Body symptoms in later life

In later life, aches, tiredness, dizziness and changes in sleep and digestion become more common. So do long-term illnesses and the medicines used to treat them. This makes body symptoms harder to sort out, for older adults, their families and their doctors.

Two mistakes are easy to make. One is to brush a symptom off as "just getting older." The other is to chase it with test after test. This page explains why body symptoms are different later in life, how depression, anxiety and medicines can hide behind them, and how families can help.

Why symptoms are harder to sort out later in life

Many older adults live with more than one long-term condition, such as arthritis, heart disease, diabetes or lung disease. Each can cause pain, tiredness, breathlessness or dizziness. On top of that, stress, grief, loneliness and low mood can add symptoms of their own.

This shows up in questionnaires. In a large national survey in Germany, scores on the PHQ-15, the body symptom questionnaire used in our MindCheck, rose with age.² Researchers who study later life warn that in older people, these questionnaires partly measure the burden of physical disease, not only stress-related symptoms.¹ So a high body symptom score in later life is a reason for a careful medical review, not a sign that symptoms are "all stress."

Long-lasting symptoms with no clear medical cause are actually less common in later life than earlier. A review of six studies looked at somatoform disorders, an older name for these conditions. They were found in a median of about 5 in 100 people aged 65 and older, compared with about 15 in 100 younger adults.¹ When they do occur, they often come mixed with symptoms from known illnesses.⁹

Medicines: a common hidden cause

Older adults often take several medicines, a pattern called polypharmacy. People 65 and older take more medicines than any other age group. Taking many medicines raises the risk of side effects and interactions, and the body handles medicines differently with age.³

Side effects can show up as body symptoms, such as dizziness, indigestion, headaches, a dry mouth or mood changes.³ Some medicines can cause balance problems and dizziness, which can lead to falls.⁵

Sometimes a side effect is mistaken for a new medical problem and treated with yet another medicine. Experts call this a prescribing cascade. It is an under-recognized reason older adults end up on many medicines.⁴ In a study of older U.S. veterans, doctors almost never noted that swelling might be a side effect of a nerve pain medicine before prescribing a water pill for it.⁴

When depression and anxiety show up as body complaints

Depression is not a normal part of aging, but it can be hard to recognize later in life. Some older adults feel numb or lose interest in things rather than feeling sad, and some are less open to talking about feelings.⁷ In some cultures, depression shows up mainly as physical symptoms, such as aches, headaches, cramps or digestive problems.⁷

A review for family doctors calls this "depression without sadness." Older adults with depression may come to the doctor with body complaints that have no medical cause, or that seem out of proportion to their illness. They may be less willing to mention emotional symptoms.⁶ The review warns that doctors and families often find a "reason" for an older person's low mood, such as illness or loss, and so treatment is delayed or never offered. Yet depression can respond to treatment whatever its cause.⁶ It also advises a careful review of all medicines.⁶

Anxiety in later life raises similar questions. Experts have suggested that older adults may report fewer emotional signs of anxiety and more body signs, though this has not been well studied.⁸ Medical conditions such as thyroid disease or diabetes can cause symptoms that look like anxiety. And when anxiety is blamed entirely on a long-term illness, it may not get treated.⁸

A Dutch study compared 118 people aged 60 and older who had unexplained body symptoms with 154 who had symptoms explained by illness. Those with unexplained symptoms had more emotional distress and more worry about their health. After taking age, sex and education into account, rates of other mental health conditions were similar in the two groups. The authors concluded that care should focus on easing distress.⁹

See Depression in later life, Anxiety in later life and Health anxiety.

Two risks: "just aging" and too many tests

Being brushed off

Aches and tiredness are common with age, but they are not something to simply accept. A new or changing symptom deserves a medical check. Dizziness, for example, can come from medicines, inner ear problems, alcohol, blood pressure problems, heart disease, diabetes, stroke, or problems with vision, thyroid or nerves. Many of these can be treated.⁵ And depression that shows up as body symptoms is easy to miss.⁶

Too many tests

Scans often find changes that come with age and cause no symptoms. In people with no back pain at all, scans showed disk wear in 96 out of 100 people aged 80, and disk bulges in 84 out of 100.¹⁰ Findings like these can be blamed for symptoms they do not cause, leading to more tests, worry and sometimes treatments that do not help.¹⁰

A helpful middle path is to ask your doctor: "What are you looking for, and would the result change what we do?" Read more in Getting checked.

Common symptoms in later life

• Dizziness and unsteadiness. Many older adults have balance problems or dizziness, and they are one reason older people fall.⁵ Ask about medicine changes, blood pressure, hearing and vision, and balance training. See Fear of falling and Falls.
• Tiredness. Poor sleep, depression, medicines and many illnesses can all cause it. See Sleep in later life.
• Pain. Long-term pain is common and often goes along with low mood. Both can be treated. See Chronic pain and mood.
• Memory worries. Worry about memory can come with depression and anxiety as well as with brain changes. See Normal aging or dementia?

What helps in later life

The same approaches are used at any age: a clear explanation, regular visits with one doctor, steady activity, good sleep, calming skills and, when needed, therapy or medicine. See Self-help and Treatment.

A few adjustments help:

• Choose safe movement, such as walking, chair exercises, tai chi or water exercise, and include balance work. See Strength and balance.
• Ask for a medicine review before adding new medicines for new symptoms.
• Bring a list of questions and someone to help remember the answers.
• Look for therapists who work with older adults. See Geriatric psychiatry and What Medicare covers for mental health.

For family caregivers

You may be the first to notice that a parent or spouse seems more tired, is eating less or keeps mentioning the same ache. You can help without taking over:¹¹

• Go to appointments if the person would like you there. Ask them to sign the office's privacy release form so the doctor can talk with you.
• Bring a full medicine list, including vitamins, supplements and medicines from other doctors.
• Make sure glasses and hearing aids are working, and ask for an interpreter if the doctor does not speak the person's language.
• Write down questions, starting with the most important, and take notes.
• Let the person answer the doctor's questions, and include them in every part of the conversation. Step out if they want privacy.

Try to avoid both extremes: waving off every complaint, or treating each new ache as an emergency. A shared symptom diary can help you both see patterns. And look after yourself too. See Caregivers and Caregiver burnout.

Common questions

Is it normal to hurt more as you age?

Some aches are more common with age, but ongoing pain is not something you have to accept. Pain often has treatable causes, and pain and low mood can both be helped. See Chronic pain and mood.

Should my mother have every test her doctor offers?

Tests are important when there is a real chance they will find something that changes her care. It is fair to ask what each test is looking for. In later life, scans often show age-related changes that are not causing symptoms.¹⁰

When to get help

See a doctor for any new, worsening or changing symptom, for weight loss you cannot explain, or if an older person seems flat, withdrawn or not themselves for more than two weeks.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.