- Email: [email protected]
Is growing old a disease? A study of the attitudes of elderly people to physical symptoms
J ChronDis Vol. 40, No. 12, pp. 1095-1098,1987 Printed
in Great
Britain.
Copyright
All rights reserved
c
0021-9681/87 $3.00 + 0.00 1987 Pergamon Journals Ltd
IS GROWING OLD A DISEASE? A STUDY OF THE ATTITUDES OF ELDERLY PEOPLE TO PHYSICAL SYMPTOMS THOMAS GJ~UP,
CARSTEN HENDRIKSEN,* ELLINOR LUND
and
EDITH STR~MGARD
Medical Gastroenterological Department C, Herlev Hospital, University of Copenhagen, Institute of Genera1 Practice, University of Copenhagen and Roedovre Municipality, Copenhagen, Denmark
(Receiued in revised form 23 March 1987)
Abstract-In a surveyof people living at home, aged 77 yearsand over, a total of 126 women and 77 men were interviewed concerning their attitudes to their physical symptoms. For each organ system the subjects indicated whether their symptoms were considered to be a normal condition for elderly people or a manifestation of a disease. To a large extent symptoms were accepted as a normal condition, however, a highly significant difference in their attitudes to symptoms stemming from different systems was found (p i 0.001). Generally, compared with severe symptoms, mild symptoms were accepted more readily as a normal condition in old age. Although most of the elderly people had seen a doctor because of their symptoms, a highly significant difference was found in consultation rates among elderly persons with symptoms from different organ systems (p < 0.001). The attitudes to symptoms influenced the tendency of the subjects to consult a doctor (p < 0.05). The need for education of elderly people and health professionals is discussed.
Elderly people
Attitudes to symptoms
INTRODUCTION
STUDY POPULATION
With advancing age an increasing number of disabilities appear [l]. Therefore, elderly people may accept their symptoms as an expected manifestation of old age rather than as a manifestation of disease. Brody found [2] that elderly people minimize their symptoms and this may be an important reason why old people are reluctant to report their needs to the health professionals [3-S]. We have investigated whether elderly people living at home consider their symptoms as a normal condition in old age or as a manifestation of disease. Further we have examined whether the attitudes of elderly people towards their symptoms influence their inclination to consult a doctor. *Correspondence should be addressed to: Dr C. Hendricksen, Stockflethsvej 20, IX-2000 Copenhagen Frb., Denmark.
AND METHODS
Study population
The original study population consisted of 285 randomly selected people living in their homes, 178 women and 107 men, aged 75 years and over. The subjects were participants in an ongoing medico-social intervention study in a suburb of Copenhagen 163.In the second year of the study, interviews about the subject’s attitudes to symptoms were carried out. At this time 49 had died, 17 had moved into nursing homes, and 16 were unable to give reliable information or could not be contacted for other reasons. Accordingly 126 women (median age 80 years, range 77-97 years), and 77 men (median age 80 years, range 77-90 years) participated in the present study. Interviews Symptoms, The patients were visited at home
1095
THOMAS GI~JP et al.
1096
by one of the authors and were interviewed about physical symptoms that had lasted for 14 days or more. The symptoms were referred to one of 7 systems: (1) vision; impaired in spite of tentative correction, (2) hearing; reduced in spite of hearing aid, (3) cardiopulmonary system; i.e. chest pain, dyspnea, cough, expectoration, palpitation, peripheral edema, or other complaints, (4) alimentary system; i.e. abdominal pain, vomiting, obstipation, diarrhea, borborygmia, or other complaints, (5) genitourinary system; i.e. incontinence, pain at voiding, dysuria, increased frequency of urination, or other complaints, (6) locomotor system; i.e. pain in the extemities, the back or the neck, reduced joint motility, (7) central nervous system; i.e. headache, vertigo, tremor, paresis, or other complaints. Grade of symptoms. For each system the symptoms were graded as mild, i.e. symptoms that did not interfere with daily living, or moderate/severe, i.e. symptoms causing moderate or severe functional or social limitations of the person’s daily living. Attitudes to symptoms. For each symptom the subjects indicated whether they considered their symptoms (a) a normal condition for elderly people, (b) a manifestation of disease, (c) neither a normal condition nor a manifestation of disease, or whether (d) they did not know how to interpret their symptoms. Consulting a doctor. For each symptom the subjects reported whether they had consulted a doctor. Statistical methods. The Chi-square test was used to compare the number of subjects within the different groups.
