Fatigue in palliative care

Fatigue can be one of the most difficult symptoms to cope with if you’re living with a serious health condition.

Fatigue is an overwhelming feeling of total exhaustion. Unlike tiredness, it doesn’t get better with rest and sleep. It’s sometimes difficult for family and friends to understand this.

There’s no specific treatment for fatigue, but advice and support can help you manage it. This can help to reduce the impact of fatigue on your day-to-day life.

What causes fatigue?

Fatigue can be due to a combination of factors.

Illness and treatment

If you’re living with a serious health condition, changes may be happening in the way your body works. This can mean your body uses more energy which can cause fatigue.

Symptoms like pain or shortness of breath may also make fatigue worse. This means it’s important for these to be managed well.

Other changes due to illness can mean everyday things take more effort. For example, some people may lose weight. Other people can put on weight due to medication or a build up of fluid.

If you have a poor appetite or nausea you’ll find eating and drinking harder. This means you may be getting less energy than usual from food and drinks. This can make fatigue worse.

Medications, surgery or other treatments for your health conditions can add to fatigue.

Mental wellbeing

Fatigue affects your wellbeing and changes in your mental health can worsen fatigue. For example:

• feeling stressed and worried uses up a lot of energy
• low mood can make you feel tired
• not sleeping well adds to fatigue

Get more advice on looking after your mental wellbeing

How to manage fatigue

Fatigue is part of many serious health conditions. There are some things that might help you.

Keep active

Physical activity like gentle exercises and walking can help if you’re living with fatigue. It may boost your appetite and give you more energy. It can also improve your general wellbeing.

If you’re able to do some physical activities, build up the amount you do very slowly. You could start with something simple like walking around your home or do short distances outside.

Try an activity that you enjoy and do it regularly if you can. You may feel more tired at times and need to rest but some activity each day is better than none.

Ask your doctor, nurse or another health professional if you’re not sure what activities might work for you. They can also give you advice on how to increase the amount you do.

Pace yourself

Using the energy you have as well as possible can help you to do more of the things that are important to you.

Knowing your limitations, doing what matters most to you and planning ahead can all help too.

You can try to:

• decide what needs to be done – think about whether some things could wait until another time or if someone else could do them
• spread out light and heavy tasks throughout the day – do things in stages rather than all together
• avoid doing lots of activities in a short space of time
• remember to stop when you feel tired
• keep a notepad handy to write things down and use it to jog your memory – for example, appointments or plans
• plan separate visits from family or friends if you can – it can be exhausting if they all come at once

Ask for support

Whether you’re the person with fatigue or you’re supporting someone with fatigue, talking about how you feel can be helpful.

If you need help with things at home or more generally, you may be able to ask family, friends and neighbours.

If you look like you’re coping well, your family and friends may not realise how much you need help. They may be waiting for you to ask for help.

Speak to your doctor, nurse or another member of your care team if you have questions about fatigue. They may arrange an assessment by an occupational therapist to help support you at home.

Managing fatigue day-to-day

There may be things you can do to help with your fatigue.

Household tasks

Fatigue has an impact on many day-to-day activities like housework and shopping. But, there are some things that can help.

You could:

• ask other people to help you with heavier work like hoovering, taking the rubbish out or gardening
• sit down to do some tasks – a perching stool may be helpful
• use long-handled dusters, mops and dustpans to avoid stretching and bending
• make a list before shopping
• find easier ways to carry your shopping, or order online

Eating and drinking

It can be difficult to cook meals when you’re feeling tired most of the time. You may not have an appetite either. There are many things you can try to help with this.

Get advice on eating and drinking in palliative care

Washing and dressing

Having a bath or shower can be tiring so remember to take your time and pace yourself. This may mean changing your normal routine.

You could:

• wear a towelling dressing gown after a shower or bath – this uses less energy than drying yourself with a towel
• wear loose clothes that are easy to put on and take off
• have your clothes ready to put on after washing
• sit down to get washed and dressed

An occupational therapist can help you work out the easiest way to have a bath or shower. Equipment like a bath seat may also be suitable for you.

It may also be helpful to have a carer coming in to support you.

Driving

Driving can be difficult, and even dangerous, if you feel very tired. You may be less alert than normal and less able to concentrate. Your reaction time will also be reduced.

It may help to:

• ask a friend or family member to drive you, if possible
• ask your doctor or nurse if hospital transport is available if you need to get to appointments
• plan trips when you know you’re usually feeling better
• avoid driving at times when roads are busy
• plan regular stops or an overnight stay if you need to make a long journey

You should not drive if you feel too tired to drive safely. If fatigue is making it hard for you to drive safely, you may need to stop driving.

If you’re taking medicines like strong painkillers, these can make you feel tired and affect your driving.

If you’re unsure whether you, or your relative, are safe to drive, discuss this with your GP.