Page 29 - JCBP-3-4

Journal of Clinical and
Basic Psychosomatics Somatic symptom disorders and aging

are particularly poorly understood, especially in older the associations between somatic symptom disorder and
adults, a population that is rapidly expanding across the neurocognitive disorders in Canada. They captured 13
world. Estimates indicate that between 2015 and 2050, the articles and found potential associations between late-onset
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proportion of the world’s population over 60 years of age SSRDs and a subsequent development of neurodegenerative
will nearly double from 12% to 22%, making it more critical disorders, specifically Lewy body spectrum disorders.
to explore a better understanding of these disorders. Older Out of the 13 articles, a total of 123 SSRD participants
adults have specific biopsychosocial mental health needs were described, including 59 participants (47.9%) with
that require specialized and age-sensitive approaches conversion disorder, 6 (4.9%) with illness anxiety disorder,
to diagnosis, assessment, and treatment. This poor and 6 (4.9%) with a somatic symptom disorder. Of the
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understanding of SSRDs among older adults increases 123 SSRD participants identified, 42 (34.1%) developed a
the risks of misidentification, mistreatment, and stigma neurocognitive disorder or Parkinson’s disease. The most
toward older adults who experience symptoms of SSRDs. common clinical diagnosis was Lewy body spectrum
Due to the limited understanding and recognition of disorder with 34 cases (80.9%). It is important to consider
SSRDs among older adults, the purposes of this paper that older adults with an SSRD could be at an elevated risk
are to discuss and elucidate the key diagnostic and for developing a neurocognitive disorder, which should be
assessment challenges of SSRDs in older adults to inform monitored closely.
further research and guide practice. While diagnosis and We now turn to diagnostic challenges associated
assessment go hand in hand, this paper has separated these with older adults and SSRDs, which include high rates
two constructs to clarify the challenges associated with of somatic multimorbidity, a misattribution to aging and
each. In the interests of transparency, our search strategy perceived stigma, and cognitive impairment. These issues
consisted of searching the APA PsycInfo and Google are discussed next.
Scholar databases for articles pertaining to both SSRDs and
aging. We used keywords including variations on “somatic 2. Diagnostic challenges
symptom and related disorders” and “older adults/elderly/
aging.” 2.1. Somatic multimorbidity
Researchers have estimated the prevalence of It is a challenging reality of aging that many older adults
somatoform disorders in older adults as ranging from 5% have multiple chronic physical conditions, called somatic
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to 13%, although definitive studies are lacking due to the multimorbidity. Somatic multimorbidity can result in
changing nature of this diagnostic category. The especially many distressing physical symptoms experienced by the
poor understanding of SSRD symptoms and presentation older adult, which may be difficult to differentiate from
among older adults could be attributed to the previous an SSRD. In cases of severe physical illnesses, it can be
diagnostic criteria that required the absence of a medically challenging to discern whether one’s concerns about being
explained disorder, where many older adults do indeed ill or impaired are reasonable or excessive (that is, part
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have physical disorders and associated somatic symptoms. of an SSRD). Several medical conditions are known to
Indeed, SSRDs in older adults present a distinct set of cause vague, confusing, and multiple somatic symptoms,
challenges to the individual and care team. An accurate including multiple sclerosis, systemic lupus erythematosus,
diagnosis and assessment must be made in older adults fibromyalgia, irritable bowel syndrome, and chronic
to provide effective treatment and to reduce the perceived fatigue syndrome. As such, these conditions may mimic
stigma that many may hold concerning SSRDs. symptoms of an SSRD and they must be ruled out before
diagnosis of an SSRD in older adults.
A recent study by Wu et al. analyzed the prevalence
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rates of somatic symptom disorder in a cross-sectional There is also frequent comorbidity of SSRDs with
study in China with younger and older adults. The other mental disorders, especially depressive and anxiety
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median age of older adults was 70 years old (n = 6814), disorders. For example, Dehoust et al. found that older
and the median age of younger adults was 48 years old adults with an SSRD were 5 times more likely to have an
(n = 2206). The prevalence of somatic symptom disorder anxiety disorder in the past year than older adults without
was higher in the older adult group (42.8% mild and 20.4% an SSRD. Moreover, older adults with mood and anxiety
moderate/severe) than in younger adults (33.3% mild disorders often present with a wide range of somatic
and 12% moderate/severe). Furthermore, depressive and symptoms, such as fatigue, poor sleep, increased heart
anxiety disorders were 3.7 times higher than the expected rate, or shortness of breath, which can mimic symptoms
amount in normative populations. Relatedly, Sammartino- of an SSRD and must be considered in the diagnostic
Arbour et al. conducted a systematic review analyzing process.
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Volume 3 Issue 4 (2025) 23 doi: 10.36922/JCBP025080013