RESULTS
No major differences between women and men were found in their attitudes to symptoms, Consequently, women and men are dealt with as one group. Attitudes to symptoms (Table I) For each system only a few (l-12%) of the elderly people stated that they did not know how to interpret their symptoms. For most of the subjects, symptoms from the eyes, ears, and genitourinary system were considered to be normal manifestations of old age, whereas symptoms from the cardiopulmonary, alimentary, and locomotory systems were not interpreted as symptoms to the same degree. This difference in attitude to symptoms was highly significant (p < 0.001). Grade of symptoms (Table 2) For each system the subjects generally considered their symptoms to be mild. For the locomotory system the lowest proportion, 47%, reported mild symptoms. When symptoms for all systems were moderate or severe, a lower proportion considered their symptoms to be normal manifestations of old age than when symptoms were mild. For visual and genitourinary systems this difference was significant (p < 0.05). Consulting a doctor (Table 3) The tendency to consult a doctor was found to be highly dependent on the localisation of the symptom (p < 0.001). The highest rate of con-
Table 1. The attitude to symptoms in 126 women and 77 men, of age 77 years or more Attitude to symptoms?
System Eyes Ears Cardiopulmonary system Alimentary system Genitourinary system Locomotor system Central nervous system
Symptom is a manifestation of disease
Symptom is neither normal nor a manifestation of disease
Do not know how to interpret symptoms
55 (68) 56 (72) 26 (28)
14(17) 7 (9) 38 (40)
9Vf) 13 (17) 26 (28)
3 (4) 2 (3) 4 (4)
41 (20) 79 (39)
4(fO) 51(72)
15 (37) ll(14)
17 (41) 10 (13)
5 (12)
112 (55) 60 (30)
21(24) 28 (47)
25 (22) 17 (28)
54 (48) 12 (20)
6 (5) 3 (5)
Number of subjects with symptoms*
Symptom is normal for elderly people _
81 (40) 78 (39) 94 (46)
*Parentheses: per cent of total number of subjects in the study. tparentheses: per cent of total number of subjects with symptoms within that system.
I(1)
Comparison of attitude to symptoms for the seven systems
p < 0.001
8 (15) 9 (23)
43 (63) 34 (62) 20 (25)
2 (8) 27 (59) 22 (23) 16 (46)
68 (84) 55 (71) 79 (84)
25 (61) 46 (58) 96 (86) 35 (58)
Symptom is normal for elderly people
13 (52) 10 (22) 25 (26) ll(31)
13 (19) 7 (13) 34 (43)
Symptom is a manifestation of disease 12 (18) 14 (25) 25 (32)
Symptom is neither normal nor a manifestation of disease/ don’t know
10 (40) 9 (20) 49 (51) 8 (23) *Parentheses: per cent of total number of subjects with symptoms from the system. tparentheses: per cent of total number of subjects who had/had not consulted a doctor.
Eyes Ears Cardiopulmonary system Alimentary system Genitourinary system Locomotor system Central nervous system
System
Number of subjects who had consulted a doctor*
Consulted a doctor Attitude to symptoms?
