Page 32 - JCBP-3-4

Journal of Clinical and
Basic Psychosomatics Somatic symptom disorders and aging

understand which scales best measure somatic symptoms examining other forms of validity of the SSEQ among
in older populations by conducting a systematic review older adults are lacking.
and examining previously collected data. They found Regarding one other common assessment tool, the
that the PHQ-15, a measure commonly used in younger somatic symptom disorder criteria B is an increasingly
35
populations, was not correlated with other SSRD scales popular scale specifically designed to measure somatic
28
such as the Whiteley Index and other somatic scales, symptoms commonly associated with somatic symptom
suggesting that the PHQ-15 was not effective in detecting disorder. To the best of our knowledge, however, this scale
SSRD psychopathology in older adults. has not yet been validated or used in older adult samples.
3.1.3. Scale for the assessment of illness behavior 3.2. Bias among mental health clinicians and
(SAIB) 29
medical providers
The SAIB is a popular self-report measure that was Another potential barrier to assessment is that some
30
primarily validated for younger adults. Engelberg et al. medical providers may have preconceived notions about
found that the factor structure of the SAIB did not replicate the normalcy of somatic symptoms in older adults, leading
well among older adults, and they created a revised version to biased assessments. Due to the prominence of physical
better fit for aging populations. They concluded that the symptoms associated with SSRDs, older adults with SSRDs
revised SAIB could be used for older adults with caution. commonly seek help from primary care doctors or general
However, this version’s psychometric properties are only practitioners, rather than mental health professionals.
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preliminarily established.
Indeed, while older individuals with SSRDs are commonly
3.1.4. Short health illness anxiety inventory 31 frequent users of diverse healthcare services, they often
do not get the proper psychotherapeutic assessment
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Boston and Merrick conducted a study with community- and treatment from specialty mental health clinicians.
dwelling older adults to better understand the prevalence As noted above, the stigma associated with SSRDs may
rates and etiology of health anxiety, as measured by prevent some older adults from accepting a referral to a
the Short Health Illness Anxiety Inventory (SHAI). All mental health professional, due to concerns about being
participants were over the age of 65 and half were between told that their physical symptoms “aren’t real” or that their
75 and 85 years of age. In this study, the mean score for problems are fully psychogenic or psychological in nature.
the SHAI was 7.04 (SD = 4.31). The typical cutoff point In medical settings, patients with SSRDs are at a higher
for SHAI scores is 15, where any score higher indicates the risk of unnecessary testing or treatment and are sometimes
presence of acute health anxiety. About 7.6% of participants seen as less favorable and challenging to physicians.
37
scored higher than 15 in the present study, which was Relatedly, Segal et al. noted that if medical providers and
10
comparable to 10% reported in general population studies. mental health professionals incorrectly attribute pain or
This finding indicates that older adults and younger adults other somatic symptoms to the aging process only, they
have similar levels of severe health anxiety. More recently, risk underestimating and undertreating possible SSRD
an exploratory study of the SHAI was conducted with
older adults to determine the factors of health anxiety symptoms among older adults.
in community-dwelling older adults in China. Results 3.3. Limited training among professionals
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showed similar prevalence rates of health anxiety using the
SHAI in older adults (9.53%) compared to prior findings Healthcare providers commonly lack specialized training
by Boston and Merrick. Both of these studies indicate that in the diagnosis and assessment of SSRDs in adults and
32
17,37
the SHAI was appropriately able to detect health anxiety in older adults. Medical team members should be well-
older adults at a similar rate to younger adults, suggesting versed in concepts from basic gerontology, for example,
some utility and effectiveness of the scale to adequately understanding the differences between normal aging and
assess health anxiety in older adult samples. abnormal aging to better diagnose and treat a wide array
of individuals with symptoms of SSRDs. Unfortunately, as
3.1.5. Somatic symptoms experiences questionnaire noted earlier, the misattribution of symptoms of SSRDs to
(SSEQ) 34 normal aging is common among older adults themselves
In a review of SSRD scales, Van Driel et al. found that none and among diverse health professionals.
27
of the 15 items in the SSEQ overlap with common physical Kleinstäuber 7 provided several thoughtful
symptoms associated with old age or are inappropriate for recommendations for clinicians and other members of the
older adult populations, providing at least some evidence medical team to consider when working with individuals
for the content validity of the SSEQ. However, studies presenting with symptoms of SSRDs or with individuals

Volume 3 Issue 4 (2025) 26 doi: 10.36922/JCBP025080013