Most older people experience, at some time, some degree of fatigue. But most problems with fatigue are not physical weakness; they are related to failure to exercise, depression, unhappiness, worry, or boredom. True weakness, as with inability to move an arm or leg, is a physical problem involving nerves, brain, or muscle, and needs immediate medical attention. Fatigue or tiredness is far more common than true weakness.

Another common cause for fatigue is overuse of one drug or another. For example, excess caffeine intake leading to poor sleep habits can cause daytime fatigue. Or tranquilizers can make you feel tired or drowsy. Once the normal sleep cycle has been disturbed, there is a tendency to grab an afternoon nap. Then the following night's sleep is not good because the afternoon nap decreased the need for sleep at night. A vicious cycle has been set in motion.

You may be assuming from this discussion that most fatigue is not serious. That is correct. Even when arthritis is associated, most fatigue results from misunderstanding your body. Reestablishing a pattern of healthy activity, more moderate drug use, and good nocturnal sleep will do wonders.

But if you have an inflammatory arthritis, such as rheumatoid arthritis or lupus, the disease may be causing the fatigue. This is a more serious kind of fatigue, and improving your living patterns will not help much. In such cases the sedimentation rate is elevated and there may be a low-grade fever. A hematocrit test may show the anemia of chronic disease. There may be some weight loss. Treatment in these cases is directed at the disease causing the fatigue and may take some time.

When you mention fatigue, most people don't even think of the problems just described. Instead they think of a problem with the thyroid or anemia. These are so unusual as causes of fatigue that you can almost forget about them. But if your fatigue persists, for more than six weeks despite home treatment, your doctor might want to check out these and other possibilities or may be able to reassure you that these problems are not present.

The chronic fatigue syndrome is an unusual and troubling problem that requires consultation with a doctor. This syndrome lasts a long time, lacks really good treatment, may follow a viral infection, and frequently includes an emotional component, sometimes aggravated by the fatigue.

Fatigue is not a symptom of old age. In fact, as you get older you need less sleep and tend to be more alert, particularly early in the day. So pay attention to this symptom.

Listen to the fatigue message from your body. Heed it, but don't give in to it. Rest if you are tired, but alternate such periods with times of activity. Fatigue, because it can lead to physical de-conditioning, can become its own cause.

Decrease all possible drugs including caffeine, nicotine, alcohol, tranquilizers, and probably television. Ingredients in common cold or allergy medications can cause fatigue, as can Valium and codeine. Suspect all drugs.

Increase new activities. Friends, hobbies, travel, vacations, and even shopping tend to break the fatigue cycle. Increase your activity level by addition of smooth, graded, and easy exercises. Exercise helps you become involved in new and different things as well as giving physical help by increasing your stamina.

Expect improvement to be slow and expect to be discouraged at times. Persevere.