16 (39) 33 (42) 16 (14) 25 (42)
13 (16) 23 (29) 15 (16)
Number of subjects who had not consulted a doctor*
2(13) 30 (91) 5 (31) 12 (48)
12 (92) 22 (96) 6 (40)
Symptom is normal for elderly people
2(13) 2 (6) 0 6 (24)
1 (8) 0 4 (27)
Symptom is a. manifestation of disease
n.s.
p < 0.01 ns. n.s.
l(3) 11 (69) 7 (28)
n.s. 5 (33) 12 (75)
n.s.
p 4 0.05
0
Consulted versus not consulted a doctor. Comparison of attitudes
1(4)
Symptom is neither normal nor a manifestation of disease/ don’t know
Not consulted a doctor Attitude to symptomst
Table 3. Relation between consultation of a doctor and attitude to symptoms
n.s. ns. 32 (54) 4 (20)
17 (29) 8 (40)
10 (17) 8 (40)
59 (53) 20 (33)
28 (53) 11 (28)
17 (32) 20 (50)
53 (47) 40 (67)
n.s. p < 0.05
p < 0.05 n.s. n.s.
Mild vs moderate/ severe symptoms. Comparison of attitudes
6 (55) 2(11)
5 (19) 3 (14) 11 (32)
Symptom is neither normal nor a manifestation of disease/ don’t know
5 (45) 6 (32)
11:58)
11 (27) 19 (24)
16 (53) 9 (15)
10 (33) 5 (8)
4 (13) 46 (77)
30 (73) 60 (76)
9 (33) 4(19) 17 (50)
13 (48) 14 (67) 6(18)
27 (33) 21 (27) 34 (36)
7 (13) 12 (21) 19 (32)
5 (9) 3 (5) 21 (35)
42 (78) 42 (74) 20 (33)
54 (67) 57 (73) 60 (64)
Symptom is a manifestation of disease
Symptom is normal for elderly people
symptoms Attitude to symptomst
Number of subjects with moderate/ severe symptoms*
*Parentheses: per cent of total number of subjects with symptoms from the system. tparentheses: per cent of total number of subjects with mild/severe/moderate symptoms.
Eyes Ears Cardiopulmonary system Alimentary system Genitourinary system Locomotor system Central nervous system
System
Moderate/severe
Symptom is neither normal nor a manifestation of disease/ don’t know
Symptom is a manifestation of disease
-__
Attitude to symptomst
Symptom is normal for elderly people
Number of subjects with mild symptoms*
Mild symptoms
Table 2. Relation between grade of symptoms and attitude to symptoms
1098
THOMASGJC~RUPet al.
sulting a doctor was found among the elderly people who had symptoms from the locomotory and cardiopulmonary systems, or from their eyes. Elderly people who did not consult their doctor generally considered their symptoms to be manifestations of normal ageing, compared with the elderly people who saw a doctor. For hearing impairment and symptoms from the genitourinary system this difference was found to be significant (p < 0.05). DISCUSSION
For each organ system a majority of the subjects accepted their symptoms as normal conditions of old age. However, the individual valuations of symptoms were found to be highly dependent on the category of organ system. If a doctor had not been consulted, more of the subjects considered their symptoms to be a manifestation of normal ageing than if a doctor had been consulted. The demonstration of such resigned attitudes to physical symptoms accords well with the findings of Brody [2] who asked elderly people to state why they did not report their symptoms to anyone. The most frequent reasons given were that the symptoms were “no big deal” or “nobody cares”. As in the present study, significant differences in the frequency of reported symptoms from different systems have been found by Dean and Holstein [7], who reported that 5 1% of patients with chest pain had consulted a doctor, as opposed to 6% of patients with psychiatric symptoms. Only a little is known about the layman’s interpretation of symptoms. Fitzpatrick [8] has given a thorough description of the “gulf” between the layman’s and the professional’s concepts of illness, and in a study by Campbell [9] it was found that doctors were more likely than laymen to rate terms such as hypertension, alcoholism and starvation as diseases. Since the present study did not include younger subjects, we do not know whether our findings apply to old people only.
