How can I keep my energy up as I age?

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Q: As I grow older, I feel like I’m more often tired and needing more naps. How can I keep my energy up?

A: Feeling constantly exhausted is not normal, regardless of your age. It’s a myth that as we age, fatigue becomes par for the course, though it is a common symptom: One study found that 29 percent of 70-year-olds and 68 percent of 85-year-olds experienced fatigue. In one study, among older adults, low energy was more often cited as the reason it’s hard to get out of bed than even chronic joint or back pain.

Fatigue may not bode well. A study of almost 1,000 adults, age 75, living in Norway and Finland, found that those who reported feeling tired in their daily activities had more than twice the odds of becoming disabled within the next five years than those who did not. People who experience fatigue are also more likely to experience loneliness and have higher mortality rates.

Talk through your symptoms of low energy with your physician, who can help tease out the nuances, which may lead to a specific diagnosis. For example, are you feeling more physically depleted, inert or sleepy? What baseline are you comparing your current symptoms to? Such questions are an important part of the initial evaluation with someone who knows your full medical history.

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Ways to boost energy for older adults

Our energy level is determined by many factors, and we can increase it in different ways.

Add more protein to your diet and cut down on ultra-processed foods and snacks. Issues with nutrition can be a big part of why we feel fatigued. Some of it is directly related to the foods we’re eating. A balanced diet for older adults should include about 0.6 g of protein per pound of body weight (a 150-pound person should aim for 90 grams of protein daily). Foods that drag us down include refined carbs and ultra-processed foods that may offer short bursts of energy but leave us feeling sluggish and unfulfilled. But there can also be problems with appetite and swallowing, commonly related to diminished saliva production (which affects one-third of older adults) or dental issues.

Take care of your oral health. Would it surprise you to learn that having fewer teeth predicts fatigue in older age? Tooth loss often results from oral infections related to poor oral health. Studies have found unhealthy dietary choices, such as eating fewer fruits and vegetables that are harder to chew, go hand-in-hand with tooth loss and increasing age.

Start strength training. Decreased muscle mass contributes significantly to why older adults feel fatigued. As early as in our 40s, we lose muscle mass, also known as sarcopenia, which can diminish our stamina. I advise patients to check their grip strength as an indicator of overall muscle quality and work on weightlifting.

We don’t have to bulk up like Arnold Schwarzenegger, but we can build muscle well into our 80s and 90s. It’s never too early or too late to start incorporating weights into our exercise routines. Studies have found that resistance training can improve older adults’ independence in daily activities and enhance energy. One old but good randomized controlled trial published in the New England Journal of Medicine in 1994 found that high-intensity resistance training was “feasible and effective” in reducing physical frailty among nursing home residents whose average age was 87.

Check for underlying diseases such as anemia. A randomized controlled trial published last year on the effect of low-dose aspirin and anemia among older adults had an unexpected finding: About 1 in 5 older adults who didn’t get aspirin and were just on a placebo developed anemia within five years of enrolling in the study. This means many older adults are at risk of experiencing low red blood cell counts over time, which can cause significant fatigue unless addressed. Besides anemia, hypothyroidism can make people feel constantly tired. As we age, hypothyroidism steadily becomes more common, especially among women. It affects less than 2 percent of people in their 20s but more than 10 percent of people in their 70s and 80s.

Other diseases associated with fatigue and older age include Parkinson’s disease, heart failure, kidney disease and cancer. Chat with your physician about your symptoms in depth and decide if you should pursue more testing.

Change your sleep patterns and bedroom temperature. As many as 50 percent of older Americans experience insomnia and other sleep disorders. Our circadian rhythm tends to shift with age, telling us to sleep and rise earlier in the day. While older adults still need to aim for 7 to 8 hours a night, according to the National Sleep Foundation, give yourself permission to nap. A systematic review from 2022 found that indulging in a little daytime siesta didn’t compromise how long older adults slept at night but did improve daytime fatigue. The American Geriatrics Society does not recommend many sleep aids, especially for older adults, who are more sensitive to medications such as Ambien or Lunesta, because they may increase drowsiness to the point of raising the risk of car accidents, falls and other dangers.

How do you set your thermostat or room fans? Some evidence suggests that older Americans sleep best between 70 and 74 degrees Fahrenheit, which is especially important during the summer months. There are also several disorders such as sleep apnea that can contribute to fatigue symptoms and are worth exploring with your physician.

Rethink your medications. At your next primary-care visit, talk about your medications and whether they are all necessary in the doses you’re taking them. Many common prescriptions – from blood pressure medications to anti-depressants – can zap our energy levels. Furthermore, too many medications in general interacting with each other is also correlated with fatigue.

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What I want my patients to know

There are so many voices telling us that aging means slowing down. If we internalize those messages, we can mistakenly normalize the idea that feeling constantly fatigued is a part of that process. One important masquerader of fatigue that often gets discussed, and for good reason, is depression. Depression can lead to feelings of boredom, difficulty sleeping and exhaustion. If you’re experiencing these symptoms, talk to someone you trust, such as a health-care provider or family member, about how to get the help you need.