Assessment of Fatigue in Older Adults: The FACIT Fatigue Scale (Version 4)

By: Kathleen F. Tennant, PhD, APRN, BC, West Liberty University, West Liberty, West Virginia

WHY: Fatigue is one of the most frequent complaints of the elderly and is strongly associated with loss of independence and decreased physical activity and functional decline. Mild depression, anemia, insomnia, and poor nutrition have been associated with fatigue. However, many older persons report complaints of “fatigue” and “exhaustion” even when no underlying medical or psychiatric illness is present (Avlund et al., 2003). Thus, the lack of an “underlying illness” makes the impact of unexplained fatigue even more crucial.

BEST TOOL: Although there are several validated tools for the measurement of fatigue, there is no gold standard (NIA, 2007). One self-report questionnaire that has been validated for use with older adults is the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale (Version 4). The FACIT Fatigue Scale is a short, 13-item, easy to administer tool that measures an individual’s level of fatigue during their usual daily activities over the past week. The level of fatigue is measured on a four point Likert scale (4 = not at all fatigued to 0 = very much fatigued) (Webster et al., 2003). The FACIT Fatigue Scale is one of many different FACIT scales that are part of a collection of health-related quality of life (HRQOL) questionnaires targeted to the management of chronic illness referred to as The FACIT Measurement System. The group tests newly constructed FACIT subscales on a sample of at least 50 subjects. The FACIT tool has been translated in more than 45 different languages permitting cross-cultural comparisons.

TARGET POPULATION: Older adults who report fatigue.

VALIDITY AND RELIABILITY: In a 2007 study, (Chandran et al., 2007) the FACIT Fatigue Scale was found to have high internal validity (Cronbach’s alpha = 0.96) and high test-retest reliability (ICC = 0.95). The correlation between the FACIT and Fatigue Severity Scale (FSS) was -0.79 tool comparison (Tennant et al., 2011). Thus, the FACIT has demonstrated reliability and sensitivity to change in clients with a variety of chronic health conditions and in the general population and in special populations such as the elderly and those living in rural areas.

STRENGTHS AND LIMITATIONS: The FACIT Fatigue Scale is easy to complete (in 5–10 minutes) and is written at the 4th grade reading level. It has demonstrated equivalence in mode of administration (interview vs. self-report) and can be used in a variety of clinical settings (community health, inpatient, outpatient, etc). Although the FACIT has been highly correlated with the FSS (Chandran et al., 2007; Tennant et al., 2011) further evaluation of this tool with the geriatric population with regard to cut-off points is recommended.

FOLLOW-UP: As needed or on a yearly basis to assess fatigue.


Best practice information on care of older adults:

The FACIT Measurement System website:

Avlund, K., Pederson, A.N., & Schroll, M. (2003). Functional decline from age 80 to 85: Influence of preceding changes in tiredness in daily activities. Psychosomatic Medicine, 65, 771-777.

Chandran, V., Bhella, S., Schentag, C., & Gladman, D. (2007). Functional assessment of chronic illness therapy-fatigue scale is valid in patients with psoriatic arthritis. Annals of the Rheumatic Diseases, 66(7), 936-39.

Dittner, A.J., Wessely, S.C., & Brown, R.G. (2004). The assessment of fatigue. A practical guideline for clinicians and researchers. Journal of Psychosomatic Research, 56, 157-170.

Hardy, S., & Studenski, S. (2008). Fatigue predicts mortality in older adults. JAGS, 56(10), 1910-1914.

Hardy, S., & Studenski, S. (2008). Fatigue and function over 3 years among older adults. Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 63A(12), 1389-1392.

National Institute on Aging (NIA). (2007). Unexplained fatigue in the elderly: An exploratory workshop sponsored by the National Institute on Aging. Retrieved June 16, 2011 from

Tennant, K., Russ, D., & Tackacs, S. (Under review, 2011). Unexplained fatigue in rural older adults: A mixed methods design.

Webster, K., & Cella, D., & Yost, K. (2003). The functional assessment of chronic illness therapy (FACIT) measurement system: Properties, applications, and interpretation. Health and Quality of Life Outcomes, 1(79), 1-7.