Fatigue as a long-term risk factor for limitations in instrumental activities of daily living and/or mobility performance in older adults after 10 years

Figures & data

Figure 1 Flowchart of the inclusion of participants in the middle of the Netherlands.

Table 1 Baseline characteristics of participants stratified by fatigue and gender

Characteristic	Males, N=285		Females, N=249
	Without symptoms of fatigue at baseline, N=232 (81.4%)	With symptoms of fatigue at baseline, N=53 (18.6%)	Without symptoms of fatigue at baseline, N=179 (71.9%)	With symptoms of fatigue at baseline, N=70 (28.1%)
Age (years)
Mean ± SD	58.6±10.8	57.2±11.3	65.5±3.7	66.0±3.8
Education,a N (%)
Low	18 (7.8)	3 (5.7)	50 (27.9)	26 (37.1)
Average	92 (39.7)	21 (39.6)	87 (48.6)	36 (51.4)
High	122 (52.6)	29 (54.7)	42 (23.5)	8 (11.4)
Marital status, N (%)
Married/living together	209 (88.4)	45 (84.9)	128 (71.5)	51 (72.9)
Divorced/widowed	9 (3.9)	3 (5.7)	35 (19.6)	9 (12.9)
Unmarried	18 (7.8)	5 (9.4)	16 (8.9)	10 (14.2)
Smoking status, N (%)
Current or former	173 (74.6)	45 (84.9)	89 (49.7)	30 (57.1)
Never	59 (25.4)	8 (15.1)	90 (50.3)	40 (42.9)
BMI (kg/m^2)
Mean ± SD	26.2±3.5	26.0±3.0	25.5±4.0	27.1±5.0
Number of chronic diseasesb
Mean ± SD	0.6±0.8	0.9±1.0	1.0±1.0	2.0±1.4
MMSE score
Median (IQR)	28.0 (2.0)	28.0 (2.0)	27.0 (2.0)	27.0 (2.2)
IADL-limitations, N (%)
No	210 (90.5)	43 (81.1)	172 (96.1)	61 (87.1)
Activity level, N (%)
Low	73 (31.6)	21 (40.4)	54 (30.7)	28 (40.0)
Medium	82 (35.5)	14 (26.9)	55 (31.3)	27 (38.6)
High	76 (32.9)	17 (32.7)	67 (38.1)	15 (21.4)

Notes:

a Education according to the ISCED: low ≤ ISCED level 3, middle = ISCED level 4, high = ISCED level 5/6/7/8;

b number of chronic diseases: coronary disease, stroke, hypertension, diabetes mellitus, chronic pulmonary disease, arthritis, hypercholesterolemia, cancer, and hip fracture.

Abbreviations: BMI, body mass index; IADL, instrumental activities of daily living; IQR, interquartile range; ISCED, International Standard Classification of Education; MMSE, Mini-Mental State Examination; SD, standard deviation.

Table 2 Association between fatigue at baseline and IADL-limitations after 10 years

	Males			Females
	OR	95% CI	P-value	OR	95% CI	P-value
Model 1a
Constant	0.13	0.08; 0.19	0.000	0.42	0.31; 0.58	0.000
Fatigue	3.13	1.52; 6.45	0.002	2.25	1.27; 3.96	0.005
Model 2b
Constant	0.00	0.00; 0.01	0.000	0.00	0.00; 0.00	0.000
Fatigue	4.73	2.02; 11.05	0.000	2.22	1.21; 4.06	0.010
Age	1.13	1.08; 1.18	0.000	1.21	1.13; 1.31	0.000
Model 3c
Constant	0.00	0.00; 0.00	0.000	0.00	0.00; 0.00	0.015
Fatigue	3.29	1.95; 5.55	0.023	1.65	0.83; 3.26	0.154
Age	1.15	1.12; 1.18	0.000	1.21	1.12; 1.32	0.000
BMI	1.06	0.94; 1.20	0.371	1.12	1.04; 1.20	0.003
Education	0.72	0.33; 1.53	0.388	1.76	1.10; 2.83	0.019
Marital status	4.23	2.77; 6.45	0.001	1.16	0.75; 1.80	0.498
Chronic disease	1.82	1.18; 2.80	0.007	1.13	0.98; 1.30	0.378
MMSE	0.92	0.67; 1.28	0.624	0.92	0.77; 1.10	0.363
Lifestyle (baseline)	1.62	0.69; 3.81	0.266	1.31	0.69; 2.49	0.418
IADL-limitations (baseline)	2.13	1.53; 2.98	0.024	2.50	0.98; 6.35	0.055
Follow-up time	1.16	1.06; 1.28	0.002	1.02	0.93; 1.12	0.707

Notes:

a Crude;

b adjusted for age;

c additionally adjusted for BMI, education, marital status, chronic disease, MMSE, lifestyle (activity), baseline IADL-limitations (HAQ), followup time.

Abbreviations: BMI, body mass index; CI, confidence interval; HAQ, Stanford Health Assessment Questionnaire; IADL, instrumental activities of daily living; MMSE, Mini-Mental State Examination; OR, odds ratio.

Figure 2 Number of participants with self-reported baseline fatigue symptoms stratified gender and IADL status at baseline and 10-year follow-up.

Abbreviation: IADL, instrumental activities of daily living.

Table 3 Association between fatigue at baseline and mobility performance after 10 years

	Males			Females
	B	95% CI	P-value	B	95% CI	P-value
Model 1a
Constant	516.91	499.02; 534.79	0.000	421.09	397.27; 444.91	0.000
Fatigue	−37.97	−81.05; 5.12	0.084	−36.16	−85.89; 13.57	0.145
Model 2b
Constant	849.17	769.03; 929.31	0.000	964.30	608.53; 1,320.07	0.000
Fatigue	−48.58	−87.48; −9.68	0.015	−33.53	−83.24; 16.18	0.174
Age	−5.67	−7.03; −4.31	0.000	−8.28	−13.85; −2.71	0.005
Model 3c
Constant	658.31	205.25; 1,111.38	0.005	1,116.83	214.86; 2,018.80	0.017
Fatigue	−39.12	−77.83; −0.41	0.048	−17.46	−67.90; 32.98	0.479
Age	−5.15	−6.61; −3.70	0.000	−7.97	−13.61; −2.33	0.008
BMI	−3.36	−7.57; 0.86	0.118	−4.85	−9.29; −0.40	0.034
Education	13.26	−15.96; 42.47	0.365	12.70	−13.03; 38.42	0.331
Marital status	−18.12	−42.94; 6.71	0.152	2.82	−20.66; 26.30	0.813
Chronic disease	−20.28	−41.63; 1.07	0.062	−3.88	−20.68; 12.91	0.644
MMSE	8.36	−3.94; 20.67	0.179	5.60	−6.92; 18.12	0.365
Lifestyle (baseline)	−11.90	−40.92; 17.13	0.422	−2.57	−49.85; 44.71	0.910
Follow-up time	0.17	−3.03; 3.37	0.917	−1.68	−8.23; 4.91	0.602

Notes:

a Crude;

b adjusted for age;

c additionally adjusted for BMI, education, marital status, chronic disease, MMSE, lifestyle (activity), and follow-up time.

Abbreviations: BMI, body mass index; CI, confidence interval; MMSE, Mini-Mental State Examination.