Physical Functioning in Older Persons With Somatoform Disorders: A Pilot Study

详细信息    查看全文

• 作者：Carolien E.M. Benraad ; MD^a ; ^{c.benraad@propersona.nl} ; Peter H. Hilderink ; MD^a ; ^b ; Dorine T.J.W. van Driel ; MSc^a ; Luc G. Disselhorst ; MD^a ; Brechtje Lubberink ; MD^a ; Loes van Wolferen ; MD^a ; Marcel G.M. Olde Rikkert ; MD ; PhD^c ; Richard C. Oude Voshaar ; MD ; PhD^a ; ^b
• 关键词：Aged ; medically unexplained symptoms ; somatoform disorders ; geriatric assessment
• 刊名：Journal of the American Medical Directors Association
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：14
• 期：1
• 页码：75.e9-75.e13
• 全文大小：138 K

文摘

Objectives

The primary objective of this study was to systematically examine the physical functioning of older persons with somatoform disorders, as this has never been carried out before. Second, we wanted to test our hypothesis that higher somatic disease burden in patients with somatoform disorders is associated with a higher level of somatisation.

Design and Setting

Observational study of patients referred for medically unexplained symptoms (MUS) to our outpatient mental health center for older adults. The patients were offered a standardized, multidisciplinary diagnostic procedure, including a comprehensive geriatric assessment. Inter-rater reliability between two geriatricians assessing the contribution of somatic pathology to the main somatic symptom was assessed.

Participants

A total of 37 patients referred for MUS (mean age 75 ¡À 6 years).

Measurements

Timed up and go test (TUG) and hand grip strength were used as measures for frailty; the Cumulative Index Rating Scale for Geriatrics (CIRS-G) sum score and severity index measured the burden of cumulative somatic morbidity. The Groningen Activity Rating Scale (GARS) measured functional status. The Whitely Index was used as measure for somatisation.

Results

Patients¡¯ main symptom could be completely explained by a somatic disease in 3/37 (8 % ) patients (kappa between geriatricians?= 0.72). A total of 32 patients met the criterion for a Somatoform Disorder according to DSM-IV-TR criteria, but somatic comorbidity partially explained the main symptom in 15/32 patients. These patients were older (P?= .049), had more somatic comorbidity (P?= .049), a slower gait speed (TUG, P?= .035), a lower hand grip strength (P?= .050), and a lower functional status (P?= .30) compared with the 17 patients without any explanation for their main somatic symptom. In contrast to our hypothesis, a higher level of somatisation was associated with less somatic disease burden.

Conclusion

Geriatric assessment has an important added value in older patients referred with medically unexplained symptoms because in half of these patients, symptoms can be partially or fully explicable following careful assessment of comorbidity and frailty.