Older patients with medically unexplained symptoms: Meaning in life

Introduction: Old age has its infirmities; as age goes by, physical complaints become more common. Having a disease can cause difficulties in giving meaning to life. For instance, patients with chronic diseases frequently ask themselves: “Why did this happen to me?”Chronic Medically Unexplained Symptoms (MUS) in later life can bring even greater challenges.MUShave serious impact on patients' lives; patients with MUS report decreased quality of life scores compared to other primary care patients. As the prognosis of unexplained physical complaints is unclear, patients with chronic MUS can have great challenges in finding meaning in life. This pilot study focuses on unraveling factors that contribute to giving meaning to life in older patients with MUS. Methods: In this qualitative pilot study, one-hour in-depth interviews with five elderly patients withMUS (>60years) were conducted. With use of a predesigned topic list (e.g. 'thoughts about relationships with family', 'thoughts about the past', 'thoughts about the future'), the trained interviewer asked questions about (later) life withMUS. Afterwards, all interviews were transcribed verbatim and coded by two independent researchers. Subsequently, codes were discussed until consensus was reached. Based on this pilot study,more patients will be included and selected using a purposive sampling strategy, varying age (75years), gender andmarital status. Results: Several interesting aspects about finding meaning in life with MUS were noticed. Firstly, finding a way of dealing with MUS ('coping'), gives patients a better sense of meaning in life. Especially the coping strategy 'acceptance' can lead to a better sense of controlling life and provides (with) a feeling of autonomy. Secondly, having positive relationships with friends and family gives older patients with MUS a sense of approval. Thirdly, doctors and counselors can contribute to a better meaning in life, by providing an overall picture of the patient's situation. Thus, physical, psychological and social factors should be considered during consultation, to make better sense of the current physical symptoms. Finally, older patients with MUS tend to live life in the present. Thinking about the future and the overall process of getting older can be frightening. Conclusions: Older patients with MUS can have difficulties in finding meaning in life. Though individual aspects, e.g. coping strategy, can contribute to finding this sense of meaning in life, other people can contribute to a sense of meaning as well. Friends and family members, but also doctors and counselors can contribute to a feeling of meaning in life by paying attention to physical, psychological and social factors in the patient's life. In contrary to the widely accepted idea that MUS patients are mainly focused on physical aspects in life, older patients with MUS themselves prefer an overall view on MUS containing physical, psychological and social factors. This holistic view gives opportunities to improving health care for older patients with MUS