, Hallberg IR. Determinants of feeling hindered by health problems in daily living at 60 years and above. Scand J Caring Sci 2008; 22: 410–21.

    PubMed  Google Scholar 

  62. Vestergaard S, Nayfield SG, Patel KV et al. Fatigue in a representative population of older persons and its association with functional impairment, functional limitation, and disability. J Gerontol Med Sci 2009; 64A: 76–82.

    Google Scholar 

  63. Gill TM, Desai MM, Gahbauer EA, Holford TR, Williams CS. Restricted activity among community-living older persons: Incidence, precipitants, and health care utilization. Ann Intern Med 2001; 135: 313–21.

    CAS  PubMed  Google Scholar 

  64. Hardy SE, Studenski SA. Fatigue and function over 3 years among older adults. J Gerontol Med Sci 2008; 63A: 1389–92.

    Google Scholar 

  65. Hardy SE, Studenski SA. Fatigue predicts mortality in older adults. J Am Geriatr Soc 2008; 56: 1910–4.

    PubMed Central  PubMed  Google Scholar 

  66. Avlund K, Legarth KH. Leisure activities among 70 year old men and women. Scand J Occup Ther 1994; 1: 35–44.

    Google Scholar 

  67. Elkjaer E, Poulsen T, Avlund K. Stability and change in physical activity in old age: the role of changes in disability. Eur J Ageing 2006; 3: 89–97.

    Google Scholar 

  68. Avlund K, Due P, Holstein BE, Heikkinen R-L, Berg S. Changes in social relations in old age. Are they influenced by functional ability? Aging Clin Exp Res 2002; 14S: 56–64.

    Google Scholar 

  69. Nilsson P, Møller L, Koster A, Hollnagel H. Social and biological predictors of menopause: a model for premature aging. J Intern Med 1997; 242: 299–305.

    CAS  PubMed  Google Scholar 

  70. Schultz IZ, Crook J, Berkowitz J, Milner R, Meloche GR. Predicting return to work after low back injury using the Psychosocial Risk for Occupational Disability Instrument: a validation study. J Occup Rehabil 2005; 5: 365–76.

    Google Scholar 

  71. Mohren DCL, Swaen GMH, Kant IJ, Borm PJA, Galama JMD. Associations between infections and fatigue in a Dutch working population: Results of the Maastricht Cohort Study on Fatigue at Work. Eur J Epidemiol 2001; 17: 1081–7.

    CAS  PubMed  Google Scholar 

  72. Huibers MJH, Kant IJ, Knottnerus JA, Bleijenberg G, Swaen GMH, Kasl SV. Development of the chronic fatigue syndrome in severely fatigued employees: predictors of outcome in the Maastricht Cohort Study. J Epidemiol Community Health 2004; 58: 877–82.

    PubMed  Google Scholar 

  73. Prescott E, Holst C, Grønbæk M, Schnohr P, Jensen G, Barefoot J. Vital exhaustion as a risk factor for ischaemic heart disease and all-cause mortality in a community sample. A prospective study of 4084 men and 5479 women in the Copenhagen City Heart Study. Int J Epidemiol 2003; 32: 990–7.

    PubMed  Google Scholar 

  74. Schuitemaker GE, Dinant BJ, van der Pol GA, Appels A. Assessment of vital exhaustion and identification of subjects at increased risk of myocardial infarction in general practice. Psychosomatics 2004; 45: 414–8.

    CAS  PubMed  Google Scholar 

  75. Schuitemaker GE, Dinant BJ, van der Pol GA, Verhelst AF, Appels A. Vital exhaustion as a risk indicator for first stroke. Psychosomatics 2004; 45: 114–8.

    CAS  PubMed  Google Scholar 

  76. Kenter EGH, Okkes IM, Oskam SK, Lamberts H. Once tired, always tired? Limitations in function over time of tired patients in Dutch general practice. Eur J Gen Pract 2007; 13: 67–74.

    CAS  PubMed  Google Scholar 

  77. Groenvold M, Petersen MA, Idler E, Bjorner JB, Fayers PM, Mouridsen HT. Psychological distress and fatigue predicted recurrence nd survival in primary breast cancer patients. Breast Cancer Res Treat 2007; 105: 209–19.

