Why Does Fatigue Increase?
There are several possible explanations.
1. Reduced physical reserves
Advanced illness can make it increasingly difficult for the body to maintain normal activity.
The heart, lungs, kidneys, and other organs may not function as effectively as before. As a result, everyday activities can require considerably more effort.
2. Chronic inflammation
Some serious illnesses cause ongoing inflammation throughout the body.
This can contribute to fatigue, weakness, reduced appetite, and a general feeling of being unwell.
3. Anemia
Anemia occurs when the blood does not have enough healthy red blood cells or hemoglobin to carry oxygen effectively.
Older adults may develop anemia because of chronic disease, nutritional deficiencies, kidney problems, or blood loss.
Symptoms can include tiredness, weakness, dizziness, and breathlessness.
4. Medication effects
Some medications can cause drowsiness or reduced alertness.
Pain medicines, sedatives, certain allergy medicines, and other treatments may affect energy levels.
Medication combinations can also contribute to excessive sleepiness, especially in older adults.
5. Poor sleep quality
An older person may spend many hours in bed without receiving restorative sleep.
Pain, breathing difficulties, nighttime urination, anxiety, sleep apnea, and frequent awakenings can all contribute.
When Does Increased Sleep Become Concerning?
Occasional tiredness is common.
However, a significant and persistent change deserves attention, particularly when someone:
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Sleeps substantially more than usual.
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Becomes difficult to wake.
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Stops participating in familiar activities.
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Has difficulty staying awake during conversations.
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Develops new confusion or disorientation.
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Experiences increasing weakness.
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Shows a noticeable decline in daily functioning.
Sudden or severe drowsiness should not automatically be interpreted as a natural part of dying.
It may indicate dehydration, infection, low blood sugar, medication toxicity, stroke, or another urgent medical problem.
If an older person suddenly becomes difficult to wake, develops new severe confusion, or has difficulty breathing, seek emergency medical care.
How Families Can Help
Families should avoid forcing an exhausted older person to follow the same schedule they maintained when they were younger.
Instead, caregivers can:
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Allow adequate rest.
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Arrange activities during periods when the person has more energy.
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Provide comfortable seating and safe mobility assistance.
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Review medications with a healthcare professional.
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Monitor changes in alertness.
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Encourage gentle movement when medically appropriate.
The goal is to preserve comfort and independence for as long as possible.
Chapter 3: Sign Two β Reduced Appetite and Unintentional Weight Loss
Another change that may occur during advanced illness is a gradual reduction in appetite.
An older person who once enjoyed large meals may begin eating smaller portions. They may leave food untouched, lose interest in favorite dishes, or feel full after only a few bites.
Over time, this may lead to weight loss and reduced muscle mass.
For families, this can be particularly distressing.
Preparing meals is often one of the ways relatives express love and care. When an older parent or grandparent refuses food, family members may feel helpless or worry that they are not providing enough nourishment.
Understanding why appetite changes can help caregivers respond more effectively.
Why Does Appetite Decrease?
Several factors may contribute.
1. Changes in taste and smell
The ability to taste and smell can change with age.
Some older adults find food less flavorful than before. Others develop an unpleasant taste in their mouths or experience reduced enjoyment of eating.
2. Dental and swallowing problems
Poorly fitting dentures, tooth pain, dry mouth, and difficulty swallowing can make meals uncomfortable.
A person may avoid certain foods because chewing or swallowing has become difficult.
3. Digestive problems
Constipation, nausea, reflux, abdominal discomfort, and delayed stomach emptying can reduce appetite.
Some medications may also contribute to nausea or changes in bowel habits.
4. Depression and emotional distress
Loneliness, grief, anxiety, and depression can affect appetite.
An older person who has lost a spouse or become socially isolated may lose interest in cooking and eating.
5. Advanced disease
Some serious illnesses can change the body's metabolism and increase inflammation.
In advanced disease, appetite may decline even when food is available and meals are prepared carefully.
This can be part of a broader process known as disease-related wasting or cachexia, depending on the underlying condition.
Why Weight Loss Matters
Unintentional weight loss in an older adult should be investigated.
It can indicate nutritional problems, chronic disease, gastrointestinal disorders, cancer, depression, or other conditions.
Loss of muscle mass is especially concerning because it can reduce strength and increase the risk of falls.