Frailty and Somatic Comorbidity in Older Patients With Medically Unexplained Symptoms

Abstract

Objectives: To examine the level of frailty and somatic comorbidity in older patients with medically unexplained symptoms (MUS) and compare this to patients with medically explained symptoms (MES).

Design: Cross-sectional, comparative study.

Setting: Community, primary care, and secondary healthcare to recruit patients with MUS in various developmental and severity stages and primary care to recruit patients with MES.

Participants: In total, 118 patients with MUS and 154 patients with MES, all aged ≥60 years.

Methods: Frailty was assessed according to the Fried criteria (gait speed, handgrip strength, unintentional weight loss, exhaustion, and low physical activity), somatic comorbidity according to the self-report Charlson comorbidity index, and the number of prescribed medications.

Results: Although patients with MUS had less physical comorbidity compared with patients with MES, they were prescribed the same number of medications. Moreover, patients with MUS were more often frail compared with patients with MES. Among patients with MUS, physical frailty was associated with the severity of unexplained symptoms, the level of hypochondriacal beliefs, and the level of somatisation.

Conclusions and implications: Despite a lower prevalence of overt somatic diseases, patients with MUS are more frail compared with older patients with MES. These results suggest that at least in some patients age-related phenomena might be erroneously classified as MUS, which may affect treatment strategy.

Keywords: Frailty; MES; MUS; comorbidity; medically unexplained.