The worried well

Abstract

Due to demographic changes, the number of older Americans has risen dramatically since the turn of the century. Along with steady improvements in longevity, however, middle class elderly perceive themselves to be less healthy than their parents. Along with escalating worry over health among this group is a diminished tolerance for minor illness, an increased expectation for optimal health and the perception that all disease is either preventible or curable. This increasing sense of concern coincides with escalating medical costs, the rise of managed care and a resurgence of health preventive and promotive discourse. In the United States arenas of health promotion and disease prevention have followed two paths. One includes the use of screening tests which promise early detection and more favorable outcomes from complex conditions like heart disease and cancer. The other is individual lifestyle modification. Both paths, testing and behavioral change, offer the illusion of decreased risks from chronic disease. Since these diseases, however, are hard to differentiate from changes related to normal aging, most of these promises are incapable of being fulfilled. Therefore, middle class elderly are burdened with personal and societal blame when they continue to suffer from age related symptoms. Screening medical test results, often abnormal in this group, are often followed by more intensive diagnostic tests and treatments. These follow-ups are not only costly in economic terms but are physiologically and socially problematic. Drug side effects, complications from surgery, infections and a lowered quality of life are often the result. This ethnographic study of white elderly middle class clients and providers attempts to show some lived consequences of our cultural discourse about disease prevention and health promotion. Aging has become a disease which turns healthy elderly into worried well.