A phenomenological study of fatigue experience in community-dwelling older adults

Abstract

Background

Fatigue has been reported to be one of the most common complaints among community-dwelling older adults. However, there is a lack of qualitative research on the experience of fatigue among community-dwelling older adults.

Objective

The aim of this study was to provide an in depth analysis of the fatigue experience of community-dwelling older adults through a phenomenological research approach in qualitative research.

Methods

Thirteen older adults with fatigue experiences were selected from the community using purposive sampling with snowball sampling. Data were collected through semi-structured interviews about participants' fatigue experiences. The interviews were analysed for qualitative content using the Colaizzi 7-step analysis.

Results

Four themes and 20 sub-themes were extracted from the fatigue experience of the elderly in the community: perception of fatigue (fatigue deprivation, fatigue is ignored, fatigue difficult to subside, and fatigue aggravation), psychology of fatigue (stress and anxiety, frustration and loss, self-reproach and helplessness, impatience and distraction, loneliness, aspirations and expectations), influence of fatigue (influence on independence, influence on motivation, influence on appetite, influence on household work, and influence on socialization), and coping with fatigue (negative coping and self-suffering, self-psychological guidance and maintaining optimism, lifestyle adjustments and physical adaptation, seeking external help and maintaining positive socialization).

Conclusion

This study tapped into the fatigue experience of community-dwelling older adults through a phenomenological research approach in qualitative research. It was found that fatigue is an important issue that cannot be ignored in the lives of community-dwelling older adults. And that fatigue influences the quality of life in old age from multiple dimensions, with older adults' perceptions of fatigue determining their attitudes toward fatigue management. The importance of fatigue in the family and society and the ability to guide older adults to cope with fatigue need to be improved. This finding suggests that researchers, community health workers, and healthcare professionals should pay more attention to fatigue among older adults. They need to provide timely and effective assessments and support to help older adults better manage fatigue. Thereby empowering them to maintain their functional ability and well-being, which are core to healthy aging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-026-07422-w.

Introduction

Fatigue is a common and complex subjective experience [1], which is often described as a subjective sensation of exhaustion, tiredness, numbness, heaviness, and debilitation [2, 3]. Both healthy individuals and those with medical conditions (e.g., cancer, cardiovascular disease, rheumatoid arthritis, etc.) may experience fatigue [1]. Similarly, fatigue is prevalent in the elderly population as they age and affects their quality of life to varying degrees. When considering fatigue in older adults, it is important to note that this population faces unique age-related physiological changes. These include, but are not limited to, a higher prevalence of chronic diseases, as well as potential declines in autonomic nervous system function [4] and hormonal alterations [5], all of which may underpin or exacerbate the experience of fatigue. Studies have shown that the global prevalence of fatigue in older adults ranges from approximately 15.3% to 31.2% [6, 7]. Despite its high prevalence and common symptomatic experience of many diseases, fatigue is often considered a secondary experience of disease or an inevitable consequence of aging [8], and thus fatigue in older adults is often overlooked by older adults themselves, community health care providers, researchers, and clinicians. However, fatigue has been reported to be a strong predictor of multiple adverse outcomes in older adults,including hospitalization, increased use of health care services, accidental disability, and death [6, 8, 9], and fatigue may predict functional decline in older adults [10].

At present, domestic and international studies on fatigue are mostly quantitative and focus on disease populations, and little is known about the experience of fatigue among community-dwelling older adults. Moreover, compared with quantitative research, qualitative research can reveal the subjective experience of fatigue and personal feelings of older adults in a more in-depth way, and can capture the hidden emotions and meanings behind the experience of fatigue. However, this rich, contextualized understanding is precisely what is missing from the current literature on community-dwelling older adults. Without such in-depth exploration, healthcare providers and family members may fail to grasp the full impact of fatigue on older adults' lives and thus cannot provide appropriate support. Therefore, to bridge this knowledge gap, this study analyzes the fatigue experience of older adults in the community through the phenomenological research method in qualitative research. Aiming to explore the real-world fatigue experiences of this group in order to generate the foundational knowledge necessary for developing targeted, culturally sensitive interventions. The ultimate objective is to empower older adults to better manage fatigue, thereby enhancing their quality of life and promoting healthy aging.

Information and methods

Research population

The maximum difference sampling method in purposive sampling combined with snowball sampling was used to select community-dwelling older adults in Shijiazhuang City as the study population. According to the maximum difference sampling strategy, we try to select participants with different general information, such as people of different ages and genders, different marital statuses and residential statuses, different cultural levels and different incomes from different occupations before retirement, and we also select community-dwelling older adults with different levels of fatigue to conduct interviews, in order to obtain the largest and most abundant amount of information. The sample size was based on the criterion that the data of the interviewees were repeated and no new themes emerged when the data were analyzed. Inclusion criteria: (1) community-dwelling; (2) age ≥ 60 years; (3) Chalder Fatigue Scale (CFQ) score ≥ 4; (4) informed consent and willingness to fully express their true feelings. Exclusion criteria: (1) those with acute exacerbation, terminal stage of disease or with serious complications; (2) those who were bedridden for a long time; (3) those who could not communicate effectively. The general information of the study subjects is shown in Table 1. Potential participants were recruited and interviewed in an iterative process alongside concurrent data analysis. Throughout this process, a number of individuals were excluded from participation prior to being formally enrolled and interviewed. Specifically, eleven individuals were excluded after being assessed against the inclusion and exclusion criteria. The reasons for exclusion were as follows: five did not meet the CFQ score threshold (CFQ < 4), three declined to participate due to personal reasons or time constraints, two were excluded due to the presence of serious complications, and one was unable to communicate effectively. Recruitment continued until data saturation was achieved, which was determined by the criterion that the data from the interviewees were repetitive and no new themes emerged during the analysis. This resulted in the final sample of thirteen participants.

