Longitudinal associations between higher self-reported energy, gait speed and cognition in older adults with fatigue, 2023, Ehrenkranz et al

Background
Older adults reporting higher energy levels have better physical function. It is not known if these associations persist among older adults reporting fatigue or if higher energy is associated with cognitive function. We examined longitudinal associations between self-reported energy, gait speed, and cognition, stratified by fatigue, in 2,613 participants (aged 74.6 ± 2.87 years) in the Health, Aging and Body Composition Study.

Methods
Self-reported energy (0-10, dichotomized at median) and fatigue (present/absent) were measured at baseline. Usual and rapid paced gait speed (m/s), modified Mini-Mental State (3MS) and Digit Symbol Substitution Test (DSST) were measured at baseline and annually over eight years. Linear mixed effect models compared changes in gait speed, 3MS, and DSST between higher and lower energy groups within fatigue strata.

Results
At baseline, 724 participants (27%) were fatigued; 240 (33%) co-reported higher energy (9% of total). The remaining 1,889 participants were fatigue-free (73%); 1,221 (65%) co-reported higher energy (47% of total). Those with fatigue and higher energy had average rapid gait declines of 0.007 m/sec/year (p = 0.04) after adjustment for demographics, comorbidities, depressive symptoms, and exercise. DSST declines were found among only fatigue-free participants (β= 0.17, p = 0.01). No statistically significant associations with energy were found for fatigue-free participants, or for usual gait or 3MS.

Conclusion
Asking about older adults’ energy levels as well as fatigue may identify a subgroup of older adults protected against physical and cognitive decline, even among those with fatigue.

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