    PubMed  Google Scholar 

  78. Schroll M, Avlund K, Era P, Gause-Nilsson I, Davidsen M. Chronic diseases and functional ability in three Nordic localities (NORA 75). Facts, Research and Intervention in Geriatrics 1997; Suppl: 149–68.

  79. Avlund K, Osler M, Damsgaard MT, Christensen U, Schroll M. The relations between musculoskeletal diseases and mobility among old people: Are they influenced by socio-economic, psychosocial and behavioral factors? Int J Behav Med 2000; 7: 322–39.

    Google Scholar 

  80. Avlund K, Rantanen T, Schroll M. Factors underlying tiredness in older adults. Aging Clin Exp Res 2007; 19: 16–25.

    PubMed  Google Scholar 

  81. Schultz Larsen K, Avlund K, Kreiner S. Functional ability of community dwelling elderly. Criterion-related validity of a new measure of functional ability. J Clin Epidemiol 1992; 45: 1315–26.

    CAS  PubMed  Google Scholar 

  82. Kay L, Avlund K. Abdominal syndromes and functional ability in the elderly. Aging Clin Exp Res 1994; 6: 420–6.

    CAS  Google Scholar 

  83. Dos Santos MHH, Frontera WR, Larson L Skeletal muscle function in older people. In Kauffman TL, Barr JO, Moran ML, eds. Geriatric Rehabilitation Manual, Second Ed. Churchill Livingstone Elsevier, 2007: 9–16.

    Google Scholar 

  84. Rantanen T. Muscle strength, disability and mortality. Scand J Med Sci Sports 2003; 13: 3–8.

    CAS  PubMed  Google Scholar 

  85. Jubrias SA, Odderson IR, Esselman PC, Conley KE. Decline in isokinetic force with age: muscle cross-sectional area and specific force. Eur J Physiol 1997; 434: 246–53.

    CAS  Google Scholar 

  86. Luff AR. Age-associated changes in the innervation of muscle fibers and changes in the mechanical properties of motor units. Ann NY Acad Sci 1998; 854: 92–101.

    CAS  PubMed  Google Scholar 

  87. Short KR, Nair KS. Mechanisms of sarcopenia of aging. J Endocrinol Invest 1999; 22: 95–105.

    CAS  PubMed  Google Scholar 

  88. Galea V. Changes in motor unit estimates with aging. J Clin Neurophysiol 1996; 13: 253–60.

    CAS  PubMed  Google Scholar 

  89. Schroll M, Schroll K, Osler M, Avlund K, Davidsen M. What can we learn from the EURONUT-SENECA study? Functionally capable for what? In Dall JLC, Ermini M, Herrling PL, Meier-Ruge W, Stähelin HB, Staufenbiel M, Eds. Adaptations in Aging. The 1994 Sandoz Lectures in Gerontology. London: Academic Press, Harcourt Brace & Company, Publishers, 1995: 241–53.

    Google Scholar 

  90. Rantanen T, Guralnik JM, Izmirlian G et al. Association of muscle strength with maximum walking speed in disabled older women. Am J Phys Med Rehabil 1998; 77: 299–305.

    CAS  PubMed  Google Scholar 

  91. Allman BL, Rice CL. Neuromuscular fatigue and aging: Central and peripheral factors. Muscle Nerve 2002; 25: 785–96.

    PubMed  Google Scholar 

  92. Bautmans I, Gorus E, Njemini R, Mets T. Handgrip performance in relation to self-perceived fatigue, physical functioning and circulating IL-6 in elderly persons without inflammation. BMC Geriatr 2007; 7: 5.

    PubMed Central  PubMed  Google Scholar 

  93. Era P, Schroll M, Hagerup L, Schultz-Larsen Jürgensen K. Changes in bicycle ergometer test performance and survival in men and women from 50 to 60 and from 70 to 80 years of age: Two longitudinal studies in the Glostrup (Denmark) population. Gerontology 2001; 47: 136–44.

