Fatigue in older persons: the role of nutrition

Abstract

Fatigue is defined as a symptom leading to the inability to continue functioning at the expected activity level. It is a highly prevalent symptom, challenging to frame into monodimensional pathophysiological mechanisms. As a result, fatigue is often underestimated in the clinical setting and is wrongly considered an unavoidable consequence of ageing. Several potential mechanisms responsible for fatigue have been proposed, including sleep patterns, autonomic nervous system abnormalities and biological complexity. Inflammation and mitochondrial dysfunction are among the most promising mechanisms through which malnutrition may cause fatigue. Not surprisingly, fatigue is highly prevalent in inflammatory conditions (e.g. COVID-19 infection). The nutritional status may also represent a critical factor in the development and presentation of fatigue, which may mimic the exhaustion of the individual's metabolic reserves. For example, the insufficient dietary intake of energy and proteins may determine the catabolism of body fat and muscles, disrupt the homeostatic balance and cause the onset of fatigue. It is necessary to conduct research on fatigue. By characterising its pathophysiological mechanisms, it will be possible to (1) support the design and development of targeted interventions, (2) improve the quality of life of many persons by acting on the symptom and (3) reduce the direct and indirect costs of a burdening condition typical of advancing age. In the present review, we provide an overview of the role that nutrition may play as a determinant of fatigue in older people, also in the context of the COVID-19 pandemic.

Association between nutritional risk and fatigue in frailty conditions for older adult patients: a multicentre cross-sectional survey study

“…Fatigue can be described as a symptom of malnutrition and frailty. 33 Fatigue is closely related to adverse outcomes, significantly increasing medical costs and reducing the quality of life. 16 34 A recent systematic review classified fatigue-related factors into four aspects: biological, behavioural, psychological and social levels, and poor nutritional status was included in the behavioural levels.…”

“… 39 40 Fatigue management strategies include strengthening physical activity, improving sleep and nutritional support to compensate for inadequate energy and protein intake to meet an individual’s specific needs that may help combat fatigue. 33 41 …”

When the Pandemic Will Be Over: Lots of Hope and Some Concerns

“…Interestingly, all these mechanisms are also observed in the context of COVID-19 [ 29 ]. Fatigue may therefore be envisioned as a clinical indicator of an underlying biological abnormality [ 30 , 31 ]. However, the subjectivity of the symptom and the lack of a gold standard measure for fatigue assessment contribute to its poor consideration in the clinical practice [ 29 ].…”

The association between frailty and perceived physical and mental fatigability: The Long Life Family Study

“…In both approaches, the operationalization of fatigue measurement has not been clearly defined and varies widely across the literature, including subjective symptoms related to fatigue (exhaustion, anergia, etc. ), further contributing to poor clinical consensus 6–9 . A systematic review of 158 frailty scales identified 120 unique fatigue items 10 .…”

“…), further contributing to poor clinical consensus. [6][7][8][9] A systematic review of 158 frailty scales identified 120 unique fatigue items. 10 Although fatigue has a variety of etiologies and mechanistic pathways, the heterogeneity further complicates research on fatigue as a frailty component.…”