Institutionalization and Sick Role Identification Among the Elderly

The purpose of this paper is to identify the effects of institutionalization on patterns of sick role identification among the aged. The paper is an effort to test empirically the implications of Goffman's (1961) general analysis of total institutions and Freidson's (1970) analysis of the social organization of illness within such contexts. These analyses argue that the institutional organization of being ill tends to reinforce patterns of illness behavior among clients by constraining the individual increasingly to adopt attitudes and behavior consistent with the assumption of the sick role. With data drawn from the 1971 Aging in Manitoba study (n = 4,805), an empirical test of this theory is presented by contrasting patterns of illness responses among the institutionalized and noninstitutionalized elderly. Specifically, the extent to which institutionalization alters the association between respondents' objective health status and respondents' self-definition of health status is analyzed. Contrary to the expectations of the theory, the results indicate that, given comparable levels of illness and disability, the institutionalized elderly are less likely to incorporate the illness label into their definition of self. In a subsequent section, the implications of these findings for the individual's overall level of life satisfaction also are identified and discussed.