Many chronic conditions can cause fatigue — but don’t overlook mental health concerns, iron level and hormones

No one expects you to have the same energy at 65 that you did at 20. But as an older adult, you shouldn’t be resigned to constantly feeling tired.

“Sure, it’s normal to tire more easily as you age,” says geriatric medicine specialist Ardeshir Hashmi, MD. “But that doesn’t mean you should always feel exhausted. If you’re so tired that you can’t complete everyday activities, it could be a sign of something more.”

As many as half of people ages 65 and older experience fatigue. Ignoring it is never a good idea.

Dr. Hashmi shares what older adults need to know about fatigue — and some surprising causes you shouldn’t overlook.

Fatigue vs. tiredness

Fatigue is a persistent, all-encompassing exhaustion, while tiredness is typically temporary. But Dr. Hashmi says the most significant difference is that fatigue worsens with time, making it harder and harder to do your activities.

“Even if you’re motivated to complete a task, your energy level and ability to sustain the activity tend to get less and less the longer you live with fatigue,” Dr. Hashmi explains. “You may not have enough ‘get up and go’ to do something. Or you may only be able to do it for a short while before having to stop and rest.”

This isn’t about feeling wiped out after a workout. We’re talking fatigue that makes it taxing to empty the dishwasher, go for a short walk or make your bed.

What causes fatigue in older adults?

Fatigue at any age can have many causes, including:

As you age, your risk for chronic conditions increases, and your risk of fatigue increases with it. Research shows that up to 74% of older adults in the U.S. who live with chronic disease experience fatigue.

Often, fatigue in older adults occurs alongside other symptoms. “Those other symptoms help us home in on the origin of your fatigue,” Dr. Hashmi shares. “They provide a drop-down menu that narrows the list of possible underlying causes.”

Often overlooked sources of fatigue in older people

Living with a chronic disease, such as cancer, Parkinson’s disease or rheumatoid arthritis, can cause fatigue. But other underlying conditions may also leave you feeling similarly exhausted. Knowing what’s at the root of your symptoms can help you find relief quicker.

Dr. Hashmi notes three health issues that often contribute to fatigue in older adults.

1. Anemia (low iron)

Anemia — when your red blood cell count is low — can happen after blood loss. But it can also be a problem if your body isn’t absorbing iron well. Or if you have another medical condition, like kidney disease. Anemia can leave you feeling weak and tired because your body isn’t getting oxygen-rich blood. Anemia caused by iron deficiency (low iron) is the most common type — and the most likely to cause fatigue.

“It’s critical to identify anemia when it happens so we can treat it. Fatigue is often the first sign of anemia,” Dr. Hashmi says.

People with anemia may have other subtle signs, including:

  • Constipation or changes in stool color
  • Darker-than-normal urine, especially if you’re also dehydrated
  • Heart palpitations, or feeling like your heart is racing
  • Postural dizziness, feeling lightheaded when you rise from a sitting position
  • Shortness of breath or discomfort while breathing

2. Hormonal issues

Age-related hormone changes can wreak havoc on your energy levels. The hormonal changes that most commonly cause fatigue include:

“Hormones control so much in your body,” Dr. Hashmi notes. “When your hormone levels are changing and unbalanced, it often leads to fatigue.”

3. Mental health condition

It’s normal to feel worn out when your mental health isn’t at its best. And fatigue can be a symptom of troubles like:

In older adults, depression may also lead to psychomotor slowing — a condition that makes your body and thoughts feel sluggish. It can mimic or worsen fatigue.

And even if you don’t feel sad, fatigue could be a sign of atypical depression, a form of depression that doesn’t cause low mood.

“Someone with atypical depression may not feel like crying all the time or even feel sad, but being tired all the time is a symptom,” Dr. Hashmi clarifies. “Talk to your provider if you find yourself sleeping and napping excessively.”

When to see a doctor for fatigue

Everyone gets tired occasionally, and you can expect to be tired more often as you age. It comes with the territory.

But how do you know when being tired means it’s time to see your doctor?

“As an older adult, you likely know your body and your routine and what you can typically handle,” Dr. Hashmi reinforces. “You may normally feel tired after a certain activity or point in the day. But contact your healthcare provider if you suddenly feel exhausted more often or if it impacts your ability to complete your daily tasks.”

How to prevent fatigue as you age

Preventive and proactive measures can be very effective for maintaining energy as you age. Dr. Hashmi recommends:

  • Exercise daily. Aerobic exercise doesn’t have to be intense, and you don’t have to do it for very long — even 10 minutes a day can make a difference.
  • Get enough protein. Protein is crucial for preserving muscle function and can help counter fatigue.
  • Eat antioxidant-rich foods. Antioxidants prevent inflammation and boost your immune system. Try berries, almonds, avocados and dark chocolate.

“Being intentional and consistent is key to keeping your energy levels up,” Dr. Hashmi advises. “And see your healthcare provider if you begin to feel fatigued.”

Fatigue isn’t something you just have to live with. Understanding what’s behind it — and getting the right support — can help you feel more like yourself again.