Nothing prepared Linda C. Johnson of Indianapolis for the fatigue that descended on her after a diagnosis of stage 4 lung cancer in early 2020.<\/p>\n

Initially, Johnson, now 77, thought she was depressed. She could barely summon the energy to get dressed in the morning. Some days, she couldn\u2019t get out of bed.<\/p>\n

But as she began to get her affairs in order, Johnson realized something else was going on. However long she slept the night before, she woke up exhausted. She felt depleted, even if she didn\u2019t do much during the day.<\/p>\n

\u201cPeople would tell me, \u2018You know, you\u2019re getting old.\u2019 And that wasn\u2019t helpful at all. Because then you feel there\u2019s nothing you can do mentally or physically to deal with this,\u201d she told me.<\/p>\n

Fatigue is a common companion of many illnesses that beset older adults: heart disease, cancer, rheumatoid arthritis, lung disease, kidney disease, and neurological conditions like multiple sclerosis, among others. It\u2019s one of the most common symptoms associated with chronic illness, affecting 40% to 74% of older people living with these conditions, according to a 2021 review<\/a> by researchers at the University of Massachusetts.<\/p>\n

This is more than exhaustion after an extremely busy day or a night of poor sleep. It\u2019s a persistent whole-body feeling of having no energy, even with minimal or no exertion. \u201cI feel like I have a drained battery pretty much all of the time,\u201d wrote a user named Renee in a Facebook group for people with polycythemia vera, a rare blood cancer. \u201cIt\u2019s sort of like being a wrung-out dish rag.\u201d<\/p>\n

Fatigue doesn\u2019t represent \u201ca day when you\u2019re tired; it\u2019s a couple of weeks or a couple of months when you\u2019re tired,\u201d said Dr. Kurt Kroenke, a research scientist at the Regenstrief Institute in Indianapolis, which specializes in medical research, and a professor at Indiana University\u2019s School of Medicine.<\/p>\n

When he and colleagues queried nearly 3,500 older patients<\/a> at a large primary care clinic in Indianapolis about bothersome symptoms, 55% listed fatigue \u2014 second only to musculoskeletal pain (65%) and more than back pain (45%) and shortness of breath (41%).<\/p>\n

Separately, a 2010 study<\/a> in the Journal of the American Geriatrics Society estimated that 31% of people 51 and older reported being fatigued in the past week.<\/p>\n

The impact can be profound. Fatigue is the leading reason for restricted activity in people 70 and older, according to a 2001 study<\/a> by researchers at Yale. Other studies have linked fatigue with impaired mobility<\/a>, limitations in people\u2019s abilities to perform daily activities, the onset or worsening of disability<\/a>, and earlier death<\/a>.<\/p>\n

What often happens is older adults with fatigue stop being active and become deconditioned, which leads to muscle loss and weakness, which heightens fatigue. \u201cIt becomes a vicious cycle that contributes to things like depression, which can make you more fatigued,\u201d said Dr. Jean Kutner, a professor of medicine and chief medical officer at the University of Colorado Hospital.<\/p>\n

Linda C. Johnson began experiencing fatigue after a diagnosis of stage 4 lung cancer in early 2020. Fatigue is a common companion of many illnesses that beset older adults.(Linda C. Johnson)<\/span><\/figcaption><\/figure>\n

To stop that from happening, Johnson came up with a plan after learning her lung cancer had returned. Every morning, she set small goals for herself. One day, she\u2019d get up and wash her face. The next, she\u2019d take a shower. Another day, she\u2019d go to the grocery store. After each activity, she\u2019d rest.<\/p>\n

In the three years since her cancer came back, Johnson\u2019s fatigue has been constant. But \u201cI\u2019m functioning better,\u201d she told me, because she\u2019s learned how to pace herself and find things that motivate her, like teaching a virtual class to students training to be teachers and getting exercise under the supervision of a personal trainer.<\/p>\n