Table 1.

The demographic characteristics of the study population

Evaluation tools

Chalder fatigue questionnaire(CFQ-11)

CFQ-11 is a widely used tool for assessing fatigue in clinical and community Settings, and it can be used for fatigue screening and evaluating the severity of fatigue [11]. This scale was condensed by Chalder in 1993 based on FS-14 [12]. At present, it has been localized and revised by many countries [13–17]. Choose "Yes" or "No" based on the subjective feelings of the subjects. The two-category scoring method is adopted. The total score ranges from 0 to 11 points. Those with an overall fatigue score of 4 or above are classified as fatigued.

Pre-interview preparation

(1) Determine the outline of the interviews: After reviewing the information and literature related to the study, the outline of the interviews was initially formulated. Three older adults were selected for pre-interviews, and the final interview outline was determined after discussion and modification by the members of the research team. The interview outline includes: ① Can you describe what kind of feeling fatigue brings to you? How do you feel physically? How do you feel mentally? Any other symptoms? When did your fatigue begin? How long does it last? ③What do you think caused your fatigue? ④ How has fatigue changed your life? How has it affected your life? ⑤ Do you tell others about your fatigue experiences? Do you seek help from others? (If yes, who do you ask for help?) What kind of help do you ask for? What kind of help would you like others to give you when you are tired? Can you share some examples? (6) In what ways do you relieve physical fatigue? How do you relieve mental fatigue? Can you be more specific and give some examples? Has your method of relief been effective for you? (7) Is there anything else you would like to add about fatigue? (2) Preparation of interview materials: a recording device, informed consent form, general information questionnaire, CFQ assessment scale, and interview outline. (3) Preparation of the interview environment: Before the interview, we agreed on the time and place of the interview with the interviewee to ensure that the interview environment was quiet and comfortable, and that the interview process was undisturbed and fully recorded.

Methods of data collection

Descriptive phenomenological research method was used to obtain the real feelings and experiences of the interviewees through face-to-face semi-structured interview method. The interviews were conducted during June-July 2024, before the interviews, the researcher explained the purpose and significance of the study to the interviewees and assured them that the content of the interviews was only used for academic research, and were recorded with the consent of the interviewees, who signed an informed consent form and then began the interviews. Interview techniques such as listening, summarizing, inducting, verifying and repeating were used to encourage patients to express their true feelings and opinions, while non-verbal behaviors such as the interviewee's expression, body language, and emotional changes were recorded. The interview lasts 15–30 min.

Methods of data analysis

The audio recordings were transcribed verbatim within 24 h after each interview and the text was imported into the qualitative research data analysis software Nvivo 11 for analysis. The data were analyzed using the Colaizzi 7-step analysis method. The analysis process included: recording and reading all the interview data; extracting meaningful statements; summarizing and distilling meanings; searching for common features or concepts of meanings to form themes, clusters of themes, and categories; linking the themes to the research phenomenon to provide a complete narrative; stating the essential structures that make up the phenomenon; and returning to the interviewee for verification.Following the Colaizzi's seven-step method, the data analysis was conducted as follows. The primary analysis, including initial coding and theme development, was performed by the first author (Yiming Wei). To strengthen the analytical rigor, this process was iterative and collaborative; the emerging codes and themes were regularly reviewed and discussed with the second author,the forth author (Mingzhu Lu, Huijuan Li) and the corresponding author (Ruili Zhang). Any discrepancies in interpretation were resolved through research team consensus, ensuring that the findings were credible and grounded in the participants' narratives.

Ethical statement

This study was performed in line with the principles of the Declaration of Helsinki.Approval was granted by the Ethics Committee of the Fourth Hospital of Hebei Medical University, with the Ethics Approval Number:2023KS127. All participants signed a written informed consent form prior to their involvement in the study. In addition, to protect the identity of the participants, the researchers used letters and numbers numbers (P1-P13) instead of the participants' real names when presenting the results of this study.

Rigor and reflexivity

To ensure the trustworthiness of this qualitative study, we addressed the criteria of credibility, dependability, and confirmability throughout the research process.

Credibility was established through prolonged engagement during interviews, allowing participants to share their experiences in depth. Member checking was performed by returning transcribed interviews and thematic summaries to participants for verification. Peer debriefing sessions were held regularly with the research team to challenge and refine the emerging analysis.

Reflexivity was practiced through continuous team discussions aimed at identifying and bracketing pre-existing assumptions. The primary researcher (the first and second author) is a nursing scholar focused on aging. The first author (Yiming Wei) is female, and the research team includes both male and female members with diverse expertise in gerontology and clinical practice.Throughout the analysis, the diverse expertise of the team,including the corresponding author's extensive experience in gerontological theory and the fourth author's background in clinical geriatric practice provided multiple lenses for interpreting the data. Our differing perspectives were actively discussed and debated in regular meetings, which helped to challenge individual biases and prevent the dominance of a single interpretation, thereby ensuring that the findings were grounded in the data itself.

An audit trail was maintained, documenting all steps from raw data to themes, ensuring the process is transparent and confirmable.