Knowledge about the attitudes of old people to symptoms is a prerequisite for optimal medical care of the elderly. The acceptance of symptoms as a normal manifestation of old age and the consequent reluctance to consult a doctor, as demonstrated in the present study, raise the question whether one should modify the health attitudes of old people through education. Although several health problems cannot be cured, consulting a doctor may result in an alleviation of discomforts. Doctors must be aware that elderly people apparently are less inclined to report symptoms from some organ systems than from others. The doctor should use an active questioning technique to secure reliable information about the health status of elderly people. project was supported by grants from Helsefonden (11/50-80) 11/41-81, and 11/38-82, Danish Medical Research Council (12-0500) and Roedovre Municipality.
Acknowledgements-The
REFERENCES I. Svanborg A. The gerontological
2. 3. 4.
5.
6.
and geriatric population study in Giiteborg, Sweden. Acta Med Stand 1977; Suppl. 611: I-37. Brady EM, Kleban MH. Physical and mental health symptoms of older people: Who do they tell? J Am Geriatr Sot 1981; 29: 442449. Williams EI, Bennett FM, Nixon JV, Nicholson MR, Gabert J. Sociomedical study of patients over 75 in general practice. Br Med J 1972; 2: 445448. Williamson J, Stokoe IH, Gray S, Fisher M, Smith A, MeGhee A, Stephenson E. Old people at home. Their unreported needs. Lancet 1964; i: 1I 17-I 120. Brody EM, Kleban MH, Moles E. What older people do about their day-to-day mental and physical health symptoms. J Am Ceriatr Sot 1983; 31: 489498. Hendriksen C, Lund E, Stromgird E. Consequences of assessment and intervention among elderly people: a three year randomised controlled trial. Br Med J 1984; 289: 1522-1524. Dean K, Holstein BJ. Illness behaviour in elderly persons. II. Self-treatment and seeking medical advice (with a Danish summary). Ugeakr Laeger 1983; 145: 687689. Fitzpatrick R. Lay concepts of illness. In: Fitzpatrick R, Hinton J, Newman S, Scambler G, Thompson J, Eds. The Experience of Illness. London: Tavistock Publications; 1984: 11-3 I. Campbell EJM, Scadding JG, Roberts RS. The concept of disease. Br Med J 1979; 2: 757-762.
in Great
Britain.
Copyright
All rights reserved
c
0021-9681/87 $3.00 + 0.00 1987 Pergamon Journals Ltd
IS GROWING OLD A DISEASE? A STUDY OF THE ATTITUDES OF ELDERLY PEOPLE TO PHYSICAL SYMPTOMS THOMAS GJ~UP,
CARSTEN HENDRIKSEN,* ELLINOR LUND
and
EDITH STR~MGARD
Medical Gastroenterological Department C, Herlev Hospital, University of Copenhagen, Institute of Genera1 Practice, University of Copenhagen and Roedovre Municipality, Copenhagen, Denmark
(Receiued in revised form 23 March 1987)
Abstract-In a surveyof people living at home, aged 77 yearsand over, a total of 126 women and 77 men were interviewed concerning their attitudes to their physical symptoms. For each organ system the subjects indicated whether their symptoms were considered to be a normal condition for elderly people or a manifestation of a disease. To a large extent symptoms were accepted as a normal condition, however, a highly significant difference in their attitudes to symptoms stemming from different systems was found (p i 0.001). Generally, compared with severe symptoms, mild symptoms were accepted more readily as a normal condition in old age. Although most of the elderly people had seen a doctor because of their symptoms, a highly significant difference was found in consultation rates among elderly persons with symptoms from different organ systems (p < 0.001). The attitudes to symptoms influenced the tendency of the subjects to consult a doctor (p < 0.05). The need for education of elderly people and health professionals is discussed.
Elderly people
Attitudes to symptoms
INTRODUCTION
STUDY POPULATION
With advancing age an increasing number of disabilities appear [l]. Therefore, elderly people may accept their symptoms as an expected manifestation of old age rather than as a manifestation of disease. Brody found [2] that elderly people minimize their symptoms and this may be an important reason why old people are reluctant to report their needs to the health professionals [3-S]. We have investigated whether elderly people living at home consider their symptoms as a normal condition in old age or as a manifestation of disease. Further we have examined whether the attitudes of elderly people towards their symptoms influence their inclination to consult a doctor. *Correspondence should be addressed to: Dr C. Hendricksen, Stockflethsvej 20, IX-2000 Copenhagen Frb., Denmark.