When should older adults be concerned about fatigue? \u201cIf someone has been doing OK but is now feeling fatigued all the time, it\u2019s important to get an evaluation,\u201d said Dr. Holly Yang, a physician at Scripps Mercy Hospital in San Diego and incoming board president of the American Academy of Hospice and Palliative Medicine.<\/p>\n

\u201cFatigue is an alarm signal that something is wrong with the body but it\u2019s rarely one thing. Usually, several things need to be addressed,\u201d said Dr. Ardeshir Hashmi, section chief of the Center for Geriatric Medicine at the Cleveland Clinic.<\/p>\n

Among the items physicians should check: Are your thyroid levels normal? Are you having trouble with sleep? If you have underlying medical conditions, are they well controlled? Do you have an underlying infection? Are you chronically dehydrated? Do you have anemia (a deficiency of red blood cells or hemoglobin), an electrolyte imbalance, or low levels of testosterone? Are you eating enough protein? Have you been feeling more anxious or depressed recently? And might medications you\u2019re taking be contributing to fatigue?<\/p>\n

\u201cThe medications and doses may be the same, but your body\u2019s ability to metabolize those medications and clear them from your system may have changed,\u201d Hashmi said, noting that such changes in the body\u2019s metabolic activity are common as people become older.<\/p>\n

Many potential contributors to fatigue can be addressed. But much of the time<\/a>, reasons for fatigue can\u2019t be explained by an underlying medical condition.<\/p>\n

That happened to Teresa Goodell, 64, a retired nurse who lives just outside Portland, Oregon. During a December visit to Arizona, she suddenly found herself exhausted and short of breath while on a hike, even though she was in good physical condition. At an urgent care facility, she was diagnosed with an asthma exacerbation and given steroids, but they didn\u2019t help.<\/p>\n

Soon, Goodell was spending hours each day in bed, overcome by profound tiredness and weakness. Even small activities wore her out. But none of the medical tests she received in Arizona and subsequently in Portland \u2014 a chest X-ray and CT scan, blood work, a cardiac stress test \u2014 showed abnormalities.<\/p>\n

\u201cThere was no objective evidence of illness, and that makes it hard for anybody to believe you\u2019re sick,\u201d she told me.<\/p>\n

Goodell started visiting long covid web sites and chat rooms for people with chronic fatigue syndrome. Today, she\u2019s convinced she has post-viral syndrome from an infection. One of the most common symptoms of long covid is fatigue that interferes with daily life, according to<\/a> the Centers for Disease Control and Prevention.<\/p>\n

There are several strategies for dealing with persistent fatigue. In cancer patients, \u201cthe best evidence favors physical activity such as tai chi, yoga, walking, or low-impact exercises,\u201d said Dr. Christian Sinclair, an associate professor of palliative medicine at the University of Kansas Health System. The goal is to \u201cgradually stretch patients\u2019 stamina,\u201d he said.<\/p>\n

With long covid, however, doing too much too soon can backfire by causing \u201c post-exertional malaise<\/a>.\u201d Pacing one\u2019s activities is often recommended: doing only what\u2019s most important, when one\u2019s energy level is highest, and resting afterward. \u201cYou learn how to set realistic goals,\u201d said Dr. Andrew Esch, senior education advisor at the Center to Advance Palliative Care.<\/p>\n

Cognitive behavioral therapy can help older adults with fatigue learn how to adjust expectations and address intrusive thoughts such as, \u201cI should be able to do more.\u201d At the University of Texas MD Anderson Cancer Center, management plans for older patients with fatigue typically include strategies to address physical activity, sleep health, nutrition, emotional health, and support from family and friends.<\/p>\n

\u201cSo much of fatigue management is about forming new habits,\u201d said Dr. Ishwaria Subbiah, a palliative care and integrative medicine physician at MD Anderson. \u201cIt\u2019s important to recognize that this doesn\u2019t happen right away: It takes time.\u201d<\/p>\n

We\u2019re eager to hear from readers about questions you\u2019d like answered, problems you\u2019ve been having with your care, and advice you need in dealing with the health care system. Visit\u00a0khn.org\/columnists<\/a>\u00a0to submit your requests or tips.<\/em><\/p>\n