Is all we know that we know nothing? A critical review of the prevalence of somatoform disorders in the elderly

Abstract

Objective: As noted in previous reviews, the prevalence rates for somatoform disorders in the elderly that have been reported are highly heterogeneous. The main aim of this paper is to identify the reasons for the substantial variation in prevalence rates and discuss the potential of future diagnostic criteria to address current difficulties. Methods: We conducted a selective review of the literature on the prevalence of somatoform disorders in elderly populations. Results: We found significant conceptual differences between the described diagnostic groups and the criteria applied across studies. Moreover, substantial disparities related to sample selection, age cut-offs, and applied measures were revealed. Conclusions: A general conceptual confusion exists throughout the literature regarding somatoform disorders in the elderly that significantly hinder the comparison and integration of results and can lead to premature conclusions. The redefinition of the somatoform disorder category in the next version of the DSM should be taken as an opportunity to address this issue and facilitate research.

Clinimetric properties of the diagnostic criteria for psychosomatic research among the elderly

“…The results overall highlight that DCPR‐R‐SSI is a clinimetric clinically useful and innovative tool to comprehensively assess psychosomatic syndromes in the elderly, thus allowing to catch what may otherwise remain underdiagnosed among elderly subjects more often than in the general population (Dehoust et al, 2017; Galeazzi et al, 2004; Mansueto et al, 2022; Wijeratne et al, 2003) due to unsuitable and mislabelling usual taxonomy (Cosci & Fava, 2016, 2019; Frances & Chapman, 2013), and above all due to the overlap between psychosomatic symptoms and age‐related complaints (Dehoust et al, 2013; Mansueto et al, 2022; Wijeratne & Hickie, 2001). Psychosomatic syndromes are usually under detected among elderly with rates ranging from 1.5% (Lyness et al, 1999) to 13% (Leiknes et al, 2007), but when DCPR were applied, the rate raised up to 60% (Mansueto et al, 2022).…”

Clinical utility of the Diagnostic Criteria for Psychosomatic Research for a comprehensive assessment of the elderly

“…The use of DCPR-R in the elderly allowed to (a) catch more diagnoses than DSM-5, (b) identify differences in terms of psychological well-being and (c) improve the prediction of psychosocial functioning over and above the DSM-5. An assessment of the elderly aiming at being comprehensive, thus including DCPR-R, is fundamental for a multi-dimensional appreciation of their health status: frailty is a syndrome that involves interaction of biological, psychological and social factors (Hoogendijk et al, 2019); in the elderly the clinical manifestations of psychological distress are more often somatic than cognitive or emotional (Drayer et al, 2005); psychosocial factors (Engel, 1960(Engel, , 1977(Engel, , 1980(Engel, , 1997 are a priority challenge being protective or risk factors for mortality as well as (multi)morbility (Dehoust & Schulz, 2013).…”

“…Psychosomatic syndromes are particularly understudied in the elderly (Andreas et al, 2021;Mangelli et al, 2006;Wijeratne et al, 2003;Wijeratne & Hickie, 2001). Possible explanation of this undervaluation can be that clinicians still tend to use the reductionist biomedical model of illness (Engel, 1960(Engel, , 1977(Engel, , 1980(Engel, , 1997 not giving relevance to all those psychosocial factors which can contribute to the individual suffering (Dehoust & Schulz, 2013;Wijeratne & Hickie, 2001); they also might have difficulties in distinguishing psychosomatic syndromes among the background noise of multiple physical co-morbidities. As a consequence, especially in the elderly, clinicians may tend to attribute patient's complaints to ageing-related features rather than to psychosocial factors (Dehoust & Schulz, 2013;Wijeratne & Hickie, 2001), thus underestimating the potential protective or risk effect of psychosocial factors for morbidity and mortality (Dehoust & Schulz, 2013).…”