Results

The 13 participants ranged in age from 60 to 89 years old, with an average age of 70.77(SD = 10.28) years old.Through interviews with 13 participants and continuous analysis, generalization and refinement of the collected data, the researcher has distilled 4 themes and 20 sub-themes of the fatigue experience of older adults in the community: perception of fatigue (fatigue deprivation, fatigue neglect, fatigue difficult to subside, fatigue aggravation), psychology of fatigue (stress and worry, frustration and loss, self-reproach and helplessness, impatience and distraction, loneliness (feeling of stress and worry, frustration and loss, self-blame and helplessness, impatience and distraction, loneliness, longing and expectation), the effects of fatigue (affecting independence and autonomy, affecting motivation, affecting appetite, affecting housework, affecting socialization), and coping with fatigue (negative coping and self-suffering; self-psychologizing and maintaining an optimistic state of mind; adjusting one's life style to adapt to one's physical state; and seeking outside help to maintain positive socialization).

Theme 1: perception of fatigue

Sub-theme 1: fatigue deprivation

Participants described how heavy housework, family chores, and caring for grandchildren and elders left them with no time to think about their own fatigue. And it is only the weakness after a busy day that makes them aware of their fatigue, and the busyness that comes with family responsibilities seems to deprive them of the perception of fatigue.

P1 : “Sometimes I get tired, I am tired, and I can't care about being tired, I can't care about being tired. There are old people I have to take care of, can't take care of tired, there are children sometimes have to take care of, can't take care of tired, busy sometimes feel really tired.”

P2 : “The worst time for him to feel fatigue is when this thing (housework) is over. It's when he doesn't feel tired at the time of doing it, but when it's over, he feels tired, and the fatigue is more pronounced.”

Subtheme 2: fatigue is ignored

Older people often suffer from one or more diseases in old age, and they are more concerned about the effects of the disease and its symptoms on themselves, and regard fatigue as a normal phenomenon in the aging process, and accept fatigue only passively.

P1: “I have a lot of problems, and I don't know what causes them, and they all pile up, and I'm not as concerned [about fatigue].”

P5: “It doesn't feel like much (fatigue) because I have underlying medical conditions myself, I have rheumatoid artery disease, I have high blood pressure, and I think I have these conditions as a contributing factor to the fatigue.”

P8: “I'm 85, fatigue is there and it's not much of a big deal.”

Sub-theme 3: fatigue difficult to subside

As we age, old age is faced with the common phenomenon of prolonged fatigue duration and diminished resilience, which makes the alleviation of fatigue in the elderly increasingly difficult.

P2: “In the past, when I was maybe a little bit tired, I would rest for two or three hours and then I would come over. after 70, it just feels like I can't rest for a day, and it's hard to slow down.”

P7: “Normal young people, you're tired from work, nothing happens when you sleep. We may take three days or two days to get over it.”

Sub-theme 4: fatigue aggravation

Poor sleep quality and high temperatures can exacerbate fatigue in older adults.

P3: “If you can't sleep, you're tired, tired, sometimes you can't sleep with some things and stuff, you just consider, you just think, you think about how to do the work, what you should cook, and your brain feels tired, and the next day your body is drained of energy.”

P2: “Especially when you are under a lot of pressure after something happens, you can't sleep. Even more often than not, I can't sleep all night long. If I can't sleep, I don't feel energetic the next day. Sometimes I can't sleep for several days and nights, and during the day I feel very tired and my head is heavy.”

P9: “It's also hot and easy to get tired now, so I just sit in the shade every day …… It's nice to cool off, and it's nice to cool off and be in a good mood.”

Theme 2: the psychology of fatigue

Sub-theme 1: stress and anxiety

The interviewees themselves have entered old age, and they described that their multiple roles,such as caring for their elderly parents, grandchildren, and even ailing spouses, aggravated their experience of fatigue. The sense of responsibility makes them feel a strong sense of duty when they are unable to fulfill their tasks, and creates a sense of stress and anxiety when they are unable to cope.

P1: “When I think of the elderly and my grandchildren, can I not be under pressure? This son and daughters are also busy, I'm tired always think of quick break to rest, tired. The pressure is great …… The original in the work, now take care of the elderly plus children, sometimes can not take care of chanting, care not over, the heart eye on the panic.”

P5: “A while ago my old partner smashed his foot he can't do the work, like in the past he used to do the work of fetching water and buying food, he can't do it now, it's all up to me to do it, and I have to take care of him, my back is still not good …… I have to take care of him, my back is not good, sometimes can be tired (expression of pain).”

Sub-theme 2: loss and frustration

Fatigue exacerbates older people's immediate perception of aging, a perception that brings psychological discomfort and may even produce a certain sense of loss. As they age, activities that were once easy to handle now become difficult, and the decline in physical endurance and stamina associated with fatigue triggers a sense of loss and frustration in older adults.

P2: “Fatigue is the feeling that the body is not able to keep up, not as energetic as it used to be, especially after the age of 70. There is an obvious decline. Especially when doing heavy work. Although it does not do any heavy work, traveling to climb a mountain is not as energetic as the original …… (frown).”

P3: “Physical strength is also much worse! I used to be able to work all day long without getting tired, and I didn't even feel tired when I did this or that. I used to be able to cook several dishes and make several patterns when the children came over for dinner. Now I feel tired after frying two dishes.”

Sub-theme 3: self-reproach and helplessness

Interviewees tried to balance the needs of different family members, but fatigue overwhelmed them, preventing them from fulfilling their family tasks and leading to self-blame. The fact that they had to take on childcare tasks even though they were physically and psychologically exhausted led to the accumulation of fatigue and a sense of helplessness among older people who had to conform to “tradition”.

P1: “There are old people and children to take care of at home …… I used to take care of myself, but now I have to take care of the elderly and the children, and sometimes I can't take care of the children after taking care of the elderly. …… Sometimes the mind's eye is so irritated. You see this take care of who can not take care of, the heart of the mind is difficult to irritable, sometimes very try ……”.

