September 29, 2023
“I’m tired,” is a common refrain for most adults, no matter their age. But fatigue is more than a couple of bad nights of sleep. It encompasses mental dullness, emotional exhaustion and physical tiredness. All of these are important indicators of your health for medical professionals.
In fact, studies show that fatigue is actually an important predictor of mortality in older adults. There are many reasons for this. Fatigue can be an indicator of an underlying illness. It can also be the first domino in a series of events that reduce quality of life. For example, when you’re tired, you move less. The less you move, the less healthy you are physically and the less you get out of the house to interact socially – impacting your mental and emotional well-being.
“I look at fatigue much like I look at a blood pressure, heart rate, respiratory rate and oxygen saturation – it’s a vital sign. It really is a way for us to tell if your whole body is working together to pull off the normal things that you want to do every day,” says Christian Sinclair, MD, hospice and palliative care specialist at the health system.
Feeling tired all the time is not normal, and it can be treated with help from your doctor.
Nonspecific but very important
Jessica Kalender-Rich, MD, geriatric specialist at the health system, says fatigue can be an overly general symptom that could lead to many different diagnoses. Doctors ask follow-up questions to determine the kind of fatigue you’re experiencing and its severity. For some people, only being able to walk a mile may be a sign of fatigue. For others, it might be an inability to get off the couch and accomplish daily tasks.
“People may feel very strong,” says Dr. Sinclair. “We may do grip strength tests and their muscles are pretty good. But it is more about that emotional component, that their brain is fatigued. And that's a slightly different version of fatigue.”
There are many things that may cause fatigue, including:
- Cancer
- Chronic illnesses, including autoimmune disease
- Infection
- Medication side effects
- Psychological conditions
Measuring fatigue
Because everyone has a different frame of reference for their own tiredness, and varied expectations for their physical ability and emotional well-being, doctors need a consistent way to measure fatigue. Dr. Kalender-Rich mentioned she uses the phenotypic scale for fragility.
“It's really about how the person feels, and how they look,” she says. “It’s less about linking the number of diagnoses and labs and scientific pieces that can be pulled from the electronic health record.”
The number 1 question on the scale is: Do you feel fatigued most of the time? If the answer is “yes,” Dr. Kalender-Rich says that is a red flag.
“Movement is medicine,” she says. “So the more tired we are, the less we move. The less we move, the more likely we are to get weaker and develop sarcopenia, or some deterioration of the muscles, which then leads to falls and then leads to less movement. And it creates this whole cycle in which frailty just continues to blossom and grow.”
What to do about fatigue
If you are feeling tired most of the time, you should see your primary care doctor. If you are experiencing fatigue and other symptoms, like weight loss, falls, fevers or night sweats, they may look at your hormone levels, vitamin levels or run other tests. That analysis could determine there is an underlying illness that needs to be treated.
In some cases, fatigue may be treated in the short term with medications like dexamethasone or steroids.
“They're meant for very short periods and very specific circumstances related to disease and to treatment,” says Dr. Sinclair.
No matter the cause, occupational therapists can help you learn how to manage and decrease fatigue.
“They can give people tips and tricks about how to maintain the energy that they have to do the things that are very important to them,” says Dr. Kalender-Rich.
Most of all, it’s important to set small, achievable goals that energize you physically, mentally and emotionally.
“My recommendation tends to be: Go on a walk with your friends,” says Dr. Kalender-Rich. “You are together, but you also are getting out and moving your body. Community is important because it helps keep us going.”
Your care team can make specific recommendations to address your fatigue. Many visits can be self-scheduled through MyChart. Don’t have a MyChart account? Sign up now to create one or call 913-588-1227 to schedule an appointment.