Fears of disease and disability in elderly primary health care patients

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Abstract

Some diseases are more frightening than others to patients and every culture or society has its own most dreaded disease(s). In some previous studies it has been shown that the fears of the patients sometimes have their roots in events in family history. In this qualitative study fourteen men and women aged 66–83 years, all of whom were primary care patients were interviewed with regard to their fears in connection with their present symptoms as well as in general. The results showed that diseases believed to entail disability, bodily changes and/or loss of control over body or environment, were the most feared. These diseases are also likely to stigmatise or shame the bearer, i.e., to change the identity for the worse. This is in line with other studies, where control and autonomy is demonstrated to be essential for elderly people's self-esteem.

Introduction

Clinical medicine takes place in the encounter between patient and doctor. In that context both parties bring their respective backgrounds, education and experiences. This constitutes a frame of reference, within which the patient's present problem can be interpreted [1]. For the doctor, medical science and professional experience are likely to be the most important sources of knowledge and values. The patient, on the other hand, has gained his/her lay knowledge from many other sources among which experience of disease in the family seems to play an important role 2, 3. The patient and the doctor have agendas for the encounter which are not necessarily congruent 4, 5. For a successful consultation, both these agendas must be dealt with to form a congruent perception of what is the problem. The patient's perception of the problem has several sources. These are general as well as personal. Prevailing lay ideas about health and disease can be modified by personal experience. This experience could for instance be education, training and professional experience, own experience of illness and events from the medical family history as well as illness affecting other emotionally significant persons. In her thesis Lunde [5]proposes a model, where the general influence on the patient's perception of the present health problems is exerted by prevailing norms and attitudes concerning health and illness. The personal experience contributes by developing and modifying these attitudes. The perceptions of the patient are therefore not static, but continuously influenced by different kinds of experience.

In previous studies 2, 3we have demonstrated that unselected primary health care patients as well as asymptomatic middle-aged men with newly discovered hypercholesterolaemia often have worries and fears concerning their condition. The patients frequently use events from their family history when interpreting their symptoms or risk factors. In some cases the patient's reflections concern hereditary aspects of disease among family members but in other the emotional closeness to affected persons is most important. Often, the event is used as an example or a modifier of more generally prevailing lay beliefs and attitudes. In this study this phenomenon was further explored. The study focused on elderly patients for two reasons: (a) they frequently consult in primary health care, sometimes with considerable worries without evidence for serious disorders; (b) they have a long life's experience of disease, own and among family and friends.

The specific aim of this study was to shed further light on the reasons for why patients fear certain diseases more than other. Special attention is paid to the significance of personal experience.

Section snippets

Subjects and methods

Seven men and seven women aged 66–83 years were interviewed. All were born in Sweden and resided in an urban district of the city of Malmö, Sweden. They were seeking care at one of the three public primary health care centres serving this district. At the time of the visit all the patients were presenting a new complaint, that was not previously investigated and diagnosed. Patients with any impaired ability to communicate verbally were not included. The patients were given oral information

Results

Thirteen of the 14 patients made one or more statements concerning diseases they considered to be especially threatening and frightening. The analysis of the patients' statements with reference to their fears resulted in four categories. More than one category could be present in one interview. The categories were the following: (1) bodily changes; (2) loss of control over environment and daily living; (3) prolonged dying and suffering; (4) loss of control over health and disease.

There were no

Discussion

Every culture and society has its own notions of disease, dying and death. Feifel [8]suggests that man in Western society has become unfamiliar with these aspects of the human condition, which have become matters exclusively for professionals. He also stresses the increasing predominance of science and the decreasing influence of religion as an important background. Furthermore, he believes, that in a society where success, happiness and orientation towards the future are highly valued, the

Practice implications

From the perspective of the individual the control of the body is fundamental to the maintenance of self-esteem. A perceived loss of control provokes the feeling of shame. Shame is a complex negative emotion that follows exposure of aspects of the self of a vulnerable, sensitive or intimate nature 18, 19. Infirmity itself, its specific attributes as well as the mere exposure of it are phenomena connected with shame. The clinical relevance of these phenomena is not without importance. The

References (21)

  • M. Harris

    Helping the person with an altered self-image

    Geriatric Nurs

    (1986)
  • V. Sacks

    Women and AIDS: an analysis of media misinterpretations

    Soc Sci Med

    (1996)
  • Troein M. High blood cholesterol. Physician and patient perspectives. Thesis, Malmö,...
  • A. Brorsson et al.

    The patient's family history: a key to the physician's understanding of patients' fears

    Fam Pract

    (1993)
  • A. Brorsson et al.

    My family dies from heart attack

    Fam Pract

    (1995)
  • J.H. Levenstein et al.

    The patientcentred clinical method. A model for doctor–patient interaction in family medicine

    Fam Pract

    (1986)
  • Lunde IM. Patienters egenvurdering – et medicinsk perspektivskift. (Thesis in Danish with English summary: Patients'...
  • Glaser BG, Strauss AL. The discovery of grounded theory. Strategies for qualitative research. New York: Aldline,...
  • Strauss AL, Corbin J. Basics of qualitative research. Grounded theory procedures and techniques. Newbury Park: Sage,...
  • Feifel H. Perceptions of death by western man. Death, dying and bereavement, Symposium, Stockholm,...
There are more references available in the full text version of this article.

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