P3: “You do too much work like today, that big girl big aunt, the second girl's family also all came, the big grandchildren also came. I got up early and went to the market to buy meat. …… After buying the meat, I forgot that I had something else scheduled for today, and I was reminded twice, but I still forgot, and I was so tired that I forgot! (pained expression)”.

P7: “Watching children is more tiring than working …… You can't help it, you can't leave him alone, his parents have to go to work, so what can you do if you don't watch him? When he goes to kindergarten, he has to go to kindergarten, and when he goes to school, he has to go to school, and the parents aren't there, so what can you do if you don't watch him? It's the same in all generations. China is this tradition (sigh).”

Subtheme 4: impatience and distraction

Feelings of fatigue often lead to a reduced ability to manage emotions and a tendency to overreact when confronted with the little things in life, such as impatience, distraction, and moodiness.

P2: “After being tired, especially after meeting things, I tend to be impatient, including some small things, I tend to be anxious, very anxious …… Some things just don't want to think about them, and sometimes I don't know what's going on, and I always want to lose my temper a little bit with others.”

P3: “(When fatigue sets in) it's just distracted, I don't want to listen to them yelling, I just want to be quiet and not think about anything.”

Sub-theme 5: loneliness

Fatigue not only comes from physical exertion, but is also affected by loneliness, lack of social interaction and the accumulation of negative emotions when alone. When older people are alone and have no tasks or activities to expend their energy, respondents feel empty and lonely, which in turn exacerbates the feeling of fatigue.

P4: “Sometimes on Saturdays and Sundays, the kids don't come over, and I don't have anything to do myself …… Also especially tired …… Sometimes I watch TV on the couch and fall asleep watching it.”

P10:…… (Feelings of fatigue) It's just that there's no one at home all day …… Just we come out to talk to our friends when we take a break. There is no one to talk to at home, the house is just self …… As soon as I enter the home, I turn on the TV, the TV with me as a companion, not to see is to listen to …… (head down).”

P13: “When I'm by myself (fatigue is the worst) …… There are things that I think about more and the more I think about them, the more fatigued I feel.”

Sub-theme 6: aspirations and expectations

Respondents inwardly longed for emotional support and concrete help from their family members to alleviate their burden of living and fatigue.

P1: “I hope they understand. You can see that the old man does not understand, and sometimes the daughter-in-law does not understand. My daughter-in-law works at the maternity hospital, and she works overtime and night shifts all the time. …… The night shift is sleeping during the day, and she doesn't look after the children, doesn't cook, and doesn't do anything. Tired I can not, sometimes dissatisfied, she will not do, but also think you do not do well …… (frown a little)”.

P9: “It's just me and my partner at home, and he doesn't know how to help with anything …… (when tired) I want him to squeeze my arms and legs.”

Theme 3: influence of fatigue

Sub-theme 1: influence on independence

Participants reported that due to physical limitations which they attributed to fatigue, they needed to rely on assistive devices (e.g., bicycles, railing handrails) to accomplish basic life tasks, and even going out on their own was affected. Fatigue restricts their freedom of movement, increases their dependence on outside help, and affects their independence and autonomy.

P4: “Sometimes it can be tiring …… Now this back is uncomfortable …… You can't get a back if you have to lift things. So this moment when I go grocery shopping, sometimes I just push the car, not to ride, but to come back and load that stuff on the car.”

P8: “No strength in my legs …… I have to tug on the railing when I go upstairs. Now I don't dare to go out, mainly because I can't go up the stairs, so I have to drag myself along the railing, which is very tiring and hard …… The kids sometimes say to me, 'Mom, you go out and play,' but I can't. ……”.

Sub-theme 2: influence on self-efficacy

Self-efficacy refers to an individual's judgment, belief, and confidence in his or her ability to perform an activity at a certain level. Participants reported that fatigue directly undermined their sense of self-efficacy. When physically fatigued, older adults no longer have enough strength and energy to do the things they previously enjoyed or to go outside, or even to worry about not being able to accomplish what they want to do. The feeling of powerlessness associated with fatigue causes them to lose confidence in their ability to accomplish tasks.

P1: “Turned out to be still more active as well. Sometimes also participated in village activities …… I can do flower pulling and paper cutting. (proud smile) Now …… I do go to dances, and sometimes I dance along …… I don't have the energy to do it as often as I used to. In the past, I could still follow the dance twice, but now I don't go, and I can't learn it. (smiles helplessly)”.

P8: “Fatigue gives me the feeling that I'm just not feeling as good as I used to …… I can't do things as well as I used to …… If I want to go somewhere, it seems like I can't do it, I can't go, and I'm afraid I won't be able to come back.”

Sub-theme 3: influence on motivation

Negative emotions such as burnout and low moods that come with fatigue discourage them from going out and doing other things.

P8: “You see you're tired, you don't want to move, you don't want to go, you don't want to do anything, things are piled up …… The mood is low, the mood is low, now you do not want to go anywhere, the day is at home ………..”

P7: “Definitely not in the mood to do anything after fatigue. The spirit is different.”

P5: “Fatigue when fatigue when fatigue bad mental state, hairy and tired, don't want to work. Don't want to exercise or do things ……”

Sub-theme 4: influence on appetite

Fatigue directly contributes to the loss of appetite in older adults, mainly in the form of decreased hunger and loss of taste sensation due to fatigue.

P13: “[When fatigued] there's no desire to eat, you don't eat as much, you don't feel as hungry”

P2: “When I'm tired, I don't want to eat, unlike usual, I usually eat everything, I eat anything, sometimes I especially love to eat, I don't want to eat after I'm tired, I don't have any taste in what I eat.”

