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Patterns and Predictors of Recovery from Exhaustion in Older Adults: The Cardiovascular Health Study

Authors

  • Heather E. Whitson MD, MHS,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • ab Stephen Thielke MD,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • cdef Paula Diehr PhD,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • cd Ann M. O'Hare MD, MA,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • ef Paulo H.M. Chaves MD, PhD,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • gh Neil A. Zakai MD, MSc,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • i Alice Arnold PhD,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • bc Sarwat Chaudhry MD,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • j Diane Ives MPH,

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • and k Anne B. Newman MD, MPH k

    1. From the aCenter for the Study of Aging and Human Development, bDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Departments ofcPsychiatry and dBiostatistics, University of Washington Health System, Seattle, Washington; eDepartment of Medicine, University of Washington, Seattle, Washington; fVeterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments ofgMedicine and hEpidemiology, Johns Hopkins University Medical Institutions, Baltimore, Maryland; iDepartments of Medicine and Pathology, College of Medicine, University of Vermont, Burlington, Vermont; jSection of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; and kCenter for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Address correspondence to Heather E. Whitson, DUMC 3003, Durham, NC 27710. E-mail: heather.whitson@duke.edu

Abstract

OBJECTIVES: To estimate the likelihood of, and factors associated with, recovery from exhaustion in older adults.

DESIGN: Secondary analysis of a cohort study.

SETTING: Six annual examinations in four U.S. communities.

PARTICIPANTS: Four thousand five hundred eighty-four men and women aged 69 and older.

MEASUREMENTS: Exhaustion was considered present when a participant responded “a moderate amount” or “most of the time” to either of two questions: “How often have you had a hard time getting going?” and “How often does everything seem an effort?”

RESULTS: Of the 964 participants who originally reported exhaustion, 634 (65.8%) were exhaustion free at least once during follow-up. When data from all time points were considered, 48% of those who reported exhaustion were exhaustion free the following year. After adjustment for age, sex, race, education, and marital status, 1-year recovery was less likely in individuals with worse self-rated health and in those who were taking six or more medications or were obese, depressed, or had musculoskeletal pain or history of stroke. In proportional hazards models, the following risk factors were associated with more persistent exhaustion over 5 years: poor self-rated health, six or more medications, obesity, and depression. Recovery was not less likely in participants with a history of cancer or heart disease.

CONCLUSION: Exhaustion is common in old age but is dynamic, even in those with a history of cancer and congestive heart failure. Recovery is especially likely in seniors who have a positive perception of their overall health, take few medications, and are not obese or depressed. These findings support the notion that resiliency is associated with physical and psychological well-being.

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