A Framework for Identifying High-Impact Interventions to Promote Reductions in Late-Life Disability

Considerable evidence now suggests that the prevalence of disability among older Americans is declining; however, how best to implement intervention strategies to promote continued or accelerated declines in disability prevalence remains unstudied. The purpose of this report is to develop and begin to demonstrate a new framework for comparing the population-level effects of different types of interventions. Drawing upon elements of the proposed framework, we reviewed the literature for seven illustrative interventions and also conducted several simple modeling exercises. Of the seven approaches we reviewed, evidence of modest reductions in the risks of disability is strongest for exercise programs that increase strength, balance, and physical activity of older adults; depression screening, combined with referral and feedback and a treatment program combining therapy with pharmacologic treatment; and multi-factor fall prevention programs. Because they can be targeted at potentially large populations, widespread implementation of such interventions could potentially reduce the prevalence of disability in the short run if adherence issues could be successfully addressed. Little evidence exists, however, about the long-term effects of such interventions. This exercise has also provided several additional insights into how to reduce population-level disability prevalence among the elderly population. Our most striking finding is that efforts with the largest potential for success are those targeted at individuals whose life experience is exemplified by a prolonged period of disability and frailty before death.. Multi-factor interventions that are targeted at frail individuals and that address individualized needs appear to be the most promising. Both short and longer-term effects are critical to consider when evaluating the population-level impact of such interventions. [90 PDF pages]