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Disability in America: Toward a National Agenda for Prevention
and older persons. These reports noted the relevance of genetics, medical care, and toxic factors in the environment; however, behavior and lifestyle change were clearly the major foci. The reports were notable for their inclusion of older adults in the health objectives, affirming that although age and disease are associated, the association is conditional and modifiable.
Recent federal initiatives have focused on the older population as a target group for preventive care and health promotion activities. For example, the surgeon general sponsored a Workshop on Health Promotion and Aging (U.S. Department of Health and Human Services, 1988b), which documents the benefits of several interventions to lower existing risks among the elderly (see the discussion later in this chapter). The recent Healthy People 2000: National Health Promotion and Disease Prevention Objectives (U.S. Department of Health and Human Services, 1990) employs the life course approach in setting objectives, including goals to increase average life expectancy to 78 years, to reduce disability caused by chronic conditions to a prevalence of no more than 6 percent of all people, and to increase years of healthy life to at least 65 years. In the area of research, the National Institute on Aging is supporting studies to understand the aging process; to improve the diagnosis, treatment, and prevention of diseases that affect older people; and to improve their quality of life (National Institute on Aging, 1989).
There are several reasons for adopting a health promotion and disease prevention approach for older adults. Life expectancy is increasing, and it is desirable to enhance health status during these additional years of life. In addition, there is increasing evidence that some harmful habits and behaviors are amenable to modification or reversal when interventions occur in later years. This capacity for modifying physiological or pathological conditions has been referred to as the plasticity of the aging process (National Research Council, 1988). Finally, the high incidence of chronic disease and disabling conditions among the elderly and the burden disease places on individuals and society dictate the need for effective methods to ameliorate the deleterious effects of illness and disabling conditions that require costly medical care services.
The public perceives aging as a process of steady deterioration, which results in subtle discrimination that is sometimes referred to as ageism. The perception that age, chronic disease, and disability are equivalent conditions prevents our society from realizing the potential benefits of a disability-free life even among older persons. This perception has also influenced the social policies and social support networks developed in our society.
The public needs to be educated about the potential for modifyingthe aging processes through individual lifestyle change and throughsocial policies ensuring adequate income, educational opportunities,and social support during a person's life course.