Little is known regarding the risk perceptions of older women for the chronic illnesses for which they are at highest risk. The purpose of this study was to explore the actual and perceived risk for six chronic illnesses: coronary heart disease, cerebrovascular disease (stroke), breast and colorectal cancer, osteoporosis, and depression. In addition, the relationship of demographic characteristics of the women and their perceived and functional health status to actual risk factors and risk perception was studied. A convenience sample of 102 rural women aged 65-91 answered a questionnaire on their actual and perceived risk for the chronic illnesses. As in younger samples, these older women generally underestimated their risk of disease. There was no relationship between demographics and risk perception, but there was a significant correlation between perceived health and functional status and risk perception. Only those actual risk factors associated with life experience were associated with increased perceived risk, supporting earlier findings that life experience has more influence on risk perception than the presence of actual risk factors per se. Based on the results of this study, clinicians should assume that older women patients are likely to underestimate their risk for common health problems. Clinicians are advised, therefore, in addition to regular evaluation of actual risk based on epidemiologic data, to probe their patients for information regarding their perception of risk and the basis of that perception. Combining information regarding perceived risk with actual risk data, the clinician can work with the patient to develop and implement an effective personalized risk management program.