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Prevention of age-associated loss of autonomy: epidemiological approaches.

The concept of autonomy is proposed as a global objective of health and social services and epidemiological contributions to devising procedures for maintaining autonomy of old people are reviewed. It is suggested that the conventional model of "normal" vs "pathological" aging, identification of the "elderly" as a separate adult age group and preoccupation with clinical as opposed to public health models of intervention and with service provision rather than with clients' needs are less than optimal. More attention should also be given to the identification of extrinsic factors in aging and to recognising ways in which the effects of aging are aggravated by social conditions and unrelieved by ineffectual and inappropriate services. Epidemiology has more to contribute to meeting the challenges of aging than is generally recognised.