Sub-theme 5: infiuence on housework

Fatigue leads to reduced willingness to do household tasks and delayed behavior in doing household tasks in older adults. Participants reported that the speed and efficiency with which household tasks were performed were also significantly reduced during periods of fatigue, leading to an increase in the time required for the task.

P6: “If I'm tired, I definitely don't want to do anything. I was going to go and clean up the house, and I don't do it, it still affects. Like I was pickling cucumbers the other day, I was going to do it, but when I was tired, I didn't want to eat, I didn't want to move. Just put it there, put it in the fridge for two days.”

P3: “…… Once you are tired, you feel that you can't do it, you don't want to do it, just like that, just leave it, don't care. In the past, I was not idle, I had to look for work even after the work was done, and I had to try everything. Now it's just sitting there, and now I don't want to try. Before always pick up this, pick up pick up that, there is no idle time, now not …….”

P13: “(When fatigued) the efficiency of doing things that's definitely slower. Like for example, normally I would say that I can cook maybe half an hour and I can finish it, at this moment I may need 40 or 50 min, the time is prolonged.”

Sub-theme 6: infiuence on o socialization

Fatigue deprives older adults of the mood and energy to stick to previously enjoyed social activities. It makes them intentionally avoid social activities.

P3: “Before I didn't have to take care of the children, there wasn't a lot of work, and there was no epidemic at that time, I just like to dance, every day I dance with my friends, and we have been dancing for several years (smiles proudly). Now this has to be in the house with the child on the tired ah, other people ask me to dance to go also do not have that mood and energy (frown).”

P8: “In the past, I used to go out in the sun, and go to the Minxin River with my friends, and sit with them and chat with them, and soak up the sun, but now my body is failing, my legs are failing, and my stamina is failing, and I seldom go up to the Minxin River to sit with them and chat with them, and soak up the sun.”

Theme 4: coping with fatigue

Sub-theme 1: negative coping, self-suffering

Older people who are faced with fatigue may choose to withhold it and bear it themselves, and they tend not to express it. Some older adults recognize fatigue as a problem that they need to face and solve on their own, and outside help cannot change this at all. Other older adults tend to conceal their fatigue in order to avoid burdening or causing anxiety to their family members.

P5: “I wish I could heal myself, but (fatigue) doesn't heal itself. Other people's help doesn't feel like it's going to get to the root of these things, it's a self thing.”

P6: “I seldom tell them that I'm tired today, or that I don't want to do anything that I wouldn't want them to do for me, I think it's not easy for them to go to work. When I get home, I try to do my chores as well as I can, right, so that they don't have to worry about anything. You have to tell them that you are not feeling well today, and that you are tired and don't want to do it, I won't say that. …… They'll just do theirs and I'll do mine.”

P8: “I do say very little (about fatigue) because it's I'm afraid the kids are always thinking about me, I'm afraid the kids are worried about me …… So I don't really talk to them about it.”

Sub-theme 2: self-psychological guidance and maintaining optimism

Respondents would self-medicate psychologically, adjust their moods and relieve their fatigue by resting, diverting their attention and watching short positive videos. There are also some older people who are fatigued but maintain a positive and optimistic mindset.

P1: “When you're tired, take a break for yourself, take a break to look at your cell phone for a while, divert your attention, and you'll be in a better mood.”

P6: “Not a lot of things on Shake Shack now, some things can speak to your heart, you see those filming family stuff, mother-in-law-daughter-in-law relationship, this relationship and that relationship, I feel as if he has some detachment effect on me, some positive energy to look at. Some things think a little open, you're in a good mood, you don't feel tired.”

P5: “This holiday season, when the children come over, they have to do the hygiene, make the house clean, and buy food and cook. This is the time to feel tired, especially tired, although tired, but the mood is especially good, we old couple is especially willing to let the children over.”

P6: “Watching your child this tired, you are watching your own child, tired and happy, because (although) you feel that he is tethered to you and can't go out to play or anything, and in your heart you feel that at this age, I should be playing, and you have to bring up the child for them, and you feel tired. But still, from the bottom of my heart, I feel how cute the grandchildren I brought up are, and I feel quite accomplished (with a smile on my face) when I watch my grandchildren grow up day by day.”

Sub-theme 3: lifestyle adjustments and physical adaptation

When faced with fatigue, older people are able to proactively adjust their lifestyles to achieve a better balance of rest and activity, maintaining physical comfort and energy levels. When performing household tasks, older people break down the task into smaller steps according to their physical state and avoid fatigue accumulation by taking intermittent breaks.

P2: “Like last year, we went on a trip, specifically looking for the play half a day to rest half a day, time and then longer not, this half a day can still rest over the energy. What was it in the past? The morning went to play, the afternoon went to play is also OK, but from last year, adjusted to play half a day, rest half a day.”

P8: “…… Even if I'm fatigued …… I should still cook and cook …… For example, if I cook, I'm all ahead of time I go ahead of time to choose the vegetables, wash them, cut everything. After the whole I then rest for a while, after resting, just when cooking, I then go to fry, so that there is a time to relieve fatigue.”

Sub-theme 4: Seeking external help and maintaining positive socialization

Older adults can alleviate the feeling of fatigue through the help and support of their family members. Or choose to go out to find friends to chat, play mahjong and other social activities and relaxing outdoor activities, not only to relieve physical fatigue, but also to obtain psychological relaxation, to avoid the accumulation of fatigue.

P3: “When my eldest girl came, she would say, ‘You don't have to look after the children, you can rest’. The second girl sometimes watches the kids when she's not busy ….. Sometimes the first girl comes here and scrubs the dishes.”

P11: “Now when I buy some food or something, I have to ask my grandchildren to help me carry it, I can't carry it by myself, I feel overwhelmed.”

