The popular contention that preoccupation with bodily functions is characteristic of older age has been accepted by the lay and medical community on the basis of received wisdom. The reality is that somatic presentations of distress have been largely ignored by geriatric (or old age) psychiatry for a number of reasons. The esultant paucity of age-specific literature necessarily limits any review of this ature. The general conceptual failings in the nosology enshrined in the Diagnostic and tatistical Manual (DSM) remain a major impediment to their study in old age. The definition of the somatoform disorders has been described as “among the tallest and most complex conceptual edifices ever erected in medicine.” Their essence—the presentation with a physical (ie, somatic) symptom(s) for which there is no, or an inadequate, patho-physiological explanation—is particularly troublesome in older people. The definition also assumes a psychogenic explanation for symptoms, although the category was intended to be etiologically neutral. Primary care studies have shown that recognition of psychological distress was lower in patients who were older or had a predominantly somatic presentation. Possible reasons for this include the masking effect of physical illness, or the incorrect belief that emotional or somatic distress is apposite to old age. Standardized assessment scales used in research that require raters to determine whether each somatic symptom is “medically explained” may also encourage a conservative approach to diagnosis in the presence of physical disease. Even if a physical cause is deemed inappropriate, the use of traditional psychiatric hierarchies in which mood and psychotic disorders are favored over “minor” disorders such as somatoform disorders means that depressive disorders may be seen as the next most likely explanation for a somatic presentation.