Fatigue in older people

As people get older, medical conditions that are commonly associated with fatigue become more prevalentAustralian Institute of Health and Welfare (AIHW), 2021Royal Australian College of General Practitioners (RACGP), 2019. In addition, the likelihood of concurrent medical conditions is greater, meaning that more than one underlying condition should be considered. More detailed clinical assessments are often needed, with consideration of a wider range of conditions. For a guide to the prevalence of conditions associated with fatigue in older adults, see A guide to the prevalence of conditions associated with fatigue in children and adolescents. For general information on the diagnostic process for fatigue, see Fatigue: diagnostic process.

Older people may under-report fatigue thinking it is due to normal aging. Fatigue and related symptoms require detailed evaluation of their particular meaning to that person. When information from older patients might be inaccurate or incomplete, permission to obtain collateral information from others, including family and carers, should be sought. Serious medical conditions are more likely to present with undifferentiated symptoms in older patients.

Note: Always consider serious medical conditions in older people with fatigue.

Special consideration should be given to excluding common and treatable conditions that are associated with fatigue in older people, including anaemia, polymyalgia rheumatica, diabetes, heart failure, hypothyroidism and chronic obstructive pulmonary disease. This might mean additional clinical evaluation and investigations, even if classic symptoms are not found on history and examination; for example, heart failure may present with fatigue, but not dyspnoea, in an older person.

Ask about sleep quality and habits, as sleep disturbances or difficulties are common in older people; for advice, see Insomnia in older people.

Assess nutritional status (see Malnutrition) and ask about eating habits and usual level of activity. Assess for polypharmacyPage, 2019, deconditioning and frailty, which are common in older people and associated with poor outcomes (eg hospitalisation, disease, mortality). Deconditioning and frailty can present with fatigue as a prominent symptom. Fatigue can also contribute to further physical decline, falls and immobility in older people, so treatable causes need to be identified earlyKnoop, 2021.

In older people, loss of motivation may be interpreted or described as fatigue. This warrants investigation, as loss of motivation can be an early feature of dementia or depression in older people.