Effects of Psychologic Dysfunction on Physical Health

Elderly persons who experience significant losses (eg, loss of a spouse or partner, economic status, physical health, or overall independence) often have diminished self-esteem and depression. A loss of control over one's life may be so disturbing that it may result in physical symptoms that represent maladaptive efforts to control other persons, gain attention, or signal for help. Vague physical decline does not always indicate physiologic aging or the subtle progression of underlying physical illness. In one study of depressed men and women > 60 years, physical complaints were reported by > 60%. The nature and rate of physical decline in a patient who is clinically depressed can reflect the will to live or die.

Many elderly persons in the community have the same degree of physical disability as those in nursing homes; the differences appear to be related to the availability of family members, the availability of other types of social support, and coexisting psychiatric disorders.

Psychosocial factors may aggravate existing physical disorders or precipitate latent ones. For example, psychologic disorders (eg, anxiety) may lead to physical discomfort in more than half of elderly persons with gastrointestinal complaints. In the elderly, about half of the cases of gastrointestinal distress (eg, irritable colon, spastic colitis, gastritis, heartburn, nausea, diarrhea, constipation) have a psychogenic component.

Physical disorders may affect psychologic disorders. More than 25% of elderly persons have impaired hearing; in such persons, a sensory-deprivation phenomenon may cause psychotic symptoms (eg, delusions).

Coexisting physical and psychologic disorders may precipitate further physical or psychologic decline. A frail elderly person with depression or psychosis may be unable to correctly take drugs to treat physical ailments.