title: Physical functioning in older persons with somatoform disorders: a pilot study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  A total of 37 patients referred for MUS (mean age 75 ± 6 years).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pro Persona Centre for Integrative Mental Health Care, Department of Old Age Psychiatry and Geriatrics, Nijmegen, The Netherlands. c.benraad@propersona.nl
authors.forename: Carolien E M
authors.initials: CE
authors.lastname: Benraad
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hilderink
authors.forename: Dorine T J W
authors.initials: DT
authors.lastname: van Driel
authors.forename: Luc G
authors.initials: LG
authors.lastname: Disselhorst
authors.forename: Brechtje
authors.initials: B
authors.lastname: Lubberink
authors.forename: Loes
authors.initials: L
authors.lastname: van Wolferen
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
authors.forename: Richard C
authors.initials: RC
authors.lastname: Oude Voshaar
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D010865:Pilot Projects; D013001:Somatoform Disorders / Q000503:physiopathology*; D018709:Statistics, Nonparametric