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Disability in America: Toward a National Agenda for Prevention
when attention is given to the psychosocial variables of personal and social resources (Riley and Riley, 1989).
The widely varying needs of persons with disabling conditions demand a multidisciplinary collaborative approach among many professionals and organizations. The interventions should be determined by the needs of each individual rather than by rigid definitions of disabilities.
Collaborative projects involving primary care providers, public healthagencies, voluntary associations, and the community should be developedto coordinate disability prevention programs that implement interventionscentered on individual needs with a goal of improving an individual'sphysical, mental, and social well-being over the life course.
Research has demonstrated the error in thinking that older adults are all alike or that they become more alike as they age (Maddox and Lawton, 1989; Rowe and Kahn, 1987). For example, among those 65 years of age and older, the risk of acquiring a disabling illness differs significantly among the categories of the younger old (65-74), the old (75-84), and the oldest old (85 and older). Patterns of disability, morbidity, and mortality also differ significantly between males and females, and the risk of disabling conditions among older adults is known to be associated with poverty, inadequate education, and social isolation (see Chapter 2). The increased awareness of the diversity of health status in later life has had a salutary effect on health and welfare professionals who are increasingly less likely to use "being older" (i.e., over 65) as an explanation of disability or as a justification for failing to intervene in the interest of improving the quality of life among impaired older adults.
DEVISING APPROACHES TO PREVENTION
Disease prevention and health promotion must be pursued throughout life. It is now well recognized that chronic conditions often can be prevented. For example, it has been estimated that 70 percent of all cancer cases are preventable through changes in lifestyles (e.g., cessation of smoking). Nonetheless, it would be naively optimistic to assume that all chronic disease can be prevented, even though the risk of developing these conditions can be reduced. Mounting evidence clearly indicates, however, that adopting healthful behaviors even late in life can be beneficial, perhaps preventing the progression of impairments to functional limitations and disability. In addition, it is clear that existing knowledge points the way to effective approaches to averting or mitigating the potentially debilitating consequences of some