Fatigue is common among the elderly, and it has many possible causes

Linda C. from Indianapolis. Nothing prepared Johnson for the exhaustion that descended upon him in early 2020 after being diagnosed with stage 4 lung cancer.

At first, Johnson, now 77, thought she was depressed. She barely had the energy to get dressed in the morning. Some days he couldn’t get out of bed.

But as he began to put his affairs in order, Johnson realized something else was going on. No matter how long he slept the night before, he woke up exhausted. He felt exhausted even if he hadn’t done much during the day.

“People used to tell me. “You know, you’re old?” And it wasn’t helpful at all. Because then you feel like there’s nothing you can do mentally or physically to deal with it,” he told me.

Fatigue is a common companion to many diseases that plague older people: heart disease, cancer, rheumatoid arthritis, lung disease, kidney disease, and neurological conditions like multiple sclerosis, among others. It is one of the most common symptoms associated with chronic disease, affecting 40% to 74% of older adults living with these conditions, according to a 2021 review by researchers at the University of Massachusetts.

This is more than just being tired after an extremely busy day or a bad night’s sleep. A persistent feeling of lack of energy throughout the body, even with minimal or no effort. “I feel like my battery is almost dead,” wrote a user named Renee in a Facebook group for people with a rare blood cancer. “It’s like an overturned dish rag.”

Fatigue does not represent “the day when you are tired. it’s a few weeks or a few months when you’re tired,” says Dr. Kurt Kroenke, a research fellow at the Regenstrief Institute in Indianapolis, which specializes in medical research, and a professor at the Indiana University School of Medicine.

When he and colleagues asked nearly 3,500 elderly patients at a large primary care clinic in Indianapolis about bothersome symptoms, 55% listed fatigue, second only to musculoskeletal pain (65%) and more than back pain (45%) and shortness of breath ( 41). %).

Separately, a 2010 study in the Journal of the American Geriatrics Society estimated that 31% of people age 51 and older reported feeling tired in the past week.

The impact can be profound. According to a 2001 study by Yale researchers, fatigue is the leading cause of limited activity in people 70 and older. Other research has linked fatigue to impaired mobility, limitations in people’s ability to perform daily activities, the onset or worsening of disability, and earlier death.

What often happens is that seniors with fatigue stop being active and become inactive, which leads to muscle loss and weakness, which increases fatigue. “It becomes a vicious cycle that contributes to things like depression, which can make you more tired,” said Dr. Jean Kutt, a professor of medicine and chief medical officer at the University of Colorado Hospital.

Photo of an old woman smiling.
Linda C. Johnson began experiencing fatigue after being diagnosed with stage 4 lung cancer in early 2020. Fatigue is a common companion to many ailments that plague older people.(Linda S. Johnson)

To prevent that from happening, Johnson devised a plan after learning his lung cancer had returned. Every morning he set small goals for himself. One day she would get up and wash her face. Next she would take a shower. Another day she was going to the grocery store. After each activity, he rested.

In the three years since the cancer returned, Johnson’s fatigue has been constant. But “I’m doing better,” she told me, because she’s learned how to handle herself and find things that motivate her, like teaching virtual classes to students training to be a teacher and training to be a personal trainer. under supervision.

When should seniors be concerned about fatigue? “If someone is doing well but now feels tired all the time, it’s important to get an evaluation,” says Dr. Holly Young, an MD at Scripps Mercy Hospital in San Diego and president of the American Board of Hospice and the American Academy of Hospice. Palliative medicine.

“Fatigue is a warning sign that something is wrong with the body, but it’s rarely one thing. Usually, several things need to be addressed,” says Dr. Ardeshir Hashmi, MD, chief of the Geriatrics Center at the Cleveland Clinic.

Among the points that doctors should check: Are your thyroid levels normal? Do you have trouble sleeping? If you have underlying medical conditions, are they well controlled? Do you have an underlying infection? Are you chronically dehydrated? Do you have anemia (lack of red blood cells or hemoglobin), electrolyte imbalances, or low testosterone? Are you eating enough protein? Have you been feeling more anxious or depressed lately? And the medications you take can contribute to fatigue.

“The drugs and the doses may be the same, but your body’s ability to metabolize those drugs and clear them from your system has changed,” Hashmi said, noting that such changes in the body’s metabolic activity are common as people age.

Many potential contributors to fatigue can be addressed. But most of the time, the causes of fatigue cannot be explained by an underlying medical condition.

That’s what happened to Teresa Goodell, 64, a retired nurse who lives outside Portland, Oregon. During a visit to Arizona in December, he suddenly found himself exhausted and out of breath during the hike, even though he was in good physical condition. At the emergency room, he was diagnosed with an asthma exacerbation and given steroids, but they did not help.

Soon, Goodell was spending hours each day in bed due to profound fatigue and weakness. Even small activities tired him out. But none of the medical tests he received in Arizona and then in Portland — chest X-rays and CT scans, blood tests, cardiac stress tests — showed any abnormalities.

“There was no objective evidence of disease, and that makes it hard for anyone to believe you are sick,” he told me.

Goodell began visiting long-standing Covid websites and chat rooms for people with chronic fatigue syndrome. Today, he is convinced that he has post-viral syndrome. One of the most common symptoms of prolonged Covid is fatigue that interferes with daily life, according to the Centers for Disease Control and Prevention.

There are several strategies for combating chronic fatigue. In cancer patients, “the best evidence supports physical activity such as tai chi, yoga, walking or low-impact exercise,” said Dr. Christian Sinclair, an associate professor of palliative medicine at the University of Kansas Health System. The goal is to “gradually stretch the stability of patients,” he said.

However, with prolonged Covid, doing too much too soon can backfire, causing ‘post-exercise deficiency’. It is often recommended to walk in the activity. doing only what is most important when energy levels are highest and resting afterwards. “You learn how to set realistic goals,” said Dr. Andrew Ash, senior education consultant at the Center for Palliative Care.

Cognitive behavioral therapy can help older adults with fatigue learn how to adjust expectations and address intrusive thoughts such as, “I should be able to do more.” Management plans for older patients with fatigue at the University of Texas MD Anderson Cancer Center typically include strategies to address physical activity, sleep health, nutrition, emotional health, and support from family and friends.

“A big part of managing fatigue is about forming new habits,” says Dr. Ishwarya Subbiah, a palliative care and integrative medicine physician at MD Anderson. “It’s important to realize that it doesn’t happen immediately, it takes time.”

We want to hear from readers about questions you’d like answered, concerns about your care, and tips for dealing with the health care system. Visit khn.org/columnists to submit your queries or suggestions.

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