It is difficult to give a general definition for fatigue, but it can be defined as a feeling of burnout during or after normal activity or a feeling of not having enough energy to start the activity.
· Weariness
Tiredness
· Exhaustion
· Weakness
· Distaste for work
· Boredom
· Reduced performance
· Listlessness
· Exercise dyspnea (Exertional dyspnea)
· Lack of energy
· Sleepiness
· Unwillingness to work
However, it is true that there is a confusion in terminology. When patients have weakness or shortness of breath during exercise, they describe it as fatigue. In fact, weakness is the definition that should be used if there is a decrease in muscle strength and this is detected in the physical examination. It should be investigated whether there are neurological or muscular causes underlying this complaint or finding. However, in the absence of physical examination findings, weakness can be used synonymously with fatigue.
If the clinician decides that the patient’s complaint is indeed fatigue, he should place it in one of the following categories and begin his initial investigations from this framework.
Physiological fatigue:
This type of fatigue occurs in a normal person under conditions of stress, diet changes, insufficient rest or sleep, or excessive activity. This type of fatigue is frequently encountered in elderly people. The presence of such factors should be investigated by taking a good history.
Organic fatigue:
This type of fatigue is associated with some medical problems and is the most common cause of fatigue in the elderly. These medical problems are anemia, chronic kidney failure, liver failure, chronic obstructive pulmonary disease, congestive heart failure, infections, various endocrine and metabolic abnormalities. In order to eliminate this fatigue, the functional capacities of organs and systems should be determined and appropriate lifestyle changes, non-pharmacological and pharmacological treatment arrangements should be made.
Cancers:
Another cause of fatigue in the elderly is cancer. If the history, interrogation of systems and physical examination findings suggest the possibility of cancer, cancer screening should be performed with appropriate diagnostic tests. For this, routine hematological tests, biochemistry tests, radiological examinations, endoscopic examinations, tumor markers are used and if there is a suspicion of cancer tissue, tissue is taken by biopsy and histopathological examination is performed. The most commonly used examinations in imaging are chest radiography, ultrasonography, tomography, upper and lower gastrointestinal endoscopy, bronchoscopy and cystoscopy.
Drugs / Toxins:
Many drug groups, which are frequently used especially in the elderly population, can cause fatigue. Antihistamines, analgesics, corticosteroids, antidepressants, sedatives and bata blockers are the drugs most blamed. The mechanisms by which these cause fatigue are different. Some may cause fatigue with direct effect and some with interruption. This issue gains even more importance as the pharmacokinetic and pharmacodynamic properties of drugs differ in the elderly. Therefore, non-evidence-based practices should be avoided in drug use in the elderly. After the correct diagnosis is made, the appropriate drug should be given in the appropriate dose and its effects should be followed closely. Even in some drugs (digoxin, theophylline, etc.), the treatment should be continued by following the blood levels. The most commonly used toxin that causes fatigue is alcohol.
Psychogenic fatigue:
Approximately 50% of the causes of fatigue are psychological factors. Coexistence with depression is the most common. It could happen at any time. It is usually present when you wake up in the morning and decreases later in the day. In parallel with the changes in emotion, thought and stress, fatigue also occurs. It may be accompanied by depression, anxiety and other somatization findings. If the underlying psychological cause is corrected with psychotherapy or pharmacological treatment, it is seen that the fatigue is also relieved.
Chronic Fatigue Syndrome:
It is a recently described syndrome and is rare in the elderly. In the investigation of cases with fatigue, no psychological or organic cause could be found in approximately 30% of cases. These cases should be examined repeatedly over time to observe for signs and symptoms that may be diagnostic clues. Until a specific diagnosis is made, these cases are considered as idiopathic chronic fatigue. In these cases, lack of motivation, lack of concentration, weakness and irritability are observed. Deceleration in psychomotor speed leads to falls and exposure to accidents.
The following two criteria must be met for the diagnosis of chronic fatigue syndrome:
Clinically evaluated, unidentified persistent or recurrent fatigue that is onset at a new or known time, is not a result of continued activity, is not relieved primarily by rest, and causes significant reduction in current work, educational, social and private life activities At the same time, 4 or more of the following symptoms They must be present and continue for 6 consecutive months or more and not precede fatigue.
1. Significant impairment in short-term memory or concentration
2. Throat pain
3. Tenderness in lymph nodes
4. Muscle pain
5. Pain in various joints without redness or swelling
6. New, disfiguring, or serious headache
7. Inability to wake up in the morning (continuing sleepiness)
8. Wrinkle that lasts more than 24 hours after a job done
In addition to these main symptoms, abdominal pain, alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, drowsiness, dry mouth and eyes, earache, palpitations, jaw pain, morning stiffness, nausea, night sweats, psychological problems (depression, irritability) , anxiety, panic attacks), shortness of breath, skin sensitivity, tingling sensation and weight loss are also expressed.
Possible causes of chronic fatigue syndrome are grouped under 5 headings:
1. Infectious agents (especially some viruses have been accused)
2. Immunological causes (related to the immune system)
3. Hormonal causes (related to the hypothalamus-pituitary-adrenal cycle)
4. Neural-induced hypotension
5. Malnutrition
Tips for Differentiating from Psychiatric Disorders
1. Symptoms and signs do not fit into any category of psychiatric illness.
2. There is no psychiatric history.
3. The patient shows a sudden change in his behavior and personality.
4. Symptoms and signs fluctuate in line with organic disease.
5. The condition does not respond to psychiatric treatment.
6. A good evaluation of clinical and functional status reveals the physical nature of the disease.
First of all, we must know how to control stress. Everyone has a stress threshold and this threshold should not be exceeded. A regular lifestyle, light physical exercises, a healthy diet and maintaining an ideal weight are the basic rules to be followed in order to be protected from chronic fatigue syndrome and similar ailments. It is also necessary to pay attention to the rhythm of sleep. Before going to bed for a comfortable sleep, removing all your daily stressors from your mind, thinking about pleasant topics or watching a movie you like can provide a regular sleep. Quitting alcohol and smoking is one of the most important factors in getting rid of fatigue.
If possible, it may be beneficial to reduce workload, share responsibilities, or stay away from the work environment for short periods of time. Even small physical changes at work can have benefits. In addition, vitamin and mineral supplements are recommended for a certain period of time, provided that they are under the control of a doctor.
Since all our elderly patients will complain of fatigue when asked, we should not think that this is not very important. Just as we focus on chest pain or shortness of breath and do the examination and treatment, fatigue, which is a non-specific complaint, should also be examined and efforts should be made for its treatment.
