Eliciting Patients’ Perception of their Condition

When caring for older adults, it is important make an attempt to elicit their own beliefs and attitudes about illness, sometimes called “explanatory models”. Some suggestions to facilitate the process are the following:

  • Maintain an accepting attitude.
  • Let the family and patient know that their ideas are valued in developing the care plan.
  • Ask the patient what they think is wrong or causing the problem.
  • Ask if the patient thinks that there may be some ways to get better that doctors may not know about.
  • Ask if anyone else has been asked to help with the problem.
  • Ask the patient what worries them most about their illness.
  • Ask why they think they are ill now.

Assumptive World: Getting into the “assumptive world” (Frank, Winkleby, Altman, Rockhill, & Fortmann, 1991) of the patient is time well spent. First, doing so provides useful information about over-the-counter medication or home remedies that might interfere with prescribed medicines.

EXAMPLE: Older persons within traveling distance of Mexico obtain pharmacologically active compounds that are not always equivalent to medications bought in the United States (Greene, 1984).

Diet: Assessing cultural beliefs about illness includes asking about diet, especially if dietary prescriptions are components of traditional healing practices in their culture.

EXAMPLE: Maintaining balance by eating or not eating foods defined as “hot” or “cold” is common in many Hispanic/Latino cultures.

Ideas on Illness: Failure to elicit ideas about illness can result in poor communication, lack of adherence to prescribed therapy, or refusal to undergo tests or therapeutic procedures.

EXAMPLE: The idea that illness is punishment for past deeds may inhibit participation in preventive or therapeutic procedures. Asking about and listening to the cultural beliefs of the patient helps establish rapport, shows respect for the older person, and can be one of the most interesting aspects of caring for older adults.