Abstract
Objectives
To design a questionnaire to evaluate and distinguish between cognitive and physical
aspects of fatigue in different age groups of “nondiseased” people and guide appropriate
prevention and interventions for the impact of frailty occurring in normative aging.
Study design and participants
The Norfolk QOL-Fatigue (QOL-F) with items of cognitive and physical fatigue, anxiety,
and depression from validated questionnaires including items from the Patient-Reported
Outcomes Measure Information System (PROMIS) databank was developed. The preliminary
QOL-F was administered to 409 healthy multiethnic local participants (30-80 years
old) in 5 age groups.
Methods
The authors distilled the item pool using exploratory (EFA) and confirmatory factor
analysis (CFA). EFA identified 5 latent groups as possible factors related to problems
due to fatigue, subjective fatigue, reduced activities, impaired activities of daily
living (ADL), and depression.
Results
CFA demonstrated good overall fit [χ2(172) = 1094.23, P < .001; Tucker-Lewis index = 0.978; root mean square error of approximation = 0.049]
with factor loadings >0.617 and strong interfactor correlations (0.69-0.83), suggesting
that fatigue in each domain is closely related to other domains and to the overall
scale except for ADL. The 5-factor solution displayed good internal consistency (Cronbach
α = 0.78-0.94). Total and domain scores were fairly equivalent in all age groups except
for the 40 to 49-year-old group with better overall scores. In addition, 70 to 79-year-olds
had better ADL scores. In item response analysis, factor scores in different age groups
were similar, so age may not be a significant driver of fatigue scores. Fatigue scores
were significantly higher in females than in males (P < .05).
Conclusions and clinical implications
The developed Norfolk QOL-F tool demonstrated fatigue as a perceived cognitive phenomenon
rather than an objective physical measure, suggesting mandatory inclusion of cognitive
as well as physical measures in the evaluation of people as they age. QOL-F is able
to distinguish QOL-F domain scores unique to different age groups, proposing clinical
benefits from physical, balance, and cognitive interventions tailored to impact frailty
occurring in normative aging.
Keywords
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Article info
Publication history
Published online: December 19, 2019
Footnotes
This study was supported by an NIH Grant: 1R21AG037123–01A1 (principal investigator: A.I. Vinik).
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
