Fatigue is a problem faced by many older adults, but it frequently goes unreported because—much like pain—it tends to be accepted as just another sign of aging. In fact, chronic fatigue can be a sign of numerous health issues, many of them serious.
So, when is fatigue worrisome?
“Fatigue definitely shouldn’t be considered a normal part of aging,” emphasizes Mount Sinai geriatrician Patricia Bloom, MD. “You should consider a real change from your baseline level of energy as a warning sign requiring medical evaluation.”
What Is Fatigue?
In the most basic sense, fatigue is persistent tiredness that cannot be overcome with a few nights of peaceful slumber. But it also may go beyond tiredness, causing physical, mental, and emotional symptoms.
“You may experience a profound lethargy that renders you physically unable to do things you should be able to easily manage and find that your muscle strength and physical coordination have decreased,” Dr. Bloom says. “Tasks that require you to focus and concentrate may seem insurmountable even if they are quite simple, and you may find it difficult to make decisions. You may feel emotionally exhausted and easily irritated, and your sleep may suffer.”
Common Causes of Fatigue
The causes of fatigue are many and varied. It can set in for as simple a reason as not eating enough—research has suggested that more than half of older adults who visit emergency departments are either malnourished or at risk for malnutrition. “Dehydration also may be a factor,” Dr. Bloom adds. “Insufficient fluid intake lowers blood volume, which reduces the delivery of oxygen to your cells. In older age, your thirst reflex diminishes, meaning that you already may be dehydrated when you feel the urge to drink.”
There also are links between chronic fatigue and underlying health conditions. Fatigue may signal an emotional or physical issue, such as depression, heart disease, poor kidney function, liver disease, thyroid disorder, anemia, cancer, or infection. In some cases, a disease or infection that is triggering fatigue may not yet have been diagnosed. For example, fatigue often is an early symptom of cancer, Parkinson’s disease, hepatitis C, and chronic obstructive pulmonary disease (COPD).
Tuberculosis (TB) is a potential cause of fatigue that frequently is missed, and older adults are at particular risk for a reactivation of latent TB (TB that was contracted years before but had been lying dormant). Pain from diseases like arthritis is another frequent contributor to fatigue, since persistent pain can sap your energy levels and demotivate you. Plus, fatigue may signal that a known health issue, such as COPD or heart failure, is worsening.
Fatigue and sleep disorders often co-exist. For instance, sleep apnea is a frequent cause of fatigue, and it is possible to have the condition without being aware of it. “Sleep apnea causes the muscles at the back of the throat to relax too much during sleep, narrowing your airway so that you can’t inhale sufficient breath,” Dr. Bloom explains. “This lowers the level of oxygen in your blood, and once your brain senses this, it briefly rouses you. This may happen as often as hundreds of times overnight, but most people don’t remember.”
Snoring is a common sign of sleep apnea, and you also may feel excessively tired after what was apparently a full night’s sleep. If you have a bed partner, he or she may be disturbed from sleep by hearing you gasp for breath after a few seconds of not breathing.
“If you think you may have sleep apnea, consult a sleep specialist,” Dr. Bloom advises. “Studies have associated sleep apnea with a range of medical conditions, including cardiovascular disease, high blood pressure, stroke, dementia, depression, diabetes, and pulmonary disease. Effective treatments are available that can help you sleep better and avoid these potentially serious consequences.”
Additionally, a medication you take may be causing your fatigue. Drugs associated with fatigue include blood pressure medications (particularly diuretics and beta-blockers), antihistamines, the antipsychotics that may be used to help manage dementia symptoms, antidepressants, muscle relaxants, antiseizure medications, sleep medications, and some pain medications and chemotherapeutic agents. “Your doctor may be able to substitute a different medication or lower a medication dosage if a drug may be contributing to your fatigue,” Dr. Bloom says.
When Is Fatigue Worrisome?
Fatigue is aways worrisome in older adults, especially if it develops suddenly, with no apparent trigger, and/or persists for longer than a couple of weeks. Dr. Bloom notes that geriatricians see fatigue as a “vital sign” predicting potential decline and death in older adults.
“It can worsen your physical function by causing you to cut back on physical activity, increase your risk for falls and automobile accidents, make you less alert and more forgetful, and result in social isolation if you are too exhausted to interact with others,” she observes. “We would definitely want to make sure that an older adult who was experiencing fatigue was eating a sufficient amount, had not experienced unexplained weight loss, and wasn’t suffering from an underlying cause that could be effectively treated with lifestyle modifications, medications or even surgery. Moreover, given that fatigue can be exacerbated by drugs and treatments like chemotherapy and radiotherapy, we would want to look closely at how we were managing a person’s health issues and potentially adjust treatment regimens in a way that might ease fatigue.”
When to See a Doctor for Fatigue
If you are ages 65 or older and feel excessively tired and drained of energy all the time, don’t just ignore your symptoms—let your doctor know, since he or she may want to order blood tests to check whether a treatable condition is causing your fatigue.
“You should immediately contact your doctor if you have been feeling fatigued and develop shortness of breath, nausea, and cold sweats, since these symptoms can be atypical signs of a heart attack, especially in older women,” Dr. Bloom cautions. “Other fatigue warning signs include fatigue that is accompanied by a fever, unexplained weight loss, or sudden confusion.”
Fatigue Self-Care Tips
Whether or not a definite cause for your fatigue has been identified, there are steps you can take that will help boost your energy levels.
- Try to get enough sleep. Seven to eight hours is considered ideal by most health experts. “If you feel tired during the day, plan a short nap,” Dr. Bloom says. “However, you should avoid napping too close to your normal bedtime.”
- Eat a healthful diet. Eating a diet that lacks sufficient calories, protein, and essential nutrients may contribute to fatigue. If physical limitations such as arthritis and/or vision impairments are affecting your ability to prepare and eat nourishing meals, contact your local senior center to ask about grocery delivery services or Meals on Wheels. Drink enough fluids, too—aim for six to eight 8-ounce glasses of water per day, unless you have been told to manage your fluid intake because of heart failure or another health issue.
- Exercise even if you feel tired. Most experts recommend exercising for at least 30 minutes a day, most days of the week. “While it may seem counterintuitive to exercise if you’re suffering from chronic fatigue, physical activity boosts your mood and energy levels, as well as increasing your mental and social engagement,” says Dr. Bloom. “It also should help you sleep better; however, don’t exercise too close to your usual bedtime, or it may interfere with your sleep.”
- Seek help for depression. “Depression is a treatable illness,” Dr. Bloom notes. “With proper management, most people with depression can regain their normal energy levels.” Symptoms of depression include feelings of profound sadness, irritability, and diminished interest in activities you used to enjoy.
- Schedule a medication review, since a drug you take may be contributing to your fatigue.
