A community-based cross-sectional study of fatigue in middle-aged and elderly women
Introduction
Fatigue is viewed as an overwhelming sustained sense of ‘a decreased capacity for physical and/or mental activity due to an imbalance in the availability, utilization, and/ or restoration of resources needed to perform activity’ [1], which differentiates pathological fatigue from a normal state in which the symptoms have a rapid onset, is of short duration, and are usually alleviated by self-regulation. There are increasing numbers of people suffering from fatigue, primarily due to strong competition, great pressure, and intense personal relationships in modern society [2], [3]. Fatigue is not only a physical problem, but it is also a social issue, as it may impair individuals' quality of life and social productivity [4], [5], [6], [7] by affecting an individual's work and home performance and function.
Fatigue, a nonspecific and widespread complaint, commonly exists in patients with various chronic diseases, such as multiple sclerosis [8], cancer [9], and stroke [10], [11]. In primary care settings, the prevalence of fatigue ranges from 2.72% to 75.7% [12]. It is also used as a sensitive indicator to evaluate the suboptimal health status in the general population. A number of studies on fatigue were conducted in the general population; it was found that the estimated prevalence of fatigue in the U.S. workforce was 37.9% [6], but it was as high as 82.1% in China [13]. The high range in prevalence rates among these studies might be due to differences between the study subjects, the measurement scales used, racial differences, diverse social environments, and the various types of fatigue examined, such as brief periods of fatigue, prolonged fatigue, and chronic fatigue. Nevertheless, fatigue is a universal symptom experienced by a substantial percentage of patients in the general population.
Several studies found that there was a higher incidence and level of fatigue in women than in men [14], [15], [16]; the underlying reasons for these gender differences in the incidence of fatigue remain unclear. It is possible that women may undergo greater stress than men as they have different physiological characteristics and social functions [17], which render them more susceptible to fatigue. In particular, in middle-aged women, increasing menopausal symptoms and reduced estrogen levels exert both physiological and psychological influences, and they also impair these women's quality of life [18]. Specifically, higher prevalence rates of cardiovascular diseases (CVDs) [19], [20], metabolic syndrome (MetS) [21], and a loss of bone density [22] were observed in postmenopausal women when compared with their premenopausal counterparts. Depression and anxiety were also common symptoms experienced during menopausal transition and postmenopause [23]. These appear to underpin the differences in the incidence of fatigue between genders. However, it remains unclear whether there are any pre-existing risk factors, such as menstrual and reproductive history, that could predict the outcomes of chronic diseases among women. Several studies found that the number of births increased the risk of CVDs [24], [25], and another study demonstrated that the risk of depression increased prominently with younger ages at menarche [26]. However, little information was available about the relationship between gynecological history and the incidence of fatigue, particularly in middle-aged and older females. In light of this, we carried out a large-scale investigation in women aged 45 years or above.
The present study aimed to explore the prevalence of fatigue in the month before study interviews in middle-aged and elderly women; it also aimed to determine the association between fatigue and socio-demographic, health-related, and gynecological characteristics. Particularly, the relationships between fatigue and history of menstruation and reproduction in these women were investigated.
Section snippets
Sampling and participants
This study was based on a cross-sectional health survey in the Shunde municipality of Guangdong province in China. The sample in this survey consisted of family members drawn from 5% of total households in this municipality. A total of 2080 households, including 6802 residents, were randomly selected using the city's household registration system via a simple random sampling method. A total of 243 individuals refused participation or did not respond, meaning that 6559 individuals took park in
Description of the samples
In this study, a total of 1272 women aged between 45.0 and 92.9 years (mean = 59.3 years ± 10.7 years) with no missing data on the CFS were included. Among them, 1043 (82.0%) were married and 229 (18.0%) were single, including those who never married, got divorced, and were widowed. A total of 848 (66.7%) women received a primary education (5 years) or lower, and 1093 (85.9%) women lived with their children. Moreover, 497 (39.1%) women who were currently working, 337 (26.5%) women were retired, and 438
Main findings
In this study, we investigated the prevalence and predictors of fatigue among females aged 45 years or older. Approximately one in three women were diagnosed with fatigue by the CFS. Similar to previous studies, we confirmed several risk factors that were associated with fatigue, but our results also demonstrated that fatigue was statistically significantly associated with hospitalization in the past year, as well as with gynecological history (i.e., menopause status and the number of live
Conclusion
A high rate of fatigue was observed in middle-aged and elderly females. It was associated with older age, single marital status, lower education level, underweight, chronic diseases, hospitalization in the past year, menopause, and a higher number of live births. A further prospective study is warranted to explore the causal relationship between fatigue and the risk factors identified in this study.
Abbreviations
- CFS
Chalder Fatigue Scale
- PF
physical fatigue
- MF
mental fatigue
- BMI
body mass index
- BP
blood pressure
- SBP
systolic blood pressure
- DBP
diastolic blood pressure
- RCPG
random capillary plasma glucose
Authors' contributions
All authors contributed to the development of the study framework, interpretation of the results, revisions of successive drafts of the manuscript, and approved the version submitted for publication. MJJ, WQL and PXW conducted the data analyses. MJJ and JJW drafted the manuscript. PXW and YXL finalized the manuscript with inputs from all authors.
Conflict of interest statement
We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.
Acknowledgments
This study was supported by the Guangzhou 121 talents program (GZRSH-2014-2048, Guangzhou Municipal Human Resources and Social Security Bureau, P.R. China). We gratefully acknowledged medical students of Guangzhou Medical University and Guangzhou Pharmacy College, staff of local Community Health Service Agencies, for their kind assistance in data collection. JJW is supported by Guangdong Exemplary Centres for Exploratory Teaching in Higher Education Institutions — General Practice Exploratory
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The first two authors contributed equally in this work.