The 12 Hallmarks of Aging in Dogs, Explained
Read full insightWhy Is My Dog Tired All the Time or Low on Energy?
By La Petite Labs Editorial 13 min read
If your dog has low energy, focus on what changed from that dog’s normal baseline. “Low energy” may mean less enthusiasm, reduced walking stamina, slower recovery after activity, or sleeping more while still eating normally. A persistent change deserves the same medical attention as constant tiredness.
If your dog is tired all the time or gets winded faster than usual, the first job is to read the pattern, not guess a cause. Start with two questions: did the energy drop suddenly or build over weeks, and is your dog simply quieter or actually struggling — refusing food, wobbly, or "not themselves"? A dog who was normal yesterday and is wiped out today needs a faster response than one who has slowly slowed down.
This page sorts fatigue into what to watch, what to write down, and which signs separate ordinary rest from real medical decline. Breathing changes, collapse, pale gums, a swollen belly, repeated vomiting, or possible toxin exposure move this from "observe" to "call today." For everything else, you'll get a quick home check and the details — onset, triggers, recovery time — that help your vet restore your dog's stamina safely instead of pushing through it.
- A dog who tires quickly or sleeps more isn't lazy — it's usually pain, poor sleep, anemia, heart or lung strain, or early disease.
- Sudden exhaustion needs same-day care. Collapse, pale or blue gums, labored breathing, a swollen belly, or repeated vomiting are emergencies.
- If your dog gets tired fast on normal walks, note the trigger, how long it lasts, and how long recovery takes.
- Pain is the most under-recognized cause: many dogs conserve movement instead of limping.
- Weight, heat, and deconditioning can flatten stamina without any disease — and the fix is different.
- A basic vet workup — exam, blood count, chemistry, sometimes thyroid or imaging — usually clarifies the picture fast.
- Once urgent causes are ruled out, daily routines that support energy and recovery can help sustain good days.
Step 1: Sort by Urgency (When to Call Today vs Monitor)
Call your vet today (or emergency care) if tiredness comes with any of the following:
- Collapse or weakness (can’t rise, wobbly, suddenly “giving out”)
- Breathing changes: rapid breathing at rest, labored effort, open-mouth breathing (especially at rest)
- Pale/white or blue-tinged gums, or gums that look much lighter than usual
- Not eating/drinking, or inability to keep water down
- Vomiting and/or diarrhea plus lethargy (especially repeated episodes, blood, or signs of dehydration)
- Suspected fever (feels unusually hot, shivering, markedly low energy) or known infection risk (recent wound, tick exposure)
- Possible toxin exposure (human meds, xylitol, rodent bait, plants, chemicals)
Monitor closely for 24–48 hours (and still call sooner if worsening) when there’s a clear recent heat/exertion context—long hike, intense play, hot day—or a mild, short-term schedule disruption, and your dog is otherwise breathing comfortably, drinking, and responsive. If energy doesn’t rebound with rest/cooling or appetite drops, escalate to a same-day call.
Low Energy in Dogs: Stamina, Enthusiasm, and Recovery
Before you call, gather the specifics your vet will use immediately. Start with onset and duration: did this begin in hours, days, or weeks, and was it abrupt after one event or slowly progressive?
Next, track triggers and recovery. Note exercise intolerance — does your dog tire after a shorter walk than usual, and do they bounce back in 10–30 minutes or stay flat for hours? Then log daily functions: appetite, thirst, stool quality, vomiting, and any change in urination.
Add three simple at-home checks (don't force activity to "test" them):
- Resting respiratory rate: when your dog is asleep, count breaths for 30 seconds and double it. A persistently high resting rate or obvious effort points to a heart or lung concern and warrants prompt veterinary guidance.
- Hydration: lift the skin over the shoulders; a slow return, plus tacky gums, can suggest dehydration.
- Gum color: healthy gums are pink. Pale gums can mean poor perfusion or anemia; blue or gray is urgent.
Bring these notes — with any new meds, recent travel, heat, or tick exposure — to make triage faster and safer.
Describe the pattern precisely: willingness to start an activity, how quickly your dog tires, how long recovery takes, and whether food interest remains normal. A dog that wants to play but cannot sustain it presents a different problem from a dog that no longer wants to begin.