    CAS  PubMed  Google Scholar 

  94. Schultz-Larsen K. Chronic disease and functional ability among 70-year-old men and women (In Danish). Ph.D.Thesis. Copenhagen: Institute of Social Medicine, 1993.

    Google Scholar 

  95. Viidik A. The book about the aging body (In Swedish). Stockholm: Liber, 2002.

    Google Scholar 

  96. Cohen M. Pulmonary Considerations in the Older Patient. In Kauffman TL, Barr JO, Moran ML, eds. Geriatric Rehabilitation Manual, Second Ed. Churchill Livingstone Elsevier, 2007: 37–42.

    Google Scholar 

  97. Cohen M. Cardiac Considerations in the Older Patient. In Kauffman TL, Barr JO, Moran ML, eds. Geriatric Rehabilitation Manual, Second Ed. Churchill Livingstone Elsevier, 2007: 31–6.

    Google Scholar 

  98. Neleson R, Dar Y, Thomas K, Dimsdale JE. The relationship between fatigue and cardiac functioning. Arch Intern Med 2008; 168: 943–9.

    Google Scholar 

  99. Riley MS, O’Brien C, McCluskey DR, Bell NP, Nicholls DP. Aerobic work capacity in patients with chronic fatigue syndrome. BMJ 1990; 301: 953–6.

    CAS  PubMed  Google Scholar 

  100. Schroll M, Løvborg B, Munck M, Avlund K, Davidsen M. Cardiac impairment as assessed by echocardiography related to work capacity and mobility in 75 year old Danes as part of NORA 75, Nordic Research on Ageing. Facts, Research and Intervention in Geriatrics 1997; Cardiology: 182–93.

  101. Appels A, Mulder P. Fatigue and heart disease. The association between ‘vital exhaustion’ and past, present and future coronary heart disease. J Psychosom Res 1989; 33: 727–38.

    CAS  PubMed  Google Scholar 

  102. Appels A. Why do imminent victims of a cardiac event feel so tired? Int J Clin Pract 1997; 51: 447–50.

    CAS  PubMed  Google Scholar 

  103. Mortensen EL, Kleven M. A WAIS longitudinal study of cognitive development during the life span from ages 50 to 70. Dev Neuropsychol 1993; 9: 115–30.

    Google Scholar 

  104. Mortensen EL, Høgh P. A gender difference in the association between APOE genotype and age-related cognitive decline. Neurology 2001; 57: 89–95.

    CAS  PubMed  Google Scholar 

  105. Suutama T, Ruoppila I, Berg S. Changes in cognitive functioning from 75 to 80 years of age: A 5-year follow-up in two Nordic localities. Aging Clin Exp Res 2002; 14S: 29–36.

    Google Scholar 

  106. Wahl H-W, Kruse A. Psychological gerontology in Germany: recent findings and social implications. Aging Soc 2003; 23: 131–63.

    Google Scholar 

  107. Fromholt P, Kirk H, Rørbye B, Schroll M, Viidik. Aging (In Danish). In: The Danish National Encyclopedia, Vol. 1. Copenhagen: Gyldendal, 1994: 227–32.

    Google Scholar 

  108. Steen G, Fromholt P, Äystö S, Berg S. Cognitive functioning in 75-year-olds: A study in three Nordic localities. Facts, Research and Intervention in Geriatrics 1997; Suppl: 79–92.

  109. Smith J, Baltes PB. Trends and profiles of psychological functioning in very old age. In Baltes PB, Mayer KU, Eds. The Berlin Aging Study. Aging from 70 to 100. Cambridge: Cambridge University Press, 1999: 197–226.

    Google Scholar 

  110. Avlund K, Fromholt P, Berg S, Davidsen M. Cognitive function and functional ability in daily life. Facts, Research and Intervention in Geriatrics 1997; Suppl: 93–105.

  111. Avlund K, Fromholt P. Instrumental Activities of Daily Living: The Relationships to self-rated memory and cognitive performance among 75-year-old men and women. Scand J Occup Ther 1998; 5: 93–100.

    Google Scholar 

  112. Oeseburg H, de Boer UA, van Gilst WH, van der Harst P. Telomere biology in healthy aging and disease. Eur J Physiol 2009; E-pub ahead of print.