P5: “For example, I am usually sometimes tired and want to relax will ask a few friends to play mahjong, or drive to the Hutuo River together to have a picnic, which will feel both physical and mental relaxation.”

P7: “Or you can find someone to talk to or something. Just gossip, you'll feel better after this and then the fatigue will lessen.”

Discussions

This study explored the experiences and experiences of fatigue among community-dwelling older adults. Although there have been studies that have explored the experience of fatigue, all of them have been among disease populations, and to the best of our knowledge, this is the first qualitative study that has been conducted with community-dwelling older adults and has focused on the experience of fatigue. Our findings reveal the perception of fatigue among older adults in the Chinese cultural context, as well as the psychological experience of fatigue among older adults, the multifaceted effects of fatigue among older adults, and the coping strategies for fatigue among community-dwelling older adults. Through our study, we were able to unearth the real meaning behind fatigue in older adults, which is important for promoting the health and well-being of older adults in the community.

Fatigue is often overlooked by older persons

Our findings suggest that both the “neglect” and “deprivation” of fatigue among older adults reflect a lack of awareness of fatigue among older adults in the community. On the one hand, older people perceive fatigue as a normal phenomenon. They tend to accept fatigue as a part of aging rather than a health problem that needs to be attended to and addressed. On the other hand, for older adults with chronic illnesses, fatigue is often perceived by them as a secondary experience to their illness. They perceive fatigue as an unavoidable side effect of medication or an associated symptom of their disease, rather than a stand-alone health problem. This is also reflected in the results of a qualitative study on the experience of fatigue in community-dwelling older adults with osteoarthritis [18], in which older adults attributed fatigue to side effects of pain medication or perceived fatigue as an inevitable consequence of the accompanying bone and joint pain. This tendency underscores a critical insight from gerontological research: fatigue should not be exclusively attributed to disease, but is increasingly recognized as a key clinical indicator of underlying aging processes. As supported by Van [19], its pathophysiology may involve a complex interplay of mechanisms distinct from, or exacerbated by, specific illnesses. These include chronic low-grade inflammation ('inflammaging'), which can directly induce sickness behaviors of fatigue [20]; mitochondrial dysfunction, leading to a systemic deficit in cellular energy (ATP) production [21, 22]. Therefore, the fatigue experienced by community-dwelling older adults may be a key clinical indicator of the intensity of underlying aging processes, rather than merely a secondary symptom of disease. There are also older adults who, despite the physical presence of fatigue, are unable to give adequate attention and response in the busy moment. As one participant put it, “It's only after being busy that I sometimes feel really tired,” suggesting that they are often forced to ignore their own fatigue signals in the midst of fulfilling family role tasks, and sorting the resolution of fatigue last. According to Elisa [8], fatigue is a manifestation of the depletion of an organism's functional reserves, which reflects the alarm that an individual sounds when he or she reaches a state of limitation in performing mental or physical activities. This alarm, if not detected or responded to in time, may directly or indirectly affect the health status of older adults.

Traditional thinking affects older people's ability to express feelings of fatigue to others

The reluctance of older adults to talk to others about their fatigue experiences found in our study is also of concern. The same has been articulated in many studies of fatigue in ill older adults [18, 23, 24]. On the one hand, as mentioned earlier, older adults believe that this is a normal phenomenon and that they do not need to talk to outsiders or seek help as a health problem. On the other hand, this phenomenon may be closely related to the importance of “patience” and “face” in Chinese culture [25]. Under the influence of Confucianism, emphasizing “patience” and “strength” are the values of many people. Under this cultural background, the elderly are often used to self-regulation and patience, and even if they are physically or mentally exhausted, they do not want to appear to be overly dependent on others or lacking in self-control. In addition, Chinese people are more “good-faced” and have a stronger sense of self-esteem. Some older people worry that expressing their fatigue will be regarded as a “weakling” who needs care and will bring a burden to the family, so they often choose to suppress their feelings. In particular, women, who have long been responsible for family care and household chores in traditional Chinese families, habitually prioritize the needs of others over their own, thus ignoring or suppressing their own feelings of fatigue, and this traditional gender role may also contribute to the reluctance of older people to talk about their fatigue.

Fatigue causes stress and negative emotions in older adults

The results of our study found that older adults with community fatigue have many negative emotions, such as irritability, frustration, loss, worry, self-blame, and other emotional distress. The reason for this may be that fatigue limits the ability of older adults to fulfill their normal social roles, which in turn creates a range of negative emotions and psychological burdens. Several studies of patients with different diseases have shown similar results. In a Meta-integration of a qualitative study of fatigue in patients with rheumatoid arthritis (RA) [26], it was found that fatigue makes it difficult for RA patients to perform their job duties, which creates negative emotions such as a sense of uselessness and guilt, and for hemodialysis patients, fatigue diminishes their ability to perform their interpersonal roles, and they suffer from loss of the ability to work and provide for their families [27]. The difference with the existing studies is that patients with illnesses mostly value their own work duties and their own social values, while our study subjects are community-dwelling older adults. Community-dwelling older adults often assume multiple role responsibilities as partners, parents, and children in the family [28]. They not only need to take care of complicated household chores, but also need to take care of their grandchildren and older elders. However, when fatigue prevents older adults from fulfilling their family responsibilities anymore, it can lead to emotions such as self-blame and helplessness. In addition, according to Pearlin's stress process model [29], role stress arises or increases when older adults are faced with multiple roles and need to juggle between conflicting role demands. During this process, older adults may feel frustrated and lost because they are unable to meet their own or their family's expectations. As well as the negative emotions of reduced self-efficacy, social value, and self-identity that they may experience as a result of difficulties in accomplishing tasks as efficiently as they did when they were younger, older adults may lose their zest for life due to chronic fatigue and stress.

