Lack of Energy May Signal Health Problems in Older Patients
By Todd Neale
NEW YORK, 09 aug 2008Although anergia is common in older patients, it may not be just a normal part of aging, but a sign of more serious health problems, researchers here said. In addition to being more likely to have several health problems, including impaired physical function, patients who lacked energy had higher rates of death at 18 months (12.2% versus 5.9%) and six years (31.1% versus 22.3%) of follow-up (P=0.00 for both), Mathew Maurer, M.D., of Columbia, and colleagues reported in the July issue of the Journal of Gerontology: Medical Sciences. Among 2,130 patients 65 and older who participated in their study, 18% met criteria for anergia.
According to Dr. Maurer, when older patients complain about being tired, most physicians "tell their patients that feeling listless is an expected part of aging, but there are reasons people are tired and they need to be investigated."
Frailty as a geriatric syndrome has received much attention from clinicians and researchers, according to the researchers, with lack of energy or exhaustion as a major component.
However, they said, it's unknown whether lack of energy alone has any clinical relevance in older patients.
So they turned to the Northern Manhattan Aging Project, which surveyed a multiethnic population of Medicare beneficiaries (mean age 74; 33.4% black, 47% Hispanic, and 19.6% white; 68.8% female) living north of 150th Street in New York. They were followed every 18 months from 1989 through 1995.
Participants were classified as having anergia if they said they "sat around a lot for lack of energy" and met at least two of six other criteria for low energy levels.
Overall, 66% of the participants had at least one complaint consistent with a lack of energy and 18% had anergia.
The condition was more common in women than in men (22% versus 12%, P<0.01) and in unmarried versus married participants (21% versus 13%, P<0.001) and with advancing age.
Those with anergia were more likely to rate their health as fair or poor compared with excellent, could walk fewer blocks without resting, reported more physical impairment on basic and instrumental activities of daily living, and were more likely to use an assistive device (P=0.00 for all).
Compared with those who did not have anergia, those with the condition were hospitalized more, and used more office visits, emergency room visits, and home care services (P=0.00 for all).
In a multivariate analysis, anergia was significantly associated with female gender, impaired physical function and instrumental activities of daily living, depression, pain, respiratory symptoms, urinary incontinence, hearing difficulty, feeling dizzy or weak, and social isolation and disengagement (P<0.05 for all).
"These factors could be the initial candidates for clinical investigation of anergia of undetermined origin," the researchers said.
Among participants with anergia at baseline, the condition persisted in 48.1% through 18 months.
"Collectively," the researchers said, "these findings would suggest that anergia warrants consideration as a geriatric syndrome."
They said that "in clinical settings, anergia, being recognizable as a 'chief complaint or concern,' is a more readily identifiable condition than frailty is."
Accordingly, "further investigations for potentially effective interventions targeted at anergia in older persons appear warranted," they said
In addition, they said, the condition could be a useful outcome measure in clinical trials.
The authors acknowledged several limitations of the study: the results were derived from a single data set, response rates were low, the data were predominantly self-reported, the survey did not include information on comorbidities such as renal failure or congestive heart failure, some participants were lost to follow-up, the criteria for anergia were preliminary, and the cross-sectional analyses could not establish causality.
The authors made no disclosures.
Primary source: Journal of Gerontology: Medical SciencesSource reference:Cheng H, et al "Self-reported lack of energy (anergia) among elders in a multiethnic community" J Gerontol A Biol Sci Med Sci 2008; 63: 707-714.
According to Dr. Maurer, when older patients complain about being tired, most physicians "tell their patients that feeling listless is an expected part of aging, but there are reasons people are tired and they need to be investigated."
Frailty as a geriatric syndrome has received much attention from clinicians and researchers, according to the researchers, with lack of energy or exhaustion as a major component.
However, they said, it's unknown whether lack of energy alone has any clinical relevance in older patients.
So they turned to the Northern Manhattan Aging Project, which surveyed a multiethnic population of Medicare beneficiaries (mean age 74; 33.4% black, 47% Hispanic, and 19.6% white; 68.8% female) living north of 150th Street in New York. They were followed every 18 months from 1989 through 1995.
Participants were classified as having anergia if they said they "sat around a lot for lack of energy" and met at least two of six other criteria for low energy levels.
Overall, 66% of the participants had at least one complaint consistent with a lack of energy and 18% had anergia.
The condition was more common in women than in men (22% versus 12%, P<0.01) and in unmarried versus married participants (21% versus 13%, P<0.001) and with advancing age.
Those with anergia were more likely to rate their health as fair or poor compared with excellent, could walk fewer blocks without resting, reported more physical impairment on basic and instrumental activities of daily living, and were more likely to use an assistive device (P=0.00 for all).
Compared with those who did not have anergia, those with the condition were hospitalized more, and used more office visits, emergency room visits, and home care services (P=0.00 for all).
In a multivariate analysis, anergia was significantly associated with female gender, impaired physical function and instrumental activities of daily living, depression, pain, respiratory symptoms, urinary incontinence, hearing difficulty, feeling dizzy or weak, and social isolation and disengagement (P<0.05 for all).
"These factors could be the initial candidates for clinical investigation of anergia of undetermined origin," the researchers said.
Among participants with anergia at baseline, the condition persisted in 48.1% through 18 months.
"Collectively," the researchers said, "these findings would suggest that anergia warrants consideration as a geriatric syndrome."
They said that "in clinical settings, anergia, being recognizable as a 'chief complaint or concern,' is a more readily identifiable condition than frailty is."
Accordingly, "further investigations for potentially effective interventions targeted at anergia in older persons appear warranted," they said
In addition, they said, the condition could be a useful outcome measure in clinical trials.
The authors acknowledged several limitations of the study: the results were derived from a single data set, response rates were low, the data were predominantly self-reported, the survey did not include information on comorbidities such as renal failure or congestive heart failure, some participants were lost to follow-up, the criteria for anergia were preliminary, and the cross-sectional analyses could not establish causality.
The authors made no disclosures.
Primary source: Journal of Gerontology: Medical SciencesSource reference:Cheng H, et al "Self-reported lack of energy (anergia) among elders in a multiethnic community" J Gerontol A Biol Sci Med Sci 2008; 63: 707-714.
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