  113. Starr J, Shiels PG, Harris SE et al. Oxidative stress, telomere length and biomarkers of physical aging in a cohort aged 79 years from the 1932 Scottish Mental Survey. Mech Ageing Dev 2008; 129: 745–51.

    CAS  PubMed  Google Scholar 

  114. Njajou OT, Hsueh WC, Blackburn EH et al. Association between telomere length, specific causes of death, and years of healthy life in health, aging, and body composition, a population-based cohort study. J Gerontol Med Sci 2009; 64: 860–4.

    Google Scholar 

  115. Woo J, Tang NLS, Suen E, Leung JCS, Leung PC. Telomeres and frailty. Mech Aging Dev 2008; 129: 642–48.

    CAS  PubMed  Google Scholar 

  116. Walston J, Hadley EC, Ferrucci L et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on frailty in older adults. J Am Geriatr Soc 2006; 54: 991–1001.

    PubMed  Google Scholar 

  117. National Institute of Aging. Workshop on Inflammation, Inflammatory Mediators, and Aging. Bethesda, Maryland. Workshop Summary. National Institute of Aging, 2005.

  118. Bruunsgaard H, Christiansen L, Pedersen AN et al. The IL-6 — 174G > C polymorphism is associated with cardiovascular diseases and mortality in 80-year-old humans. Exp Gerontol 2004; 39: 255–61.

    CAS  PubMed  Google Scholar 

  119. Krabbe KS, Mortensen EL, Avlund K et al. Genetic priming of a proinflammatory profile predicts low IQ in octogenarians. Neurobiol Aging 2009; 30: 769–81.

    CAS  PubMed  Google Scholar 

  120. Bruunsgaard H, Benfield TL, Andersen-Ranberg K et al. The tumor necrosis factor alpha — 308G> A polymorphism is associated with dementia in the oldest old. J Am Geriatr Soc 2004; 52: 1361–6.

    PubMed  Google Scholar 

  121. Bruunsgaard H, Ladelund S, Pedersen AN et al. Predicting death from tumour necrosis factor-alpha and interleukin-6 in 80-year-old people. Clin Exp Immunol 2003; 132: 24–31.

    CAS  PubMed Central  PubMed  Google Scholar 

  122. Schmaltz HN, Fried LP, Zue Q-L et al. Chronic cytomegalovirus infection and inflammation are associated with prevalent frailty in community-dwelling older women. J Am Geriatr Soc 2005; 53: 747–54.

    PubMed  Google Scholar 

  123. Cesari M, Penninx BWJH, Pahor M et al. Inflammatory markers and physical performance in older persons: The InCHIANTI Study. J Gerontol Med Sci 2004; 59A: 242–8.

    Google Scholar 

  124. McDermott MM, Ferrucci L, Liu K et al. D-Dimer and inflammatory markers as predictors of functional decline in men and women with and without peripheral arterial disease. J Am Geriatr Soc 2005; 53: 1688–96.

    PubMed  Google Scholar 

  125. Ferrucci L, Harris TB, Guralnik JM et al. Serum IL-6 level and the development of disability in older persons. J Am Geriatr Soc 1999; 47: 639–46.

    CAS  PubMed  Google Scholar 

  126. Penninx BWJH, Kritchevsky SB, Newman AB et al. Inflammatory markers and incident mobility limitation in the elderly. J Am Geriatr Soc 2004; 52: 1105–13.

    PubMed  Google Scholar 

  127. Roubenoff R, Parise H, Payette HA et al. Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: The Framingham Heart Study. Am J Med 2003; 115: 429–35.

    CAS  PubMed  Google Scholar 

  128. Cesari M, Onder G, Zamboni V et al. C-Reactive Protein and lipid parameters in older persons aged 80 years and older. J Nutr Health Aging 2009; 13: 587–93.

    CAS  PubMed  Google Scholar 

  129. Krabbe KS, Mortensen EL, Avlund K et al. Brain-derived neutrophic factor predicts mortality risk in older women. J Am Geriatr Soc 2009; 57: 1447–52.

