Publications by Vicki Freedman for Health Policy Center

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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.)

This article attempts to resolve previously published inconsistencies across national surveys in trends in activity limitations among the elderly. The authors prepared estimates from five national surveys from 1982-2001, and investigated sources of the inconsistencies. The panel found consistent declines of 1%-2.5% per year for two commonly used disability measures: difficulty with, and help with daily activities. Mixed evidence was found for the use of help or equipment. The panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results affected results. The implications of the findings for policy, national survey efforts, and further research are discussed. (Freedman, VA, E Crimmins, RF Schoeni, B Spillman, H Aykan, K Land, J Lubitz, K Manton, L Martin, D Shinberg, T Waidmann. 2004. "Resolving Discrepancies in Old-Age Disability Trends Across National Surveys: Report From a Technical Working Group." Demography 41(3):417-441.)

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