These findings, particularly the theme that participants attributed their fatigue to the burdens of multiple family roles, present a notable tension with the prevailing gerontological paradigm. This paradigm emphasizes an active and engaged lifestyle as a cornerstone of successful aging [30]. The fatigue expressed by our participants, therefore, may not stem from activity per se, but rather from the specific, often obligatory and relentless, nature of their caregiving and household responsibilities. This suggests that the context and meaning of activities are critical; when tasks are perceived as overwhelming demands that preclude personal recovery and autonomy, they can be experienced as a profound drain on energy, even within an otherwise 'active' life.

Fatigue is persistent in the elderly

In our results, participants mentioned that “after the age of 70, it just feels like I can't take a day off”. This suggests that it is more difficult to “get over it” in older adults than in younger ages, and that older adults seem to experience more persistent fatigue. This “temporal character” of fatigue in older adults was also reported in Su et al.'s [18] study, where this particular property, “temporality”, was often reported by older adults as “mostly tired”, “persistent fatigue”, “constant fatigue”, “constant fatigue”, “constant fatigue”, “constant fatigue”, and “constant fatigue”.”, “persistent generalized fatigue”, and “persistent fatigue and functional decline”. Participants in our study also reported that after fatigue they were “moody” and felt that they “didn't want to do things” and that “things were piling up”, and that fatigue caused things to be left undone or postponed, leading to anger, frustration, and frustration. Fatigue causes things to be left undone or postponed, which leads to feelings of anger, despair, and powerlessness. This phenomenon reveals the dual physical and psychological burdens of older persons, which may be closely related to longer recovery times from fatigue.

Sleep status affects perceived fatigue in older adults

Poor sleep exacerbates the perception of fatigue in older adults. The effect of sleep on fatigue in older adults has been explored in a number of quantitative studies, and the findings of Japanese scholars, Takeshi [32], suggest that community-dwelling older adults with low sleep quality the previous day will have higher levels of fatigue the next day. In addition to this, we found that the psychological burden of older adults is the underlying cause of poor sleep quality and further contributes to fatigue the next day. Interviewees mentioned that “especially after something happens…… I can't sleep”, which reflects the fact that older people's sleep is often affected when they are under a lot of psychological stress. Compared with young people, due to physiological deterioration, older people's ability to adapt and adjust to psychological stress decreases, and they are more likely to be affected by negative emotions such as anxiety and depression [33], which make it more difficult for them to maintain a good night's sleep [34], thus aggravating the sense of fatigue both physically and mentally. Therefore, the aggravation of fatigue in the elderly is not only closely related to the quality of sleep, but the psychological burden also plays an important role in it. Whereas young people are usually able to recover their physical and mental state more rapidly through adequate rest and exercise, older adults more often report difficulty in relieving it through rest [35].

Fatigue leads to decreased physical and social functioning in older adults

Our findings suggest that limited physical activity is the most direct effect of fatigue on older adults, which is consistent with the results of a prospective cohort study [36]. Previous studies [37] have also confirmed the tendency of older adults to alter their level of physical activity to keep fatigue within acceptable limits. For example, many community-dwelling older adults mentioned feeling less energetic and motivated due to fatigue or less independent as a result of fatigue, which caused them to reduce the frequency of going out to participate in activities such as friends' gatherings, community events, and even to give up their previous hobbies, such as recreational activities, such as dancing and physical exercise. However, it is worth noting that chronic social deprivation can deprive them of opportunities to connect with others, leading to loneliness among older adults. Similarly, loneliness in older adults can in turn trigger or exacerbate fatigue, as our participants mentioned that they also experience fatigue when lacking the company of their children and family. In this regard, psychological research has shown [38] that loneliness can lead to chronic stress by activating the physiological stress response, which releases stress hormones such as cortisol, which when accumulated in the body can lead to increased fatigue in older adults [39]. In addition, loneliness also tends to trigger mood disorders such as anxiety and depression [40], and depressive symptoms are important predictors of fatigue in older adults [41].

Inadequate social support for fatigued older people

A noteworthy finding in this qualitative study of community-dwelling older adults' experiences of fatigue was that older adults relied primarily on self-regulation to cope with their fatigue, including by swiping short videos on their cell phones, listening to music, and physical activity.Furthermore, while our participants described a range of cognitive and behavioral strategies to cope with their fatigue, it is crucial to consider the potential physiological boundaries of such management. In our findings reflects the participants' conscious efforts to exert agency over their condition. However, the efficacy of these psychological and behavioral strategies may be inherently constrained by underlying physiological dysregulation, such as the age-related decline in autonomic nervous system function [4]. This type of dysfunction can impair the body's fundamental capacity for stress resilience and energy recovery, suggesting that a comprehensive approach to fatigue must address both psychosocial coping mechanisms and potential biological limitations. Although some interviewees also received informal support from family and friends, the study data showed that none of the interviewees mentioned receiving professional social support for fatigue from healthcare professionals or community caregivers. This finding suggests a potential gap in, or lack of access to, professional support within the current social support system for older adults with fatigue, from the participants' perspective. This highlights a need to improve the visibility and accessibility of relevant support services. In addition to this phenomenon found in our study, it is also true in other qualitative studies of disease-related fatigue. Examples include stroke [42, 43], chronic obstructive pulmonary disease [44] and cancer [45]. All of these studies have something in common: the majority of participants did not receive professional guidance and support on fatigue from healthcare professionals and community caregivers. The consistent reporting of this gap across studies suggests that, from the patient's perspective, the clinical focus may be perceived as being primarily on the underlying disease, rather than on managing concomitant symptoms like fatigue. There is a lack of 'fatigue' clinics in our country, and community-dwelling older people experiencing fatigue have nowhere to go to talk about their fatigue experience and get the right guidance to manage it effectively. As reviewed by Su [31], there is a lack of guidelines on how to manage fatigue in many countries, including ours. Therefore, coupled with our findings and existing literature, there is a clear need to enhance awareness and understanding of fatigue among healthcare workers and community caregivers, and to develop pathways through which older adults can access effective guidance to manage this symptom.