    PubMed  Google Scholar 

  130. Janszky I, Lekander M, Blom M, Georgiades A, Ahnve S. Self-rated health and vital exhaustion, but not depression, is related to inflammation in women with coronary heart disease. Brain Behav Immun 2005; 19: 555–63.

    CAS  PubMed  Google Scholar 

  131. Schubert C, Hong S, Natarajan L, Mills PJ, Dimsdale JE. The association between fatigue and inflammatory marker levels in cancer patients: A quantitative review. Brain Behav Immun 2007; 21: 413–27.

    CAS  PubMed  Google Scholar 

  132. Cho HJ, Seeman TE, Bower JE, Riefe CI, Irwin MR. Prospective association between C-Reactive Protein and fatigue in the Coronary Artery Risk Development in Young adults Study. Biol Psychiatry 2009; 66: 871–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  133. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1977; 1: 358–401.

    Google Scholar 

  134. Olsen LR, Jensen DV, Noerholm V et al. The internal and external validity of the Major Depression Inventory in measuring severity of depression. Psychol Med 2003; 33: 351–6

    CAS  PubMed  Google Scholar 

  135. Murrell SA, Salsman NL, Meeks S. Educational attainment, positive psychological mediators, and resources for health and vitality in older adults. J Aging Health 2003; 15: 591–615.

    PubMed  Google Scholar 

  136. Schroll M, Avlund K, Davidsen M. Predictors of five-year functional ability in a longitudinal survey of men and women aged 75 to 80. The 1914-population in Glostrup. Aging Clin Exp Res 1997; 9: 143–52.

    CAS  Google Scholar 

  137. Skapinakis P, Mavreas V. Cross-cultural differences in the epidemiology of unexplained fatigue syndromes in primary care. Br J Psychiatry 2003; 182: 205–9.

    PubMed  Google Scholar 

  138. Seeman TE, Singer BH, Ryff CD, Love GD, Levy-Storms L. Social relationships, gender, and allostatic load across two age cohorts. Psychosom Med 2002; 64: 395–406.

    PubMed  Google Scholar 

  139. Kuh D, Bassey J, Hardy R, Sayer AA, Wadsworth M, Cooper C. Birth weight, childhood size, and muscle strength in adult life: evidence from a birth cohort study. Am J Epidemiol 2002; 156: 627–33.

    PubMed  Google Scholar 

  140. Sayer AA, Syddall HE, Gilbody HJ, Dennison EM, Cooper C. Does sarcopenia originate in early life? Findings from the Hertfordshire cohort study. J Gerontol Med Sci 2004: 59: M930–4.

    Google Scholar 

  141. Kuh D, Hardy R, Butterworth S et al. Developmental origins of midlife grip strength: findings from a birth cohort study. J Gerontol Med Sci 2006; 61: 702–6.

    Google Scholar 

  142. Kuh D, Hardy R, Butterworth S et al. Developmental origins of midlife physical performance: evidence from a British birth cohort. Am J Epidemiol 2006; 164: 110–21.

    PubMed  Google Scholar 

  143. Guralnik JM, Butterworth S, Wadsworth ME, Kuh D. Childhood socioeconomic status predicts physical functioning a half century later. J Gerontol Med Sci 2006; 61: 694–701.

    Google Scholar 

  144. Harvey SB, Wessely S, Kuh D, Hotopf M. The relationship between fatigue and psychiatric disorders: Evidence for the concept of neurasthenia. J Psychosom Res 2009; 66: 445–54.

    PubMed Central  PubMed  Google Scholar 

  145. Avlund K, Holstein BE, Osler M, Damsgaard MT, Holm-Pedersen P, Rasmussen NK. Social position and health in old age. The relevance of different indicators of social position. Scand J Public Health 2003; 31: 126–36.

    PubMed  Google Scholar 

  146. Osler M, Madsen M, Andersen AMN et al. Do childhood and adult socioeconomic circumstances influence health and physical function in middle-age? Soc Sci Med 2009; 68: 1425–31.