Pain and Poor Sleep: the Quiet Pair That Drains Energy
Pain is the most under-recognized reason a dog seems tired — and most dogs in pain never yelp or limp. They simply conserve movement. Arthritis, spinal or dental pain, and soft-tissue injuries lead to more sleeping and less enthusiasm. Watch for small tells: a slower sit-to-stand, hesitation at stairs, licking a joint, avoiding slippery floors, or choosing rugs and corners where moving is easier.
Pain also wrecks rest. A dog may nap all day yet never settle deeply, which makes daytime fatigue worse. If your dog tires quickly and seems stiff after resting, move pain higher on your list. The encouraging part: pain is often treatable through weight management, targeted medication, physical therapy, and home adjustments that reduce strain — and energy frequently returns once it's addressed.
Why Does My Dog Get Tired So Fast? Heart and Lung Limits
Heart and lung conditions can make a dog’s world smaller before obvious symptoms appear. Reduced stamina, slower walking pace, and needing frequent breaks can be early clues. Some dogs develop a soft cough, faster breathing at rest, or reluctance to lie on one side. Heat and humidity often magnify the problem, because cooling requires efficient breathing and circulation.
If your dog gets tired very quickly and you notice panting when they haven’t been active, or breathing that looks effortful, treat it as a priority. Your veterinarian may recommend chest imaging, heartworm testing, and sometimes an echocardiogram, depending on exam findings. These conditions are not something to “push through” with more exercise.
Anemia and Low Oxygen Delivery: When the Body Runs Short
Anemia is a classic cause of low energy: the body has less capacity to carry oxygen where it needs to go. Dogs with anemia may seem weak, sleep more, or fatigue early on walks. Pale gums can be a clue, though gum color varies and lighting can mislead. Causes range from parasites and chronic disease to bleeding, immune-mediated issues, or nutritional problems. (see our Dog Sleep Calculator →)
Because anemia has many possible drivers, it’s not something to self-treat with iron or “blood-building” supplements. A simple blood test can identify it quickly, and the next steps depend on the pattern your veterinarian sees. If your dog gets tired quickly and also has reduced appetite or weight loss, anemia is one reason an exam shouldn’t wait.
“Fatigue is rarely a single clue; it’s a pattern that becomes legible with calm observation.”
Endocrine Changes That Flatten Energy over Weeks or Months
Endocrine conditions can quietly reshape energy. Hypothyroidism is often associated with lethargy, weight gain, and skin or coat changes. Diabetes can cause fatigue alongside increased thirst and urination. Cushing’s disease may show up as panting, muscle weakness, and a “tired but wired” restlessness. These problems can look like ordinary slowing down until the pattern becomes unmistakable.
The good news is that many endocrine issues are diagnosable with targeted lab work. If my dog gets tired very quickly and I’m also noticing changes in thirst, appetite, coat, or body shape, I consider that a strong reason to ask for a medical workup rather than assuming it’s age.
Infection, Inflammation, and Parasites That Sap Stamina
Infections and inflammation can drain energy even when fever isn’t obvious. Dental disease, skin infections, urinary tract infections, tick-borne illnesses, and chronic ear problems can all create a background load that leaves a dog less resilient. Sometimes the only visible sign is that the dog “just isn’t themselves.”
Parasites are another quiet culprit. Intestinal parasites can affect nutrient absorption and cause intermittent GI signs; heartworm disease can reduce exercise tolerance. Prevention helps, but no plan is perfect, and exposure varies by region and lifestyle. If your dog gets tired quickly and has diarrhea, weight loss, or a new cough, ask your veterinarian whether parasite testing is appropriate.
Weight, Underfeeding, and Calorie Cuts That Drain Energy
Weight and conditioning are blunt but powerful influences on stamina. Extra weight increases the work of breathing, adds load to joints, and makes heat harder to shed. Under-conditioning does something similar: muscles fatigue sooner, and the cardiovascular system has less reserve. Either way, the dog looks “tired,” but the fix is different than treating a disease.
If your dog gets tired quickly on walks but perks up at home, consider whether the pace is too fast, the terrain too demanding, or the temperature too warm. A slow, consistent routine—shorter walks more often, gentle hills later, rest breaks built in—can rebuild capacity without triggering soreness. Your veterinarian can also help you choose a safe target weight and timeline.
