Weakness and fatigue are very common near the end of life. It’s still important to do as much for yourself as you can, but make sure you find time to rest.
- Fatigue is a feeling of extreme tiredness and lack of energy.
- There are multiple factors that can contribute to the experience of fatigue near the end of life.
- If you have a medical condition or any obvious causes of fatigue are found, treatment will focus on the condition or cause.
- There are several things you can do to help you manage weakness and fatigue.
What are the causes of weakness and fatigue?
The causes of weakness and fatigue near the end of life are not always known. Often there are multiple causes. Common causes include:
- medicines such as opioids, benzodiazepines or tricyclic antidepressants
- sleep disturbances
- symptoms due to illness such as pain, nausea and vomiting or constipation
- treatment such as radiotherapy, chemotherapy or surgery
- metabolic disturbances such as high blood calcium, high blood sugar, low potassium, high sodium, low magnesium, low blood count (anaemia), renal failure, liver failure and dehydration
- poor nutrition
- emotional causes such as depression, anxiety, stress
- weight loss due to illness (cachexia) or loss of appetite
- other accompanying illnesses such as cancer, heart disease, liver disease, thyroid disease and motor neurone disease.
What are the symptoms of weakness and fatigue?
It is quite common to feel tired and weak when you require palliative care. Other symptoms can include:
- low energy
- poor concentration and motivation
- muscle weakness
- requiring help from others to move
- poor or disturbed sleep
- difficulty carrying out daily activities such as cooking, washing and dressing
- feeling irritable and lacking confidence
- poor short-term memory
- feeling depressed and anxious.
See your doctor if you experience any of these symptoms.
How is weakness and fatigue diagnosed?
Your doctor may ask you some questions to find out the possible causes of your fatigue. You may need to complete a fatigue diary to monitor the timing of your tiredness and how it is affecting your daily life.
Your doctor may also do a physical examination and carry out tests, such as blood and urine tests, to better understand what is causing your symptoms.
How is weakness and fatigue treated?
If the fatigue relates to your medical condition or the related causes listed above, treatment will focus on the condition or cause. If there is no medical cause, treatment will focus on self-care. Talking therapy (counselling) may be useful if you are feeling anxious or depressed.
How can I care for myself with weakness and fatigue?
- Use your energy for the things you enjoy – accept help with less important activities such as household chores.
- You may need to move things around your house so you don’t have to walk so far between the areas of the house you use the most.
- Talk with your care team about services and equipment available to support your daily activities.
Read more about self-care for tiredness and fatigue.
What support is available with weakness and fatigue?
People often feel guilty about not being able to carry out as many tasks as they used to. It can be frustrating and distressing, especially when you need help from people most of the time. Talk through your feelings with your family and friends to get the support you need. If you need extra help with daily activities such as washing, dressing or cooking, your doctor may be able to arrange this for you.
Below are some support services and information for people affected by cancer and their family/whānau:
Emotions & cancer Cancer Society of NZ
How we can help Cancer Society of NZ
NZ cancer services - find a hospital/service near you Healthpoint
More cancer support groups
The following links provide further information about weakness and fatigue in palliative care. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Weakness & tiredness in palliative care HealthInfo Canterbury, NZ
Managing fatigue in palliative care HammondCare, Australia
Fatigue Marie Curie, UK
Managing the symptoms of cancer Macmillan Cancer Support, UK
|Dr Karen Chung is a GP. She works for Counties Medical and the Auckland Regional Public Health Service. She is also a clinical editor at Auckland Regional HealthPathways and has worked on the palliative care pathways.|