Determinants and mechanisms of fatigue in older adult patients with stroke: A structural equation modeling approach

Background This study aimed to explore the determinants and pathways of fatigue in older adult patients with stroke, drawing upon the theory of unpleasant symptoms, to inform clinical interventions. Methods A convenience sampling method was used to recruit 234 older adult patients with stroke between July 2024 and January 2025. Data were collected using the Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Social Support Rating Scale, and Stroke Specific Quality of Life Scale. Statistical analysis was conducted using R software (version 4.4.3), and a structural equation model was constructed. The mediating effect was evaluated using the Bootstrap method. Results Fatigue levels were significantly higher in patients with greater anxiety, depression, poorer sleep quality, and higher C-reactive protein (CRP) levels, and in those with lower education level and poorer stroke-specific quality of life (all p < 0.05). The structural equation model demonstrated a good fit (CFI = 1.000, RMSEA = 0.000). Anxiety, depression, and sleep quality were identified as complete mediators between education level, social support, CRP levels, and fatigue. The mediating effect accounted for 70.1 of the total effect, indicating that anxiety, depression, and sleep quality collectively explain most of the association between sociodemographic, psychosocial, and inflammatory factors and fatigue in this population. Conclusion Fatigue among older adult patients with stroke is influenced by multiple interrelated factors, with anxiety, depression, and sleep quality acting as key mediators. These findings support routine screening and targeted management of psychological distress and sleep problems to mitigate fatigue during stroke rehabilitation.