What is the cause of fatigue in a 60-year-old male?

From the Guidelines

For a 60-year-old male with fatigue, I recommend a comprehensive workup starting with a complete history and physical examination, followed by laboratory testing including complete blood count, comprehensive metabolic panel, thyroid function tests (TSH, free T4), hemoglobin A1c, vitamin B12, folate, iron studies, and urinalysis, as suggested by 1. This approach is crucial in identifying potential underlying causes of fatigue, such as anemia, hypothyroidism, diabetes, depression, sleep disorders, medication side effects, and heart failure.

Key Components of the Workup

• A focused fatigue history, including onset, pattern, duration, and associated or alleviating factors, as outlined in 1
• Evaluation of disease status and risk of recurrence, as well as assessment of treatable contributing factors, such as comorbidities, medications, and nutritional issues, as discussed in 1 and 1
• Laboratory testing to identify potential underlying causes of fatigue, such as anemia, hypothyroidism, and diabetes, as suggested by 1
• Medication review to identify potential contributors to fatigue, as highlighted in 1
• Depression screening using tools like the PHQ-9, as depression commonly presents as fatigue in older adults, as noted in 1

Additional Considerations

• Lifestyle modifications, including regular physical activity, adequate hydration, proper nutrition, and good sleep hygiene, should be recommended regardless of the underlying cause, as suggested by 1
• Further cardiac evaluation with an ECG and possibly stress testing may be considered if initial workup is unrevealing, especially with cardiovascular risk factors, as discussed in 1
• Treatment will depend on the specific etiology identified, ranging from iron supplementation for anemia to levothyroxine for hypothyroidism or CPAP therapy for sleep apnea, as outlined in 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Fatigue Workup for a 60-year-old Male

The workup for a 60-year-old male with fatigue should involve a comprehensive history and physical examination to guide the diagnosis, as stated in 2.

• A thorough history should focus on identifying common secondary causes of fatigue, such as medications, anemia, and life-threatening problems like cancer, as mentioned in 3.
• The physical examination should include cardiopulmonary, neurologic, and skin examinations to help guide the workup and diagnosis, as stated in 2.
• Laboratory studies, such as a complete blood count (CBC), may be useful in assessing cardiovascular and metabolic diseases, as suggested in 4.
• However, it is important to note that results of laboratory studies affect management in only 5 percent of patients, and if initial results are normal, repeat testing is generally not indicated, as mentioned in 3.

Classification of Fatigue

Fatigue can be classified as:

• Physiologic fatigue, which can be addressed by proper sleep hygiene, a healthy diet, and balancing energy expenditure, as stated in 2.
• Secondary fatigue, which is improved by treating the underlying condition, as mentioned in 3 and 2.
• Chronic fatigue, which may require cognitive behavior therapy, exercise therapy, and acupuncture, as suggested in 2.

Management of Fatigue

The management of fatigue should prioritize treating the underlying condition, if applicable, and may involve:

• A structured plan for regular physical activity, such as walking, as mentioned in 3.
• Cognitive behavioral therapy and exercise therapy, as suggested in 2 and 5.
• Education on pacing activity to not exceed limited energy capacity, as stated in 2.