Citation URL: http://www.urban.org/JoanneLynn

Considerable evidence suggests that disability prevalence among older Americans has fallen, but less is known about how to promote further declines. This report develops and begins to demonstrate a framework for comparing population-level effects of interventions. We reviewed the literature for seven interventions and conducted simple modeling exercises. Evidence is strongest for exercise programs that increase strength, balance, and physical activity; depression screening with referral and feedback and therapy with pharmacologic treatment; and multi-factor fall prevention programs. Little evidence exists about the long-term effects of such interventions. Both short and long-term effects are critical when evaluating the population-level impact of such interventions.

Although the prevalence of late-life disability has been declining, how to promote further reductions has been unclear. We developed an analytical framework that compares the effects of different interventions on the prevalence of late-life disability. We considered three potentially high-impact intervention strategies: physical activity programs, depression screening and treatment, and fall prevention. We conclude that in the short run multi-component fall-prevention efforts have the greatest impact. At present, longer-term impacts cannot be assessed based on the current literature and may differ from short-run conclusions, since increases in longevity may temper the effect intervention strategies have on prevalence of late-life disabilities. (Milbank Quarterly 84(3): 493-520, 2006.)

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