Fatigue and Anaemia in Older Adults

What do we mean by tiredness?

Ask your parent to describe it: - Fatigue: a lack of energy, heaviness, exhaustion not relieved by rest. - Sleepiness: tendency to doze off; points to sleep disorders, sedating medicines or other causes; see sleep apnoea in older adults: signs and next steps and insomnia in older adults: sleep hygiene and when to get help. - Muscle weakness: difficulty lifting, standing or climbing; see sarcopenia: muscle loss, protein and strength. - Breathlessness on effort: points to the heart, lungs or anaemia. - Low mood and loss of interest: may look like tiredness; see depression in older adults.

Anaemia: the most common fixable cause

Anaemia means too little haemoglobin, the protein in red cells that carries oxygen. Lower oxygen delivery causes fatigue, weakness, breathlessness, pale skin, a fast heartbeat, dizziness, headache, cold hands and feet, poor concentration and, in people with heart disease, chest pain. In older adults, it is often caused by iron deficiency (frequently from slow bleeding in the gut), vitamin B12 or folate deficiency, long-term illness or inflammation, and kidney disease. The cause must be found. Taking iron without a diagnosis may not help and may delay detection of bleeding or other serious problems. For the full picture of causes, tests and treatment, see iron and anaemia in older adults and vitamin B12 in older vegetarians.

Other common causes of fatigue

• Thyroid disease, under- or overactive; see thyroid problems in older adults.
• Diabetes, high or low sugar; see diabetes after 60: a home care guide.
• Heart failure, heart rhythm problems, coronary disease: fatigue and breathlessness may be early signs; see heart failure at home: daily checks and warning signs.
• Lung disease: COPD, low oxygen; see COPD at home guide.
• Kidney or liver disease.
• Infections: urinary, chest, tooth, tuberculosis; fatigue may be the only sign in older people; see fever in older adults: why it can be subtle and when to call and slow recovery after infection in older adults.
• Medicines: many cause drowsiness, slow heart rate, low blood pressure or low sugar; a medicine review is essential; do not stop any medicine yourself; see polypharmacy and deprescribing: taking fewer, better medicines and medicine side effects families should watch for.
• Poor nutrition, low protein or calories; vitamin D deficiency; see malnutrition in older adults: signs and prevention and vitamin D deficiency in India.
• Dehydration and electrolyte problems; see hydration for older adults: how much and how to remember.
• Poor sleep, sleep apnoea, restless legs, pain at night; see restless legs and night cramps in older adults.
• Depression, anxiety, loneliness, grief; see grief and bereavement in later life.
• Chronic pain; see chronic pain in older adults: a whole-person approach.
• Cancer, which may cause fatigue, weight loss and anaemia.
• Inactivity and deconditioning, after illness or bed rest.
• Alcohol; see alcohol and medicines in older adults.
• Hearing and vision problems, which make daily life more tiring; see hearing loss and isolation in later life.
• Frailty, where fatigue is a central feature; see frailty in older adults: what it means and what helps.

What the doctor will do

Expect questions about the pattern and duration of tiredness, sleep, appetite, weight, bowel habits (black stools?), bleeding, breathlessness, mood, medicines, alcohol and other symptoms, followed by an examination and tests, which commonly include:

• Blood count (haemoglobin and red cell size), iron studies, B12 and folate.
• Thyroid, blood sugar, kidney and liver tests, calcium, vitamin D.
• Markers of inflammation or infection; urine test; sometimes chest X-ray.
• Electrocardiogram, and further heart or lung tests if needed.
• Tests for bleeding in the gut, if anaemia suggests it.
• Screening for depression and cognitive problems.
• Sleep assessment.

A comprehensive geriatric assessment brings these together for complex cases; see comprehensive geriatric assessment explained.

What families can track at home

A short diary for one to two weeks helps the doctor:

• Energy: a daily score from 0 to 10, and the times of day when it is best and worst.
• Sleep: hours, night waking, daytime naps, snoring.
• Food and fluids, weight weekly; see weighing scales and unplanned weight loss in older adults.
• Pulse and blood pressure, lying and standing if dizzy; see how to measure blood pressure at home accurately.
• Oxygen saturation if breathlessness is present or the doctor advises, remembering its limits; see pulse oximeters: how they work and how to use one.
• Temperature if unwell.
• Bowel movements, stool colour, any bleeding.
• Mood, interest, activity, falls, confusion.
• Medicines taken, with times.
• Triggers and relief: exertion, meals, heat, time of day.

Home strategies for energy

### Pace the day

• Plan the day around the best hours, doing important tasks when energy is highest, often morning.
• Break tasks into steps with rests; sit for washing, cooking and dressing; use a shower chair; see bathing safely with a shower chair.
• Prioritise: do what matters; let go of what does not.
• Short rests rather than long naps; limit daytime naps to about thirty minutes in the early afternoon to protect night sleep.
• Avoid "boom and bust": overdoing it on a good day often leads to days of exhaustion.

### Move a little every day

Gentle, regular movement builds energy and strength, although it may feel counterintuitive. Start very small: a few minutes of walking, chair exercises and stretching, increasing slowly; see chair exercises for seniors and walking programme for older adults. A pedal exerciser can help those with limited mobility; see pedal exerciser guide. Stop for chest pain, severe breathlessness, dizziness or palpitations and tell the doctor.

### Eat and drink well

• Regular meals with protein at each; see how much protein do older adults need and high-protein Indian meals for seniors.
• Iron-rich, B12-rich and vitamin C-rich foods as part of a balanced diet; see iron and anaemia in older adults.
• Enough fluids.
• Small, frequent meals if appetite is poor; see loss of appetite in older adults: causes and practical fixes.
• Limit excess sugar, caffeine late in the day and alcohol.
• Supplements only if the doctor finds a need; a multivitamin is not an answer to fatigue; see multivitamins for older adults: helpful or wasteful? and supplements and medicine interactions: a safety guide. Do not take iron tonics or "energy" products without a diagnosis.

### Sleep

Keep a regular routine, get morning daylight, limit evening screens, caffeine and heavy meals, keep the bedroom cool and dark, and treat pain and night-time urination; see insomnia in older adults: sleep hygiene and when to get help. Report loud snoring and pauses in breathing.

### Mood and connection

Stay in touch with people, keep pleasant routines and interests, and seek help for low mood. Fatigue and depression often go together and each worsens the other.

When to see a doctor, and when it is an emergency

See a doctor within days for fatigue that is new, worsening or lasts more than two weeks, especially with weight loss, loss of appetite, pallor, breathlessness, swelling, fever, night sweats, black stools, bleeding, falls, new confusion or low mood.

Call 112 or go to hospital at once for chest pain or pressure, severe breathlessness, fainting, a very fast or very slow pulse with dizziness, vomiting blood or black tarry stools with weakness, stroke signs (face droop, weakness, speech difficulty), severe confusion or drowsiness, or collapse.

When to ask a professional

Ask the doctor for a thorough assessment of persistent fatigue, including blood tests and a medicine review. Ask a dietician for a nutrition plan, a physiotherapist for a graded exercise programme, and a counsellor or psychiatrist if mood is low. Ask an occupational therapist for energy-saving strategies. Seek urgent help for the emergency signs above.