Weight can reduce stamina, but an aggressive calorie cut can also create low energy. Record the actual daily calories—including treats—alongside weekly weight and body-condition changes. Do not keep reducing food when energy falls; ask the veterinarian to reassess the calorie target and whether pain, endocrine disease, or nutrient imbalance is contributing.
Heat, Air Quality, and Stress: Environmental Reasons Dogs Slow Down
Environment can make a healthy dog look unwell. Heat is the obvious one: dogs cool themselves primarily through panting, and some breeds or individuals simply can’t keep up. Poor air quality, wildfire smoke, and high pollen days can also reduce exercise tolerance. Even a change in household routine—new baby, travel, construction noise—can lead to stress-related fatigue.
Look for context clues. Does fatigue appear only outdoors, only after car rides, or only at certain times of day? Does your dog recover quickly in a cool room? These details can help you adjust the environment while you pursue medical answers. When owners tell me their dog gets tired quickly, the “where” and “when” often matter as much as the “how much.”
Nutrition, Tolerance, and Food Safety Factors That Shape Energy
Nutrition can influence energy in two ways: what’s in the bowl, and what your dog can actually use. Even a “good” diet may be a poor fit if calories are too low for activity, too high for a sedentary dog, or if digestive tolerance is off. Subtle GI issues—soft stool, gas, picky eating, frequent grass-eating—can quietly reduce nutrient availability and leave a dog looking flat. A thoughtful diet history (brand, formula, treats, chewables, table scraps) is often more revealing than owners expect.
Food safety matters, too. Contaminants and recalls are uncommon, but they do happen, and long-term exposure to certain contaminants may contribute to chronic tiredness in dogs [1]. If your dog’s fatigue coincides with a new bag, a new brand, or a new treat habit, keep the packaging and lot number and discuss it with your veterinarian. This isn’t about fear; it’s about ruling out a preventable variable.
“A dog can sleep more and still be un-rested—pain and disrupted sleep often travel together.”
DVM Voice: Clinical Vignette of a Common Pattern in Senior Dog Aging
Case provided by JoAnna Pendergrass, DVM
Rex, a 7-year-old Labrador Retriever, was brought in after his owner noticed he was slower to rise, hesitant on stairs, and less able to play as before. Examination showed stiffness and reduced hip mobility; radiographs confirmed degenerative joint changes.
His care required weight management, veterinary-guided pain control, nutritional support, and rehabilitation — a comprehensive plan, but one started only after visible decline appeared.
Clinical takeaway: Rex’s case reflects the value of proactive aging support: maintaining lean body condition, monitoring mobility early, and supporting cellular resilience, antioxidant defense, and healthy inflammatory balance before decline becomes obvious.
Single-case vignette. Not generalizable. Veterinary oversight is essential for pain, stiffness, or suspected joint disease.
Medication and Supplement Side Effects That Mimic Low Vitality
Medications and supplements can change energy in ways that look like “aging.” Sedation is a known effect of some allergy medications, anti-anxiety drugs, pain medications, and certain anti-itch therapies. Less obvious: a drug may reduce appetite, alter sleep architecture, or make exercise feel harder by changing heart rate or blood pressure. If your dog gets tired very quickly after starting something new, note the start date, dose timing, and whether fatigue peaks a few hours later.
Bring every label to the appointment, including joint chews and “calming” products. Your veterinarian can check for interactions and decide whether a trial adjustment is safe. Never stop prescription medications abruptly without guidance. The point is not to blame a medication that’s helping; it’s to tune the plan so comfort doesn’t come at the cost of vitality.
Age and Life Stage Shifts That Change a Dog’s Baseline
Age changes the baseline. Senior dogs often sleep more, recover more slowly after exertion, and show less tolerance for heat or long, repetitive activity. But “normal aging” shouldn’t erase personality. When an older dog stops seeking interaction, loses interest in food, or seems confused, it’s worth checking for pain, endocrine disease, cognitive change, or organ stress. Many of these are manageable, and early support tends to preserve quality of life longer.
Ongoing tiredness deserves a vet's assessment, since it can point to treatable conditions. When it reflects the natural energy decline of aging, cellular energy support for older dogs through daily nutrition is a gentle complementary step.
Puppies, on the other hand, can look tired because they are growing fast and sleeping a lot—until they’re not. A puppy who is listless, not eating, vomiting, or having diarrhea needs prompt veterinary attention. Life stage context matters: what’s “expected” for one dog can be a warning sign for another.