    PubMed Central  PubMed  Google Scholar 

  147. Dzurec L. Relationship as an inherent component in healthy women’s fatigue. West J Nurs Res 2002; 24: 441–53.

    PubMed  Google Scholar 

  148. Støvring N, Avlund K, Schultz-Larsen K, Schroll M. The cumulative effect of smoking at age 50, 60, and 70 on functional ability at age 75. Scand J Public Health 2004; 32: 296–302.

    PubMed  Google Scholar 

  149. Christensen U, Støwing N, Schultz-Larsen K, Schroll M, Avlund K. Functional ability at age 77; is there an impact on physical inactivity from middle age to early old age? Scand J Med Sci Sports 2006; 16: 245–51.

    CAS  PubMed  Google Scholar 

  150. Bennet BK, Hickie IB, Vollmer-Conna US et al. The relationship between fatigue, psychological and immunological variables in acute infectious illness. Aust NZ J Psychiatry 1998; 32: 180–6.

    Google Scholar 

  151. Drent M, Wirnsberger RM, de Vries J, van Dieijen-Visser MP, Wouters EFM, Schols AMWJ. Association of fatigue with an acute phase response in sarcoidosis. Eur Respir J 1999; 13: 718–22.

    CAS  PubMed  Google Scholar 

  152. Whiteside TL, Friberg D. Natural killer cells and natural killer cell activity in chronic fatigue syndrome. Am J Med 1998; 105: 27S–34S.

    CAS  PubMed  Google Scholar 

  153. Barr JO. Evaluation of pain in older individuals. In Kauffman TL, Barr JO, Moran ML, eds. Geriatric Rehabilitation Manual, Second Ed. Churchill Livingstone Elsevier, 2007: 443–6.

    Google Scholar 

  154. Zautra AJ, Fasman R, Parish BP, Davis MC. Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Pain 2007; 128: 128–35.

    PubMed  Google Scholar 

  155. Ciccone CD. Pharmacology considerations for the aging individual. In Kauffman TL, Barr JO, Moran ML, eds. Geriatric Rehabilitation Manual, Second Ed. Churchill Livingstone Elsevier, 2007: 63–8.

    Google Scholar 

  156. Vass M, Hendriksen C. Polypharmacy and older people — a GP perspective. Z Gerontol Geriatr 2005; 38: (Suppl 1): 14–7.

    Google Scholar 

  157. Vass M, Hendriksen C. Medication for older people — Aspects of rational therapy from the general practitioner’s point of view. Z Gerontol Geriatr 2005; 38: 190–5.

    CAS  PubMed  Google Scholar 

  158. Crombie IK, Irvine L, Williams B et al. Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents. Age Ageing 2004; 33: 287–92.

    PubMed  Google Scholar 

  159. Fried LP, Ferrucci L, Darer J et al. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol Med Sci 2004; 59: 255–63.

    Google Scholar 

  160. Bandeen-Roche K, Xue QL, Ferrucci L et al. Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol Med Sci 2006; 61: 262–6.

    Google Scholar 

  161. Walston J, McBurnie MA, Newman A et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities. Arch Intern Med 2002; 162: 2333–41.

    PubMed  Google Scholar 

  162. Bergman H, Ferrucci L, Guralnik J et al. Frailty: An emerging research and clinical paradigm — issues and controversies. J Gerontol Med Sci 2007; 62A: 731–7.

    Google Scholar 

  163. Xue Q-L, Bandeen-Roche K, Varadhan R, Zhou J, Fried LP. Initial manifestations of frailty criteria and the development of frailty phenotype in the Women’s Health and Aging Study II. J Gerontol Med Sci 2008; 63A: 984–90.

    Google Scholar 

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Correspondence to Kirsten Avlund DrMedSci.

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Review article based on the 5th Andrus Viidik Lecture in Gerontology, given by K. Avlund at the 20th Nordic Congress of Gerontology, Reykjavik, Iceland, May 30–June 2, 2010. The Nordic Gerontological Federation (NGF) initiated these lectures when Professor Viidik retired from the NGF, after having been its Secretary (1974–1988) and Chairman (1988–2002).

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Avlund, K. Fatigue in older adults: an early indicator of the aging process?. Aging Clin Exp Res 22, 100–115 (2010). https://doi.org/10.1007/BF03324782

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