Weakness and fatigue
Please be aware - this information is for healthcare professionals
Many people living with a terminal illness experience weakness and fatigue, throughout their illness and towards the end of their life. It is important to recognise the importance of these symptoms and not dismiss them.
Fatigue is an overwhelming feeling of tiredness that isn’t resolved by sleeping. While weakness may be helped by resting, increasing intake of foods and fluids and interventions such as blood transfusions, fatigue may not be managed as easily.
Signs of fatigue may include:
- sleeping problems
- lack of motivation
- feeling drained
- unable to concentrate
- feeling of heavy arms and legs
- difficulty completing simple tasks eg washing, dressing
Why is the patient so fatigued?
It isn’t always possible to know the exact reasons behind weakness and fatigue. Sometimes they can be side effects of particular treatments, such as chemotherapy and radiotherapy.
Fatigue can be the result of condition or illness-related weight loss (cachexia), or weight gain. Anxiety and depression can also play a part. Some people may feel frustrated by these symptoms.
Is there anything that I can do to make things better?
There are some simple things you could suggest that may help. The patient’s sleeping pattern might be disturbed, so you could suggest sleeping or resting during the day, rather than only sleeping at night time.
Some people may be having a lot of visitors at this time. This may be physically and emotionally draining, so you may wish to discuss this, sensitively, with the patient and the people responsible for their care.
Gentle exercise can encourage strength and appetite. Sometimes the more exercise a person does, the more they feel they want to do. The community or specialist physiotherapist might have some ideas or suggestions of gentle regimes that the patient could try. An occupational therapist could also advise on this.
Mental stimulation can be useful too, such as attending a day centre, trying art and music therapy or working on puzzles like crosswords or Sudoku. Visiting a day centre can also provide the opportunity to share experiences with others. While going out will be tiring in itself, the sense of achievement may help to stimulate further activity at home. Working on things like a memory box with family members may help mental stimulation.
A well-balanced diet including plenty of fluids and energy-giving foods may also help build energy levels. The patient may have a reduced appetite, so a higher calorific intake could help to boost their energy levels. There are specific food supplements available over the counter and with a prescription that can increase calorie and nutrient intake.
Eating little and often can help when normal-sized meals feel too much to cope with. Some family members may want to give the patient a lot of food to build their strength, and you should take time to explain to them why using a smaller plate can be helpful.
There may be certain food odours that make the person feel nauseous so it is worth exploring with them what they would like to eat.
You may also want to talk to them about where they eat. For example, sitting at a dinner table can be tiring, especially if it is a social environment (though keep in mind that eating meals in bed may not be beneficial, as this may increase feelings of isolation).
Our page on hydration and nutrition has more information.
Is there any medication that can help?
Occasionally, the GP or specialist nurse may suggest a short burst of steroid therapy to improve the patient’s appetite and energy levels. But the effects won’t last long, and there is a limit to how often this can be used.
There are also some side effects from using steroids such as steroid-induced diabetes, low bone density and weight gain. Some hormonal drugs such as prednisolone are occasionally prescribed, although the benefits are clinically disputed. It isn’t the right course of action for everyone, so it’s good to discuss it with the appropriate professional before mentioning it to the patient and their family.
Who else should I talk to?
- The specialist palliative care team.
- The patient’s GP.
- A district nurse.
Points to remember
- Weakness and fatigue are common symptoms at the end of life.
- It is important to recognise tiredness and fatigue as real problems and not to dismiss them.
- Anxiety and depression may be a factor.
- A high-calorie diet, gentle exercise and mental stimulation may help.
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