Aging Versus Disease: The Opinions of Older Black, Hispanic, and Non‐Hispanic White Americans About the Causes and Treatment of Common Medical Conditions

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Abstract
BACKGROUND Little is known about how older people interpret disease and how those interpretations might relate to use of medical services. OBJECTIVE To assess opinions of older subjects about the cause and treatment of common diseases and how they are related to health behaviors. DESIGN In‐home interview of a population‐based sample (n = 601) of noninstitutionalized black, Hispanic, and non‐Hispanic white American men and women aged 75 and older in Galveston County, Texas. RESULTS Substantial proportions of the subjects considered heart disease, arthritis, or difficulty sleeping to be a normal part of aging. In multivariate analyses including age, gender, education, marital status, living arrangement, global self‐rating of health, and comorbidity, older black subjects were less likely to view heart disease (OR = 0.41; 95% CI, 0.26–0.64), arthritis (OR = 0.48; 95% CI, 0.31–0.73), or sleep problems (OR = 0.50; 95% CI, 0.32–0.77) as a normal part of aging than were non‐Hispanic whites. Blacks were more than three times as likely to attribute heart disease to overwork or stress than were non‐Hispanic whites. In multivariate analyses, subjects who considered all three of the medical conditions to be a normal part of aging (“fatalistic”) were less likely to have received preventive medical services in the previous year (OR = 0.13; 95% CI, 0.02–0.96), and subjects who felt that nothing could be done to treat any of the conditions (“nihilistic”) were less likely to have a regular physician (OR = 0.24; 95% CI, 0.08–0.74). CONCLUSIONS Substantial numbers of older subjects are fatalistic about the cause of disease and/or nihilistic about its treatment. These attitudes are associated with decreased utilization of health services. Attempts to improve the health of underserved groups should employ interventions that are sensitive to the health beliefs of the targeted group.