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.
Initially, Johnson, now 77, thought she was depressed. She could barely summon the energy to get dressed in the morning. Some days, she couldnât get out of bed.
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 didnât do much during the day.
âPeople would tell me, âYou know, youâre getting old.â And that wasnât helpful at all. Because then you feel thereâs nothing you can do mentally or physically to deal with this,â she told me.
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. Itâs one of the most common symptoms associated with chronic illness, affecting 40% to 74% of older people living with these conditions, according to a by researchers at the University of Massachusetts.
This is more than exhaustion after an extremely busy day or a night of poor sleep. Itâs a persistent whole-body feeling of having no energy, even with minimal or no exertion. âI feel like I have a drained battery pretty much all of the time,â wrote a user named Renee in a Facebook group for people with polycythemia vera, a rare blood cancer. âItâs sort of like being a wrung-out dish rag.â
Fatigue doesnât represent âa day when youâre tired; itâs a couple of weeks or a couple of months when youâre tired,â said Dr. Kurt Kroenke, a research scientist at the Regenstrief Institute in Indianapolis, which specializes in medical research, and a professor at Indiana Universityâs School of Medicine.
When he and colleagues at a large primary care clinic in Indianapolis about bothersome symptoms, 55% listed fatigue â second only to musculoskeletal pain (65%) and more than back pain (45%) and shortness of breath (41%).
Separately, a in the Journal of the American Geriatrics Society estimated that 31% of people 51 and older reported being fatigued in the past week.
The impact can be profound. Fatigue is the leading reason for restricted activity in people 70 and older, according to a by researchers at Yale. Other studies have linked fatigue with , , and .
What often happens is older adults with fatigue stop being active and become deconditioned, which leads to muscle loss and weakness, which heightens fatigue. âIt becomes a vicious cycle that contributes to things like depression, which can make you more fatigued,â said Dr. Jean Kutner, a professor of medicine and chief medical officer at the University of Colorado Hospital.
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, sheâd get up and wash her face. The next, sheâd take a shower. Another day, sheâd go to the grocery store. After each activity, sheâd rest.
In the three years since her cancer came back, Johnsonâs fatigue has been constant. But âIâm functioning better,â she told me, because sheâs 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.
When should older adults be concerned about fatigue? âIf someone has been doing OK but is now feeling fatigued all the time, itâs important to get an evaluation,â 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.
âFatigue is an alarm signal that something is wrong with the body but itâs rarely one thing. Usually, several things need to be addressed,â said Dr. Ardeshir Hashmi, section chief of the Center for Geriatric Medicine at the Cleveland Clinic.
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 youâre taking be contributing to fatigue?
âThe medications and doses may be the same, but your bodyâs ability to metabolize those medications and clear them from your system may have changed,â Hashmi said, noting that such changes in the bodyâs metabolic activity are common as people become older.
Many potential contributors to fatigue can be addressed. But , reasons for fatigue canât be explained by an underlying medical condition.
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 didnât help.
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 â a chest X-ray and CT scan, blood work, a cardiac stress test â showed abnormalities.
âThere was no objective evidence of illness, and that makes it hard for anybody to believe youâre sick,â she told me.
Goodell started visiting long covid web sites and chat rooms for people with chronic fatigue syndrome. Today, sheâs 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, the Centers for Disease Control and Prevention.
There are several strategies for dealing with persistent fatigue. In cancer patients, âthe best evidence favors physical activity such as tai chi, yoga, walking, or low-impact exercises,â said Dr. Christian Sinclair, an associate professor of palliative medicine at the University of Kansas Health System. The goal is to âgradually stretch patientsâ stamina,â he said.
With long covid, however, doing too much too soon can backfire by causing â.â Pacing oneâs activities is often recommended: doing only whatâs most important, when oneâs energy level is highest, and resting afterward. âYou learn how to set realistic goals,â said Dr. Andrew Esch, senior education advisor at the Center to Advance Palliative Care.
Cognitive behavioral therapy can help older adults with fatigue learn how to adjust expectations and address intrusive thoughts such as, âI should be able to do more.â 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.
âSo much of fatigue management is about forming new habits,â said Dr. Ishwaria Subbiah, a palliative care and integrative medicine physician at MD Anderson. âItâs important to recognize that this doesnât happen right away: It takes time.â
Weâre eager to hear from readers about questions youâd like answered, problems youâve been having with your care, and advice you need in dealing with the health care system. Visit  to submit your requests or tips.