Increasing longevity and prevalence of long‐term conditions contribute to older adults being the greatest users of health services. However, relatively little is known about the health and illness beliefs of the oldest old or how they decide to seek help in response to symptoms. Through analysis of in‐depth interviews with day centre attendees aged 80–93, we find that a moral, hierarchical approach to health problems and help‐seeking exists; similar to Cornwell's () findings among 50–60 year‐olds of a similar social group 30 years ago. However, when acting independently, those in their eighties and nineties report modifying their health and illness beliefs and behaviour, in response to their own perceived old age. Some health problems are ‘demedicalised’, being increasingly attributed to age and by being self‐managed. Others are perceived as potentially more serious, leading to increased consultation with medical services. When obliged to act outside their moral belief–behaviour framework by others, the participants expressed feelings of disempowerment, yet resisted modifying their moral beliefs. This may represent resistance to adopt the ‘sick role’, while seeking to maintain control over uncertain health as functional dependence and frailty increases. This study furthers theoretical understanding of the health and illness beliefs and behaviour of the oldest old, with important practical implications.