Fatigue

Fatigue hits everyone at some time or another. It can be caused by stress, lack of sleep, poor diet, or too much work, among other things. In addition to those causes, patients who are receiving palliative care may have fatigue from the illness itself, side effects of the treatment or therapies, and/or trying to deal with all the issues surrounding the end-of-life stage. 

Why is Fatigue Such an Issue in Palliative Care? 

Fatigue can affect a patient both physically and psychologically. Physically, someone who is fatigued may not have the energy to physically participate in his or her own care, may be too tired to eat or drink, may avoid spending time with family and friends, and can easily become depressed. Interestingly, someone who is fatigued may have a very hard time sleeping, adding to the feeling of being tired. 

Managing Fatigue in the Palliative Care Setting 

Helping a patient who is feeling fatigued will depend on the cause. 

Medication side effects: 

If medication, such as analgesics for the pain, is causing the fatigue, the palliative care team may decide to: 

• Switch the medication 
• Change the dosage 
• Change the times the medication is given 

Therapy: 

If the patient is receiving therapy such as palliative radiotherapy and this is causing the fatigue, the healthcare team may want to re-evaluate if the therapy is worth the side effects. They may decide that it isn't and therefore either stop the treatment or adjust it. 

Lack of refreshing or restorative sleep: 

If someone isn't getting a good, proper rest, this could be helped by: 

• Prescribing sleep aids 
• Encouraging good sleep habits A
• djusting medications during the day that don't result in excessive napping 
• Minimize the number of disturbances to the patient throughout the night. 

Lack of physical exercise: 

While someone who is at the end-of-life stage will probably not be moveing around very much; sometimes, the simple acts of getting up in a chair to sit by a window, having a shower, or being brought outside can provide enough exercise to stimulate a good refreshing rest. 

Poor nutrition: 

Eating is often not a priority for someone who is at the end of life. He or she may have no appetite or may want to eat but may have lost the sense of taste. A lack of taste reduces the enjoyment that someone gets from eating or drinking favorite foods. 

To encourage adequate nutrition, a dietician may be able to suggest certain foods or drinks, in small amounts, that might appeal to someone who needs the nutrients but doesn't have the energy or will to eat. 

Depression: 

Many people who are depressed find themselves feeling very fatigued. It's not unusual for someone with depression to sleep the day away. The feeling of exhaustion is very physical although the cause may be psychological. Some people at the end-of-life stage do well with anti-depressants and/or with counseling. 

Anxiety: 

Anxiety can be a tiring state. Someone who is anxious is often in a heightened state, waiting for something bad to happen or fretting over what has happened. As with depression, some people at the end-of-life stage do well with anti-anxiety medications and/or with counseling.