pose low risks of activity limitation, whereas the least prevalent conditions, such as multiple sclerosis and lung or bronchial cancer, pose very high risks of disability. Thus conditions that frequently result in disability may be more appropriate targets for primary prevention strategies, and those that pose lower risks of developing into disability may be more appropriately addressed by secondary or tertiary prevention strategies.

Many chronic conditions are associated with the aging process, which contributes to the widely held stereotype that aging is synonymous with a decline in functional capacity. An increasing body of research contradicts this stereotype, demonstrating that the physical and mental health status of elderly people can improve as well as deteriorate. Studies show, for example, that the adoption of health-promoting practices even late in life is beneficial. Potentially debilitating problems such as those associated with incontinence and osteoporosis are amenable to skillful rehabilitation. Prospects are good for increasing the number of disability-free years in the average life span, but much more research on the aging process, on potentially effective interventions, and on the delivery and coordination of services is needed.

Secondary Conditions Associated with Disability

People with disabling conditions are often at risk of developing secondary conditions that can result in further deterioration in health status, functional capacity, and quality of life. Secondary conditions by definition are causally related to a primary disabling condition and include decubitus ulcers, contractures, physical deconditioning, cardiopulmonary conditions, and mental depression. Considerable research has been done on the etiology and prevention of certain secondary conditions (e.g., pressure sores); in general, however, secondary conditions have received very little attention from researchers and health care and social service providers, despite the causal relationship that makes many of them easily predictable.

Much of what is known about the prevention of many secondary conditions is incidental and often results from deduction based on individual or clinical experience. There is a clear need for systematic evaluations of currently used interventions, as well as for research devoted to developing treatment protocols for people with specific types of disabilities. Such protocols would list assessment and treatment strategies for patients whose conditions matched prespecified characteristics, addressing not only medical needs but also environmental (social and physical) and behavioral risk factors associated with secondary conditions. Implementation of the protocols, of course, will require the participation of a wide spectrum of professionals in medical and nonmedical fields, as well as the people with disabling conditions themselves, their families, personal attendants, and advocates.

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