The proposed studies use multi-dimensional scaling and open-ended interviews to uncover the content and underlying dimensions of elderly people's illness cognition: i.e. the cues they use to identify specific illnesses, and their ideas about the cause, time line and consequences of illness. The procedures will also tap how they respond emotionally to illness and how they cope with it. Scales will be developed to measure these factors in clinical populations so we can compare elderly and middle-aged respondents and patients to one another and to patients with four different chronic diseases (hypertension, COPD, arthritis and cancer - in remission). We will study how illness cognition affects emotion and coping, how all three affect selection of symptoms for reporting at clinic visits, how the three affect confusions between different illnesses and how they influence compliance with treatment for problems presented by the patients in comparison to unreported problems uncovered by the practitoner. We will assess whether patients misidentify the nature and cause of illness because their expectations regarding symptom presentations are appropriate to the natural history of disorders in the middle rather than the later years of life. The final goals are to see whether illness representations and coping are related to feelings of age and to the development of dependency and to unnecessary physical and psychosocial disability. Seeing illness as progressing uncontrollably with age may provoke loss of hope and depressive feelings and lead to apathy and withdrawal from social relationships. These hypotheses will be tested in the four clinical populations of elderly patients. Finally, an intervention study is proposed comparing a participatory interaction with a standard, treatment control. The participatory interaction is designed to enhance the patient's perception that he/she is an active agent in the identification and treatment of illness problems and to increase his/her feeling of competence, reduce his/her sense of psychological age, and generalize improved coping skills to every-day problems so as to reduce physical and psychosocial disability.
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