Suggestion

This study focuses on community-dwelling older adults experiencing fatigue and employs a phenomenological approach to conduct an in-depth investigation. Based on the research findings, the following recommendations are proposed. We hope that these suggestions will help guide efforts to improve the status of fatigue among older adults in the community.

Enhancing awareness and education

Healthcare providers should proactively assess fatigue in older adults, not dismissing it as a normal part of aging. Public health campaigns and patient education materials should be developed to reframe fatigue as a manageable health signal, based on the themes of 'perception of fatigue' we identified.

Supporting family caregivers

Given that family roles are a major source of fatigue and psychological distress, support systems for older adults in caregiving roles are crucial. This could include implementing community-based respite care services and providing families with communication strategies to better share the burden of household and caregiving tasks.

Promoting community-based interventions

Communities should develop and offer tailored programs that combine gentle physical activity (to counteract reduced motivation and independence) with social interaction (to alleviate loneliness). These programs should be designed with the understanding that fatigue makes initiation difficult, thus requiring low-threshold access and a supportive environment.

Fostering person-centered coping strategies

Clinicians can use the 'coping with fatigue' themes identified in this study to guide conversations with older patients, validating their current strategies while introducing new techniques to replace negative coping mechanisms like self-suffering."

Strengths and limitations

The strength of this study lies in our focus on the fatigue experiences of community-dwelling older adults, an area that has been neglected in previous research. To the best of our knowledge, this is the first qualitative study to apply phenomenological research methods to explore the experience of fatigue among community-dwelling older adults. Our study makes an important contribution to improving knowledge and understanding of fatigue in older adults. Another strength is that this study took into account the Chinese cultural context and analyzed it in depth in relation to the cultural context, and the results can be generalized to other regions with similar socio-cultural contexts.

Several limitations should be acknowledged. First, our interviews relied on participants' ability to accurately recall details of their fatigue experiences, which may introduce recall bias.

Second, this phenomenological study did not employ standardized instruments such as the COMPASS-31 scale [46] to quantitatively assess symptoms of dysautonomia (e.g., orthostasis, thermoregulation issues) or tools like the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep disturbances. Nor did we perform biochemical screenings to exclude underlying hormonal abnormalities or other specific medical conditions known to cause fatigue. This was a deliberate methodological choice aligned with our research aim: to prioritize the lived experience of fatigue as narrated by older adults themselves, without reducing their subjective reality to a set of biomedical diagnoses. However, this approach results in a sample comprising individuals whose fatigue may stem from diverse and unverified etiologies. Consequently, while our thematic descriptions represent the shared essence of the fatigue experience as perceived by community-dwelling older adults, they do not allow us to delineate how this experience might vary based on specific physiological underpinnings. We recognize this as a necessary trade-off in a purely phenomenological inquiry.

Third, regarding the sample size, it is important to note that in qualitative research, sample size is determined by data saturation rather than a predetermined number of participants. In this study, data collection and analysis proceeded iteratively, and recruitment continued until no new themes emerged, indicating that saturation was achieved with 13 participants. Although the sample size is modest, the richness of the interview data and the rigor of the analytical process support the trustworthiness and transferability of the findings to similar populations and contexts. As with all qualitative studies, the findings are context-dependent and are not intended for statistical generalization.

Despite these limitations, this study was conducted through a well-designed qualitative research protocol that included rigorous sample selection, data collection, and analysis procedures to ensure the reliability and validity of the findings. Future research that integrates physiological assessments with qualitative inquiry would be highly valuable to further unravel the complex interactions between subjective fatigue experiences and their underlying biological mechanisms.

Conclusion

The present study, through in-depth interviews and understanding of the fatigue experiences of older people in the community, found that fatigue was perceived as an important issue in their lives that cannot be ignored, but is often overlooked by researchers, health care workers, and even by the older people themselves. The findings suggest that fatigue affects older people physically, psychologically, and socially, and that older people adopt a variety of coping strategies to deal with fatigue, but lack the specialized social support provided by community health workers. This finding suggests that researchers, community health workers, and healthcare professionals need to pay more attention to fatigue in older adults and provide timely and effective assessment and support to help older adults better manage fatigue, thereby empowering them to maintain their functional ability and well-being, which are core to healthy aging.

Authors’ contributions

Author Contributions: The individual contributions of each author are as follows: Yiming Wei:Design of the work, Conceptualization,Methodology,Software，Analysis,Investigation, Writing-Original Draft, Writing-Review & Editing. Mingzhu Lu: Design of the work,Methodology, Software, Analysis，Writing-Review & Editing. Ruili Zhang:Design of the work,corresponding author, Data Curation, Writing-Review & Editing, Supervision. Huijuan Li: Design of the work,Writing-Review & Editing, Supervision. Xiaohan Cheng：Design of the work,Writing-Review & Editing, Supervision Jiahui Zhai：Design of the work,Writing-Review & Editing, Supervision.

Funding

This study received no specific funding.

Data availability

The materials described in the manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes, without breaching participant confidentiality.

Declarations

Consent for publication

Written informed consent for publication was obtained from all participants.

Clinical trial number: not applicable.

Competing interests

The authors declare no competing interests.