Illness career descent in institutions for the elderly

This paper examines the social psychological consequences of illness careers in a retirement facility. As elderly residents' health declines, they experience an illness career descent. This refers to the movement through the social structure of the healthcare facility as a consequence of the downward trajectory of chronic illness. Illness career descent requires the formal relocation of the individual and the informal social consequences of loss of control, stigmatization, and segregation from prior friendship networks. Individuals react in a three-stage manner. At first, residents resist being moved down. Next, there is a negative impact on their self-image as relocated residents accept the evaulation by staff that they have become less competent. Third, they adjust to their new location and enhance their self-image by developing new roles, finding a poor dear, re-evaluating prior stereotypes, and engaging in post-decisional dissonance reduction.The author wishes to express his deepest appreciation to Jacob Climo, Peter Conrad, Stan Kaplowitz, and Shulamit Reinharz for their encouragement and their suggestions on earlier drafts of this paper.