Frequent physical symptoms are common complaints among older adults with depression. Vague aches and pains — including chronic joint pain, limb pain, back pain, gastrointestinal problems, fatigue, sleep disturbances, and appetite changes — often point to an underlying psychiatric origin.
When older adults complaining of these symptoms seek treatment in the primary care setting, providers may interpret symptoms as signs of somatic illness and miss the diagnosis of depression; frequent complaints of painful physical symptoms are correlated with greater severity of underlying depression.

Frequent physical complaints are also characteristic of older adults with generalized anxiety disorder, a condition that frequently coexists with symptoms of depression and affects over a quarter of individuals above age 65. Health anxiety is especially prevalent among older adults with chronic conditions, such as hypertension, urinary incontinence, hearing impairment, and poor sleep habits. Presentation of anxiety may also be complicated by high rates of comorbid medical and psychological conditions and related pharmacologic treatments.

Anxiety and medical problems often have a reciprocal influence, with psychological problems increasing one’s vulnerability to physical disease. Older adults who have experienced a fall, for example, may develop a fear of falling and begin to self-restrict mobility, resulting in reduced exercise and increased risk for physical complications of immobility.
Physical disease can also cause psychological symptoms, in the case of patients with diagnosed cardiovascular disease who fear experiencing palpitations and shortness of breath during physical activity.
Elderly patients exposed to psychosocial stressors also tend to struggle with anxiety. Negative life events, such as loss of a spouse, change in employment status, and compromised independence, are likely to worsen symptoms of anxiety if not addressed.

Adapted from Hartford Institute for Geriatric Nursing. ConsultGeri. Internet. Accessed on September 9, 2016.