Managing an uncertain illness trajectory in old age: patients' and physicians' views of stroke

Uncertainty is a central feature of a chronic illness trajectory, resulting from questions about the effects of the illness on daily life, what symptoms mean, and what the future holds. When chronic illness occurs late in life, uncertainty is magnified, and serious questions arise about whether the individual will be able to weather the disruption and go on with daily life. This article examines illness trajectories from two vantage points, that of older persons who have had a stroke and that of physicians who care for stroke patients, by means of interviews with 36 persons who had strokes and with 20 physicians. Physicians' views of stroke were informed not only by knowledge of physiological processes but also by biomedical ideologies and cultural meanings associated with their patients' ages and impairments. People who had strokes focused on recovery; they assumed the trajectory was open to manipulation if they worked hard enough. The vague medical response to uncertainty affected patients' interpretations; what they were not told shaped their expectations about recovery as much as what they were told. The uncertain trajectory of stroke in old age is one example of how illness experience is affected by cultural attitudes about age, biomedical ideologies, the provision of health care services, and economically driven health policies. The anticipation of recovery by persons who have had strokes and the letdown when recovery does not occur reflect critical dilemmas in biomedicine and in society itself that have implications for health policy.