Affective state and symptoms prevalence in the elderly.

Abstract

To the Editor:—Hale and Coll in their article “Symptoms Prevalence in the Elderly”1 conclude, renforcing a principle of geriatric medicine, that age alone is not sufficient to explain the occurrence of a symptom. When an elderly patient complains of a symptom, it cannot simply be cast aside as a price of aging but is more likely to be correlated with a disease. We agree with these conclusions, but we also note that Hale and Coll paid no attention to symptoms as possible affective manifestations. This is really important in advanced age and may explain why women report more symptoms than men. Our group recently developed a multidimentional study carried out by a group of general practitioners on a large “healthy” geriatric population living in Brescia, Italy (386 males and 815 females, 70 to 75 years of age). In this study, information was collected on 23 common symptoms (aches, chest discomfort with exercise, dyspnea, irregular heart beat, cough, swollen feet or ankles, pain in calves/legs, paresthesias, tiredness, dizziness, tinnitus, unsteadiness, difficulty walking, dysphagia, anorexia, toothache, constipation, dysuria, nosebleeds, headaches, amaurosis fugax, deafness, itching) and on the affective domain using Beck's Depression Inventory Scale (modified) (BDIS). The results indicate a remarkable frequency of somatic symptoms among the elderly that scored above the BDIS cut-off point indicating mild to moderate depression. In fact, both in male and female subjects depression correlates with a higher incidence of somatic complaints, and the number and frequency of symptoms is higher in women than in men (P < 0.01). Data support that somatic complaints should be considered as possible manifestations of a depressed mood. On the other hand, our findings confirm the greater tendency in women to express dysphoric mood through somatic symptoms. Adult women tend to consider emotion as more important in life than men do; however, they tend to inhibit their emotions more often and hide affective problems behind somatic symptoms.