AND METHODS
Study population
The original study population consisted of 285 randomly selected people living in their homes, 178 women and 107 men, aged 75 years and over. The subjects were participants in an ongoing medico-social intervention study in a suburb of Copenhagen 163.In the second year of the study, interviews about the subject’s attitudes to symptoms were carried out. At this time 49 had died, 17 had moved into nursing homes, and 16 were unable to give reliable information or could not be contacted for other reasons. Accordingly 126 women (median age 80 years, range 77-97 years), and 77 men (median age 80 years, range 77-90 years) participated in the present study. Interviews Symptoms, The patients were visited at home
1095
THOMAS GI~JP et al.
1096
by one of the authors and were interviewed about physical symptoms that had lasted for 14 days or more. The symptoms were referred to one of 7 systems: (1) vision; impaired in spite of tentative correction, (2) hearing; reduced in spite of hearing aid, (3) cardiopulmonary system; i.e. chest pain, dyspnea, cough, expectoration, palpitation, peripheral edema, or other complaints, (4) alimentary system; i.e. abdominal pain, vomiting, obstipation, diarrhea, borborygmia, or other complaints, (5) genitourinary system; i.e. incontinence, pain at voiding, dysuria, increased frequency of urination, or other complaints, (6) locomotor system; i.e. pain in the extemities, the back or the neck, reduced joint motility, (7) central nervous system; i.e. headache, vertigo, tremor, paresis, or other complaints. Grade of symptoms. For each system the symptoms were graded as mild, i.e. symptoms that did not interfere with daily living, or moderate/severe, i.e. symptoms causing moderate or severe functional or social limitations of the person’s daily living. Attitudes to symptoms. For each symptom the subjects indicated whether they considered their symptoms (a) a normal condition for elderly people, (b) a manifestation of disease, (c) neither a normal condition nor a manifestation of disease, or whether (d) they did not know how to interpret their symptoms. Consulting a doctor. For each symptom the subjects reported whether they had consulted a doctor. Statistical methods. The Chi-square test was used to compare the number of subjects within the different groups.
RESULTS
No major differences between women and men were found in their attitudes to symptoms, Consequently, women and men are dealt with as one group. Attitudes to symptoms (Table I) For each system only a few (l-12%) of the elderly people stated that they did not know how to interpret their symptoms. For most of the subjects, symptoms from the eyes, ears, and genitourinary system were considered to be normal manifestations of old age, whereas symptoms from the cardiopulmonary, alimentary, and locomotory systems were not interpreted as symptoms to the same degree. This difference in attitude to symptoms was highly significant (p < 0.001). Grade of symptoms (Table 2) For each system the subjects generally considered their symptoms to be mild. For the locomotory system the lowest proportion, 47%, reported mild symptoms. When symptoms for all systems were moderate or severe, a lower proportion considered their symptoms to be normal manifestations of old age than when symptoms were mild. For visual and genitourinary systems this difference was significant (p < 0.05). Consulting a doctor (Table 3) The tendency to consult a doctor was found to be highly dependent on the localisation of the symptom (p < 0.001). The highest rate of con-
Table 1. The attitude to symptoms in 126 women and 77 men, of age 77 years or more Attitude to symptoms?
