handicap, respectively. This system is discussed and recommended by the committee as a framework for the consequences of disease in Chapter 2.

Besides a causal role in the process of disablement, each of the 13 issues selected met two other criteria. They had to affect appreciable numbers of older people, and interventions to modify them had to be available, although not necessarily fully developed. Although arthritis and Alzheimer's disease are not included in this report, their absence here should not be taken as a signal that they are undeserving of national attention.

The report covers a wide range of health policies. Each chapter provides a definition of the health risks related to the central topic, a discussion of incidence and prevalence, costs and measures of cost, remediability, and a set of recommendations to the research, education, and service communities. These chapters address fields with varying degrees of maturity. Some issues such as high blood pressure, osteoporosis, and smoking are familiar to health care professionals, and so these chapters have been written to inform policymakers and the public about the latest findings and their relevance for health policy. Other issues such as physical inactivity, depression, nutrition, and sensory loss are familiar topics but still in the early stages of development in terms of research, service standards, and procedures to address the functional difficulties of older people. These chapters discuss the available evidence and suggest ways in which these fields should be broadened in light of the aging population. Of this latter group, perhaps social isolation is the youngest of all. This chapter therefore discusses strategies for laying theoretical groundwork.

GENERAL ISSUES OF HEALTH PROMOTION AND DISABILITY PREVENTION

Unfortunately, American culture clings to some very pessimistic assumptions about aging. Growing old is often associated with frailty, sickness, and a loss of vitality. We frequently assume that older individuals are a burden to the state, their families, or even to themselves. In fact, many older individuals lead satisfying lives and maintain their health well beyond society's expectations.

"Quality of life": we are called upon as health professionals to improve it, yet it is an elusive goal. Certainly one reason is that no one individual or institution has proposed a definition that all can agree with. The committee will not attempt a definition in this report but would simply like to put forth the observation that health



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