Breed, Body Type, and Conditioning Differences in Stamina
Breed, body shape, and size influence stamina. Brachycephalic dogs (short-nosed breeds) may fatigue quickly because airflow is mechanically limited, especially in heat or excitement. Giant breeds may tire sooner due to orthopedic load, while very small dogs can burn through energy quickly and struggle with temperature regulation. None of this is a character flaw; it’s physiology and engineering.
Conditioning is the other piece. A dog who has been less active for weeks—because of weather, schedule, or a minor injury—can decondition faster than owners realize. If your dog gets tired quickly after a period of inactivity, a gradual return to exercise can be safer than “weekend warrior” bursts. Your veterinarian can help you set a ramp-up plan that respects joints, heart, and lungs.
What a Thoughtful Veterinary Workup Usually Looks Like
A useful veterinary workup for chronic fatigue is usually straightforward. Expect a careful history, a full physical exam, and baseline lab work (often including a complete blood count and chemistry panel). Depending on findings, your veterinarian may add thyroid testing, urinalysis, fecal testing for parasites, heartworm testing, blood pressure, or imaging. The goal is to move from a vague symptom to a short list of likely causes.
Help the appointment by bringing specifics: when fatigue started, whether it’s constant or episodic, any cough or panting, appetite and water changes, stool quality, and exercise tolerance (for example, “slows after 10 minutes” rather than “seems tired”). If you can capture a short video of the concerning behavior, it often clarifies what words can’t.
Red Flags That Should Move You from Watching to Acting
There are moments when waiting is the wrong instinct. Seek urgent veterinary care if fatigue comes with collapse, pale or blue-tinged gums, labored breathing, a distended abdomen, repeated vomiting, black/tarry stool, inability to stand, or sudden weakness in the back legs. These can signal internal bleeding, heart crisis, bloat, toxin exposure, or other emergencies where time matters.
For non-emergent but persistent fatigue—especially if it lasts more than a few days, worsens, or changes your dog’s behavior—schedule a visit. Chronic tiredness is not a diagnosis; it’s a prompt to look for the underlying story. The earlier you identify the driver, the more options you typically have.
A Weekly Low-Energy Snapshot to Share with Your Vet
At home, focus on quiet, measurable support rather than dramatic changes. Keep exercise gentle and consistent, prioritize cool hours for walks, and offer low-impact enrichment (sniffing games, short training sessions, slow feeders). Track appetite, water intake, and stool quality for a week. If your dog gets tired very quickly, shorten outings before they hit the wall; repeated overexertion can make recovery slower and can mask the pattern your veterinarian needs to see.
Also consider sleep quality. Nighttime rest can be disrupted by pain, itching, needing to urinate, or anxiety. A dog who naps all day may still be sleep-deprived. If you notice pacing at night, frequent position changes, or reluctance to lie down, mention it—those details often point toward treatable discomfort.
For seven days, record the same signals at the same time: appetite, water intake, stool, play initiation, walking pace, recovery after activity, sleep, and any medication changes. That vitality snapshot is more useful than “seems tired” because it shows direction and context.
Where a Daily Energy-Support Routine Fits (After the Vet)
Once your veterinarian has ruled out urgent disease, a daily routine can support the systems that shape everyday energy — healthy aging, cellular resilience, and recovery after normal activity. Even a complete diet meets basic requirements without specifically targeting how an aging body manages wear over time.
This is where Hollywood Elixir fits: a food-mixed daily routine built around NAD+ support for energy in aging dogs (nicotinamide riboside plus niacin), antioxidant defense (glutathione, astaxanthin, vitamins C and E), and mitochondrial cofactors like CoQ10 — the energy systems older dogs lean on every day. The active amounts are printed on the label, so you can see what your dog is getting and review it with your vet. It supports normal cellular energy; it does not treat whatever caused the fatigue, so medical answers always come first.
Think of it as scaffolding for good food, appropriate exercise, and weight management — steady, repeatable support that dogs tolerate because it goes into a meal, not another treat. Consistency matters more than intensity.