System Eyes Ears Cardiopulmonary system Alimentary system Genitourinary system Locomotor system Central nervous system
Symptom is a manifestation of disease
Symptom is neither normal nor a manifestation of disease
Do not know how to interpret symptoms
55 (68) 56 (72) 26 (28)
14(17) 7 (9) 38 (40)
9Vf) 13 (17) 26 (28)
3 (4) 2 (3) 4 (4)
41 (20) 79 (39)
4(fO) 51(72)
15 (37) ll(14)
17 (41) 10 (13)
5 (12)
112 (55) 60 (30)
21(24) 28 (47)
25 (22) 17 (28)
54 (48) 12 (20)
6 (5) 3 (5)
Number of subjects with symptoms*
Symptom is normal for elderly people _
81 (40) 78 (39) 94 (46)
*Parentheses: per cent of total number of subjects in the study. tparentheses: per cent of total number of subjects with symptoms within that system.
I(1)
Comparison of attitude to symptoms for the seven systems
p < 0.001
8 (15) 9 (23)
43 (63) 34 (62) 20 (25)
2 (8) 27 (59) 22 (23) 16 (46)
68 (84) 55 (71) 79 (84)
25 (61) 46 (58) 96 (86) 35 (58)
Symptom is normal for elderly people
13 (52) 10 (22) 25 (26) ll(31)
13 (19) 7 (13) 34 (43)
Symptom is a manifestation of disease 12 (18) 14 (25) 25 (32)
Symptom is neither normal nor a manifestation of disease/ don’t know
10 (40) 9 (20) 49 (51) 8 (23) *Parentheses: per cent of total number of subjects with symptoms from the system. tparentheses: per cent of total number of subjects who had/had not consulted a doctor.
Eyes Ears Cardiopulmonary system Alimentary system Genitourinary system Locomotor system Central nervous system
System
Number of subjects who had consulted a doctor*
Consulted a doctor Attitude to symptoms?
16 (39) 33 (42) 16 (14) 25 (42)
13 (16) 23 (29) 15 (16)
Number of subjects who had not consulted a doctor*
2(13) 30 (91) 5 (31) 12 (48)
12 (92) 22 (96) 6 (40)
Symptom is normal for elderly people
2(13) 2 (6) 0 6 (24)
1 (8) 0 4 (27)
Symptom is a. manifestation of disease
n.s.
p < 0.01 ns. n.s.
l(3) 11 (69) 7 (28)
n.s. 5 (33) 12 (75)
n.s.
p 4 0.05
0
Consulted versus not consulted a doctor. Comparison of attitudes
1(4)
Symptom is neither normal nor a manifestation of disease/ don’t know
Not consulted a doctor Attitude to symptomst
Table 3. Relation between consultation of a doctor and attitude to symptoms
n.s. ns. 32 (54) 4 (20)
17 (29) 8 (40)
10 (17) 8 (40)
59 (53) 20 (33)
28 (53) 11 (28)
17 (32) 20 (50)
53 (47) 40 (67)
n.s. p < 0.05
p < 0.05 n.s. n.s.
Mild vs moderate/ severe symptoms. Comparison of attitudes
6 (55) 2(11)
5 (19) 3 (14) 11 (32)
Symptom is neither normal nor a manifestation of disease/ don’t know
5 (45) 6 (32)
11:58)
11 (27) 19 (24)
16 (53) 9 (15)
10 (33) 5 (8)
4 (13) 46 (77)
30 (73) 60 (76)
9 (33) 4(19) 17 (50)
13 (48) 14 (67) 6(18)
27 (33) 21 (27) 34 (36)
7 (13) 12 (21) 19 (32)
5 (9) 3 (5) 21 (35)
42 (78) 42 (74) 20 (33)
54 (67) 57 (73) 60 (64)
Symptom is a manifestation of disease
Symptom is normal for elderly people
symptoms Attitude to symptomst
Number of subjects with moderate/ severe symptoms*
*Parentheses: per cent of total number of subjects with symptoms from the system. tparentheses: per cent of total number of subjects with mild/severe/moderate symptoms.
