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Chronic Fatigue in the Elderly

Fatigue has physical or mental causes and is prevalent in the elderly. Fatigue may be generally categorized as recent (＜1 month), prolonged (1∼6 months), or chronic (＞6 months). Chronic fatigue syndrome (CFS), as defined by the CDC in 1994 requires fatigue (at least 6 months) that not be caused by other medical conditions, substance abuse within the last 2 years, obesity (BMI≥45) or major psychiatric conditions. Two or more of eight minor findings (1. Postexertional malaise 2. Impaired memory or concentration 3. Sore throat 4. Tender glands 5. Aching or stiff muscles 6. Joint pain 7. Headaches 8. Unrefreshing sleep) must be present. A psychiatric evaluation is essential for patients with chronic or idiopathic fatigue. Most of patients can be diagnosed after a careful examination in primary care. Treatment for recent fatigue should be directed toward the underlying cause or contributing conditions. No single treatment for chronic fatigue is optimal. Every measures include magnesium, L-carnitine and Graded exercise therapy can be considered for patients with chronic fatigue. As with any treatment, the side effects and risk/benefit ratio must be considered.