Putting the Story Together for a Calmer, More Confident Next Step
If you’re still asking yourself, “why does my dog get tired so quickly,” you’re already doing the most important thing: noticing a change and taking it seriously. Fatigue is one of the most common, least specific symptoms in dogs, which is exactly why it deserves a calm, structured response—observe, rule out the urgent, test thoughtfully, then support what’s left, whether that’s weight management, routine adjustments, or daily energy support supplements for dogs your vet has okayed. Many dogs improve once pain is addressed, parasites are treated, weight is adjusted, or a medication plan is refined.
And if the workup is reassuring, it’s reasonable to focus on long-term vitality—keeping joints comfortable, maintaining lean muscle, and supporting the internal “energy economy” that tends to drift with age. The best plan is the one your dog can live with daily: simple, consistent, and responsive to what you see.
“When the workup is reassuring, the focus shifts from fear to stewardship: comfort, conditioning, resilience.”
Educational content only. This material is not a substitute for veterinary advice. Always consult your veterinarian about your dog’s specific needs. These statements have not been evaluated by the Food and Drug Administration. Products mentioned are not intended to diagnose, treat, cure, or prevent any disease.
Glossary
- Lethargy: A noticeable drop in normal energy, interest, or responsiveness.
- Exercise Intolerance: Fatiguing earlier than expected for a dog’s age, breed, and conditioning.
- Deconditioning: Loss of fitness from reduced activity, leading to quicker fatigue and slower recovery.
- Anemia: Reduced red blood cells or hemoglobin, which can lower oxygen delivery and stamina.
- Orthopedic Pain: Discomfort from joints, bones, or spine that can reduce movement and disrupt sleep.
- Heartworm Disease: A parasite infection that can impair heart and lung function and reduce endurance.
- Hypothyroidism: Low thyroid hormone levels that may be associated with low energy and weight gain.
- Cushing’s Disease: A hormonal disorder that can cause panting, muscle weakness, and reduced vitality.
- Resting Respiratory Rate: Breaths per minute while asleep or fully relaxed; changes can signal cardiopulmonary stress.
Related Reading
Aging & Senior Dog Guidance
• Dog Age Calculator
• Dog Lifespan by Breed
• Dog Dementia
• Lethargy in Dogs
• My Dog Won't Eat
• Dog Pacing At Night
• Dog Licking Paws
• Can Dogs Dehydrate
Healthy Aging Support
• NAD+ for Dogs
• NMN for Dogs
• Antioxidants Supplements for Dogs
• Best Senior Dog Supplements & Vitamins
• Rapamycin for Dogs
References
Numbered references support claims cited in the article. Context labels are inferred from source titles—not a substitute for reading the methods—and do not turn indirect evidence into pet-specific proof.
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[1]
Rumbeiha W, Morrison J. A review of class I and class II pet food recalls involving chemical contaminants from 1996 to 2008. Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2011· DOI 10.1007/s13181-010-0123-5Title design/context: reviewSpecies/context named in title: animal-unspecifiedEvidence boundary: The title identifies an animal, pet, or veterinary context but does not establish the species or actual study population; consult the full source before applying it to an individual pet.↩
FAQ
Is low energy normal in senior dogs or always concerning?
Some slowing is normal with age, but a senior dog should still show interest in food, comfort, and connection. A meaningful drop in activity can signal pain, weight changes, or illness rather than “just aging.”
Because arthritis can reduce activity and quality of life, it’s worth discussing mobility and comfort with your vet.
Which fatigue symptoms in dogs need urgent care?
Go urgently if fatigue comes with collapse, trouble breathing, blue or very pale gums, repeated vomiting, a swollen belly, black/tarry stool, or sudden inability to stand. These can signal emergencies where waiting can be dangerous. If your dog is stable but “off,” schedule a prompt visit and bring notes or videos.
Why does my dog get tired so quickly on short walks?
Early fatigue on short walks can come from heat, deconditioning, excess weight, pain, or limits in heart or lung function. The key detail is recovery: does your dog bounce back after a brief rest, or stay depleted for hours? If stamina has clearly changed, ask your veterinarian about a focused exam and baseline testing.
When is being tired normal for a dog versus concerning?
More sleep can be normal with age, after a busy day, or during hot weather. It becomes concerning when fatigue is new, worsening, or paired with changes in appetite, breathing, mobility, or mood.
If your dog’s “baseline personality” feels dimmed, it’s worth an exam and basic labs. If your dog's baseline personality feels dimmed, a veterinary exam and basic labs are the right next step.
