Fatigue is a very common symptom in palliative care - nearly all people living with a life-limiting illness will have fatigue at some point. It can be very frustrating and upsetting for patients, and for the people around them, as they become less able to carry out their usual activities. But sometimes even small changes to daily routines can improve energy levels.

Fatigue is a term used to describe an overall feeling of tiredness or lack of energy. It isn’t the same as simply feeling drowsy or sleepy. When you’re fatigued, you have no motivation and no energy. Being sleepy may be a symptom of fatigue, but it’s not the same thing.

What is fatigue?

Fatigue is a persistent feeling of extreme tiredness, weakness or lack of energy. It’s different to normal tiredness as it’s not necessarily caused by doing lots of exercise or movement, and it’s not always relieved by rest.

Fatigue is a subjective feeling and patients will experience it in their own way.

Patients often describe fatigue as one of the most difficult symptoms to manage. Fatigue can affect all aspects of life and can cause:

  • extreme tiredness
  • feeling weak and heavy-limbed
  • difficulty sleeping or an altered sleep pattern
  • difficulty carrying out activities such as washing and dressing
  • difficulties with short-term memory
  • difficulty concentrating, which makes it hard to do activities such as reading, driving and socialising
  • difficulty making decisions
  • low mood
  • lack of motivation.

Having fatigue can mean that the patient is less able to do the activities that they enjoy. It can happen at unpredictable times. It can also affect relationships with those around them, as they might need more support.

Fatigue can trigger lots of emotions. Patients may feel guilty about not being able to do as much at work or at home as they used to. They may feel frustrated if they feel like they’re missing out on things, or angry if they can’t identify what’s causing their fatigue.

Managing fatigue

Fatigue is best managed by a multidisciplinary team of health and social care professionals. This may include the patient’s GP, district nurse, an occupational therapist, physiotherapist and a patient’s Nurse Specialist.

Often there is no quick fix for fatigue and the best way to manage it is to help make the most of the energy patient’s do have. The following tips may help:

  • Encourage the patient or their carers to keep a diary, to see when they have the most energy.
  • Plan the day ahead so that they can do activities when they have most energy.
  • Spread activities out across the day with enough rest in between − short naps during the day might be helpful.
  • Prioritise the activities that are most important to them.
  • Suggest sitting down to do tasks like preparing meals.
  • Encourage good sleep habits at night. For example, cut down on screen time before bed.

An occupational therapist can help with planning the best way to do activities and supply equipment such as walking aids.

It might be helpful to talk to the patient and anyone who supports them about who can take on extra duties at home so the patient doesn’t have so much to do. Some patients might feel like they need permission to ask for help, or feel guilty about not doing things themselves. If the patient is having lots of visitors, this may contribute to their fatigue. Let them know they can rearrange visits, or say no to visitors, if they want to.

Physical activity and diet

Regular physical activity enhances energy levels and can improve quality of sleep at night. Patients might need encouragement to try physical activity if they are feeling tired or have low motivation. A physiotherapist can recommend appropriate exercises for individual patients.

Fatigue can have an emotional and mental impact, as well as physical. Complementary therapies, like massage or meditation, may help with feelings of stress and tension and help to increase energy levels.

Having a well-balanced diet and plenty of fluids can improve energy levels. It might be easier to have small frequent meals rather than a few large meals.