Review of the literature



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RELATIONSHIP BETWEEN FATIGUE AND FATIGABILITY ON PHYSICAL FUNCTION: A REVIEW OF THE LITERATURE

by

Mohanraj Nagaraja

BA, University of Virginia, 2009

Submitted to the Graduate Faculty of

the Department of Epidemiology

Graduate School of Public Health in partial fulfillment

of the requirements for the degree of

Master of Public Health


University of Pittsburgh

2015





UNIVERSITY OF PITTSBURGH

GRADUATE SCHOOL OF PUBLIC HEALTH


This essay is submitted

by

Mohanraj Nagaraja


on
December 12, 2015

and approved by


Essay Advisor:

Evelyn O. Talbott, DrPH

Professor ______________________________________

Department of Epidemiology

Graduate School of Public Health

University of Pittsburgh

Essay Readers:
Nancy W. Glynn, PhD ______________________________________

Assistant Professor

Director, Master’s Degree Programs

Department of Epidemiology

Graduate School of Public Health

University of Pittsburgh

Steven M. Albert, PhD _______________________________________

Professor

Chair, Department of Behavioral and Community Health Sciences

Graduate School of Public Health

University of Pittsburgh

(If you have an extra reader, add their info; you can adjust the spacing on this page to fit it.)



Copyright © by Mohanraj Nagaraja

2015

ABSTRACT
E
Evelyn O. Talbott, DrPH
RELATIONSHIP BETWEEN FATIGUE AND FATIGABILITY ON PHYSICAL FUNCTION: A REVIEW OF THE LITERATURE

Mohanraj Nagaraja, MPH

University of Pittsburgh, 2015

valuating fatigue and fatigability’s association with physical function is of public health importance because among the older population almost 38.7% report one or more disabilities. Fatigue is also one of the most commonly reported reasons (65.5 episodes per 100 person-months) for restricted activity among community-dwelling older adults. Past research has only examined the relationship between fatigue and physical function, generally showing positive associations. However, fatigability may be a more useful concept when examining whether fatigue can predict physical function because it classifies fatigue in relation to a specific activity of fixed intensity making it a more objective measurement. Measuring perceived fatigability in place of physical activity may be a cost effective and less time consuming option when studying decline in physical function in older adults. Reducing fatigability and increasing physical activity can also potentially delay older adults entering the disablement pathway and improve their quality of life. A literature review highlighting major studies in the field of fatigue and fatigability may shed light on the gap in literature concerning the effects of fatigue on adverse health outcomes. This work is of public health importance as the symptom of fatigue is highly prevalent in older adult populations and if let unaccounted for can result in disability and worsened quality of life.

TABLE OF CONTENTS


TABLE OF CONTENTS v

List of tables vi



1.0 Introduction 1

2.0 methods 13

3.0 Results 14

4.0 Discussion 20

bibliography 28

bibliography 28


List of tables





Table 1. Literature Review of the Association between Fatigue and Fatigability and Physical Function and Physical Activity in Older Adults 24



  1. Introduction

    1. Aging Population


The number of adults aged 65 and older is expected to more than double by 2050, rising from 40.2 million to 88.5 million in the United States (3). This substantial increase in the aging population creates numerous implications for the country and the health care system. As adults start to age several health complications can arise that decrease their quality of life. Assessing the needs of a growing vulnerable population is necessary to help alleviate the consequences of these health concerns that effect older adults.

Older adults view fatigue as a primary source of function limitation (2). It is the most commonly reported reason (65.5 episodes per 100 person-months) for restricted activity among community-dwelling older adults (2). Fatigue remains a reported cause of difficulty in Instrumental Activities of Daily Living (IADLs) (17%) and mobility (9%) for older women in studies such as the Women’s Health and Aging Study (WHAS) (4). Fatigue is also listed as a key component of the frailty syndrome, an elevated risk of disastrous declines in health, which can also be associated with functional decline in older adults (5). Physical activity can preserve mobility, functional capacity, strength, endurance, and aid in survival (6, 7, Error: Reference source not found).

A decline in physical functioning serves as a primary determinant of loss of quality of life in older adults. It can be described as a combination of the “overall impact of medical conditions, lifestyle, and age-related physiologic changes in the context of the environment and social support system” (9). Even mild decreases in physical function can lead to numerous consequences such as loss of independence, increased caregiver burden, and greater financial expenditures (10, 11). The pathway to disability or a diminishing in physical function can be described in four consequential steps. Step one in the pathway is the onset of disease states. Step two consists of the physiological manifestation of disease in multiple systems followed by step three, functional limitations. The final step in the pathway is the onset of disability (12, 13). Identifying adults who have not yet entered this pathway, who are in a pre-disability category, can help create interventions that can modify this pathway described by Nagi and remove older adults from the risk of disability along with improving their physical function (11).

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