This article appears in May-June Family magazine.

When growing older, common complaints such as pain, fatigue, poor sleep, depression, anxiety and difficulty breathing may often be more serious than one realizes.

Nearly half of adults 65 and older have two or more of these symptoms and one-fourth have three or more, according a to national study of 7,609 U.S. Medicare beneficiaries recently published by the Journal of the American Geriatrics Society. Doctors often miss these symptoms — and the more serious health issues they point to — because patients only talk about one of these symptoms during a visit.

About the study

The study defined symptoms as negative health-related experiences reported by patients but not observed by clinicians. Symptoms account for most outpatient visits and are among the leading causes of disability, the study said.

Having multiple symptoms is common among older adults and increases the risk for a range of negative health outcomes over time, such as falls and hospitalization, said the study’s lead author Kushang Patel, research associate professor in anesthesiology and pain medicine at the University of Washington School of Medicine.

In less extreme circumstances, compound symptoms often interfere with accomplishing daily activities, Patel said.

During the study researchers assessed patients’ physical performance over a six-year period and monitored the occurrence of falls, disability, hospitalization, nursing home admission and mortality.

Note all symptoms

While some symptoms can be attributed to a specific disease or condition, such as chest pain with heart disease, often symptoms have multiple causes and can reinforce each other.

When older patients visit the doctor to discuss pain management, they may also be experiencing fatigue and sleep difficulty, Patel said. Those three symptoms are the most common triad, affecting 4.7 million older Americans, the study found.