The proposed study of lay care represents an extension of a nine year research program focusing on strategies used by nonmetropolitan elderly in coping with declining health and functional capacity. The project will explore the process of illness behavior, which involves interpretation of symptoms, lay consultation, and intervention strategy, including, self care and professional treatment. Special attention will be focused on the conditions under which symptoms are ignored or normalized outside of a medical model. The study will also examine the impact of structural characteristics of lay referral networks on access to information and other coping resources. Data for the analysis will be collected through health diaries and interviews with a probability sample of people 65 years of age and older living in a predominantly nonmetropolitan region of northeastern New York. Illness behavior is a recursive process, and the time-series data produced by health diaries will permit inferences of causality which are not possible in studies relying exclusively on cross-sectional data. Collecting information from a probability sample of elderly living in small towns or rural communities represents an extension of previous studies, most of which are based on patient populations, convenience samples, or urban respondents. Studying lay care among the elderly offers a number of benefits. The majority of symptoms are treated outside the formal medical care delivery system, and a large proportion of those who receive medical care have treated themselves before seeking professional advice. This may be especially true of symptoms experienced by older people with multiple chronic conditions, which may be ignored either because they are confused with symptoms of an earlier condition or because they are viewed as inevitable consequences of aging.