Eyes Ears Cardiopulmonary system Alimentary system Genitourinary system Locomotor system Central nervous system
System
Moderate/severe
Symptom is neither normal nor a manifestation of disease/ don’t know
Symptom is a manifestation of disease
-__
Attitude to symptomst
Symptom is normal for elderly people
Number of subjects with mild symptoms*
Mild symptoms
Table 2. Relation between grade of symptoms and attitude to symptoms
1098
THOMASGJC~RUPet al.
sulting a doctor was found among the elderly people who had symptoms from the locomotory and cardiopulmonary systems, or from their eyes. Elderly people who did not consult their doctor generally considered their symptoms to be manifestations of normal ageing, compared with the elderly people who saw a doctor. For hearing impairment and symptoms from the genitourinary system this difference was found to be significant (p < 0.05). DISCUSSION
For each organ system a majority of the subjects accepted their symptoms as normal conditions of old age. However, the individual valuations of symptoms were found to be highly dependent on the category of organ system. If a doctor had not been consulted, more of the subjects considered their symptoms to be a manifestation of normal ageing than if a doctor had been consulted. The demonstration of such resigned attitudes to physical symptoms accords well with the findings of Brody [2] who asked elderly people to state why they did not report their symptoms to anyone. The most frequent reasons given were that the symptoms were “no big deal” or “nobody cares”. As in the present study, significant differences in the frequency of reported symptoms from different systems have been found by Dean and Holstein [7], who reported that 5 1% of patients with chest pain had consulted a doctor, as opposed to 6% of patients with psychiatric symptoms. Only a little is known about the layman’s interpretation of symptoms. Fitzpatrick [8] has given a thorough description of the “gulf” between the layman’s and the professional’s concepts of illness, and in a study by Campbell [9] it was found that doctors were more likely than laymen to rate terms such as hypertension, alcoholism and starvation as diseases. Since the present study did not include younger subjects, we do not know whether our findings apply to old people only.
Knowledge about the attitudes of old people to symptoms is a prerequisite for optimal medical care of the elderly. The acceptance of symptoms as a normal manifestation of old age and the consequent reluctance to consult a doctor, as demonstrated in the present study, raise the question whether one should modify the health attitudes of old people through education. Although several health problems cannot be cured, consulting a doctor may result in an alleviation of discomforts. Doctors must be aware that elderly people apparently are less inclined to report symptoms from some organ systems than from others. The doctor should use an active questioning technique to secure reliable information about the health status of elderly people. project was supported by grants from Helsefonden (11/50-80) 11/41-81, and 11/38-82, Danish Medical Research Council (12-0500) and Roedovre Municipality.
Acknowledgements-The
REFERENCES I. Svanborg A. The gerontological
2. 3. 4.
5.
6.
and geriatric population study in Giiteborg, Sweden. Acta Med Stand 1977; Suppl. 611: I-37. Brady EM, Kleban MH. Physical and mental health symptoms of older people: Who do they tell? J Am Geriatr Sot 1981; 29: 442449. Williams EI, Bennett FM, Nixon JV, Nicholson MR, Gabert J. Sociomedical study of patients over 75 in general practice. Br Med J 1972; 2: 445448. Williamson J, Stokoe IH, Gray S, Fisher M, Smith A, MeGhee A, Stephenson E. Old people at home. Their unreported needs. Lancet 1964; i: 1I 17-I 120. Brody EM, Kleban MH, Moles E. What older people do about their day-to-day mental and physical health symptoms. J Am Ceriatr Sot 1983; 31: 489498. Hendriksen C, Lund E, Stromgird E. Consequences of assessment and intervention among elderly people: a three year randomised controlled trial. Br Med J 1984; 289: 1522-1524. Dean K, Holstein BJ. Illness behaviour in elderly persons. II. Self-treatment and seeking medical advice (with a Danish summary). Ugeakr Laeger 1983; 145: 687689. Fitzpatrick R. Lay concepts of illness. In: Fitzpatrick R, Hinton J, Newman S, Scambler G, Thompson J, Eds. The Experience of Illness. London: Tavistock Publications; 1984: 11-3 I. Campbell EJM, Scadding JG, Roberts RS. The concept of disease. Br Med J 1979; 2: 757-762.