Methods: A series of criteria to evaluate interventions designed to improve risk-factor profiles for latelife disabilities was developed: size of the target population (i.e. how many people have the risk-factor), strength of the relationship between having the risk-factor and the risk of developing disability, effectiveness of the intervention, influence of the intervention on length of life and competing risks (i.e. what other risks does a person incur by living longer) were examined. An expert panel then selected three promising areas of intervention - increasing physical activity, screening / treating depression, and fall prevention. The authors then applied their proposed evaluation criteria to studies examining interventions designed to improve risk-factors for these three areas of late-life disability.

Findings: The authors reviewed articles focusing on three main areas of intervention: 1) exercise (interventions to reduce inactivity, lack of endurance/strength), 2) depression screening or treatment (interventions for unrecognized/ untreated depression), and 3) fall prevention (multi-component interventions to reduce risk-factors for falls including muscle weakness, balance, cognitive impairments, and home hazards). In the United States, the population of elderly residents eligible for these interventions was estimated to be 19 million (51%) for exercise therapy, 10 million (30%) for depression interventions, and 12 million (33%) for fall prevention strategies. The reviewed literature on the risk of developing disability based on the presence of the risk-factors revealed that inactivity doubled the risk of disability. Untreated depression was associated with a similar doubling of risk of disability. The presence of fall risk-factors was associated with twice to three times the risk of developing disability. The likely effectiveness of the interventions to improve risk-factor profiles for all three areas of disability was judged to be moderate and the effect on mortality was at best moderate for all interventions.

Conclusions: The authors have presented a potentially useful strategy for deciding which interventions have the greatest impact on late-life disability. This process could be a useful tool when deciding where to allocate resources. Overall, the authors concluded that multi-component fall intervention strategies would likely have the greatest impact on reducing the burden of late-life disability because of the strong link between falls and disability, and the large at-risk population. However, they caution that the reviewed literature did not provide enough evidence on long-term effects of the interventions or quality of life. Canadian policy-makers will need to account for local characteristics such as size of the population and the prevalence of risk-factors prior to selecting interventions.

Reference: V. A. Freedman, N. Hodgson, J. Lynn, B.C. Spillman, T. Waidmann, A.M. Wilkinson, D.A. Wolf. "Promoting declines in the prevalence of late-life disability: Comparisons of three potentially highimpact interventions." Milbank Quarterly. 2006; 84(3): 493-520.

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