American Board of Family Medicine (ABFM) Practice Exam

Which symptom is most likely to be observed in a depressed elderly patient?

1. Suicidal ideation

2. Somatic symptoms

3. Depressed mood

4. Preoccupation with guilt

The correct answer is: Somatic symptoms

In elderly patients, depression often manifests through a variety of symptoms, and one of the most prominent ways is through somatic symptoms. These can include complaints of physical pain, fatigue, insomnia, and gastrointestinal issues that do not have a clear medical cause. Unlike younger individuals who may more readily report classical symptoms of depression, such as a persistently low mood or excessive guilt, older adults may express their emotional distress through physical complaints. This somatic representation can often lead to misdiagnosis or delayed diagnosis, as these patients may present to various healthcare providers for treatment of their physical symptoms instead of their underlying depressive condition. While suicidal ideation, depressed mood, and preoccupation with guilt are also relevant symptoms of depression, they tend to manifest less obviously in elderly patients. Instead, they may show subtle signs of sadness or guilt without explicitly expressing these feelings. Consequently, recognizing somatic symptoms is crucial for identifying depression in this population, as it can lead to appropriate treatment and better outcomes for elderly patients suffering from depression.