Why is my dog tired all the time at home?
Home fatigue can reflect pain (especially arthritis), poor sleep, stress, medication effects, or low-grade illness. It can also be a conditioning issue if activity has dropped recently, even if your dog seems “fine” otherwise. Track sleep, appetite, thirst, and willingness to move for a week, then share it with your veterinarian.
Why does my dog get tired so quickly in warm weather?
Heat raises the cost of activity because dogs rely on panting to cool down. Humidity, poor air quality, and short-nosed anatomy can make cooling less efficient, so a dog may fatigue early even on familiar routes.
Shift walks to cooler hours, shorten sessions, and watch breathing closely. Short walks in cooler hours and close attention to breathing help.
Can dog food quality affect chronic tiredness over time?
It can. Beyond calories and digestibility, food safety matters: contaminants and recalls are uncommon but real, and long-term exposure to contaminated food may contribute to chronic tiredness(Rumbeiha W, 2011). If fatigue aligns with a new diet or treats, keep the bag and lot number and discuss it with your veterinarian.
How long should I wait before calling the vet about dog fatigue?
Call promptly if fatigue is sudden, severe, or paired with breathing changes, vomiting, diarrhea, collapse, or refusal to eat. For milder fatigue, a reasonable threshold is a few days without improvement, or any clear trend toward worse stamina. A short symptom diary helps your veterinarian move faster.
Discover LPL-01: How This Fits Into a Larger Canine Longevity System
Aging in dogs is not driven by a single pathway. It’s the result of interacting biological systems—energy metabolism, oxidative stress, immune signaling, and structural integrity—changing over time.
This article explores one piece of that puzzle. If you want to understand how these pieces connect—and what actually moves the needle—you need to zoom out.
Start with the underlying science:
- Canine Geroscience Framework →
A structured view of how aging progresses across cellular energy, inflammation, and resilience systems. - Senior Biological Defense Coverage (BDC) Modeling →
A systems-level map of which biological pathways decline first, and how layered interventions can support them. - 2026 Market Research: Best Dog Longevity Supplements →
A 2026 industry report and review of leading senior-dog and cellular-aging formulas. - LPL-01 Standard →
The formulation system that translates these models into real-world supplementation—covering multiple pathways in a coordinated way.
Essential Summary
Why is it important to understand why my dog is tired all the time?
When a dog seems tired all the time, the cause can range from pain and poor sleep to heart, lung, endocrine, or infectious disease. The most helpful next step is to notice patterns—what triggers fatigue, how fast recovery happens, and any changes in appetite, breathing, or behavior—then share those details with your veterinarian for a focused workup.
Hollywood Elixir is designed for steady, system-level support—helping aging dogs maintain everyday vitality, resilience, and recovery as routines change over time. It fits best alongside good nutrition, appropriate exercise, and veterinary guidance, especially when you want a consistent daily foundation rather than a single-issue fix.
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Hollywood Elixir is amazing! She put back on 5 lbs to a healthy weight, her eyes are shiny, her coat is beautiful!
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We go on runs. Lately he's been keeping up with no problem!
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Wondering why your dog is tired all the time?
If you're searching to understand why your dog is tired all the time
If you’re asking why is my dog tired all the time, start with two parallel moves: a veterinary check to rule out the big medical drivers, and a quieter home plan that protects recovery. Keep walks shorter and cooler, avoid sudden bursts of exertion, and write down what “tired” looks like—pace, breathing, stiffness, appetite, and how long it takes to bounce back. That record often speeds up diagnosis.
When serious causes are excluded or managed, many owners still want a steady foundation for day-to-day vitality that isn’t tied to a single nutrient claim.
If your vet has ruled out a medical cause and your dog is simply aging, some owners add a daily longevity supplement like Hollywood Elixir to support energy and vitality. Learn about Hollywood Elixir.
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A complement to your veterinarian's plan — never a replacement for prescribed medication.
Learn about how our DVMs think about dog aging
Dr. JoAnna Pendergrass DVM
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First, decide whether the change was sudden vs gradual: a dog who was normal yesterday and is now wiped out needs a faster response than a dog who has slowly slowed down over weeks. Next, gauge severity—are they simply less energetic, or are they struggling to stand, refusing food, or acting “not themselves”?