Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Freedman, V.A., N. Hodson, J. Lynn, B.C. Spillman, Timothy A. Waidmann, A.M. Wilkinson, and D.A. Wolf. 2006. "Promoting declines in the prevalence of late-life disability: Comparisons of three potentially high-impact interventions." Milbank Quarterly, 84(3): 493-520.
Although the prevalence of late-life disability has been declining, how best to promote further reductions remains unclear. This article develops and then demonstrates an approach for comparing the effects of interventions on the prevalence of late-life disability. We review evidence for three potentially high-impact strategies: physical activity, depression screening and treatment, and fall prevention. Because of the large population at risk for falling, the demonstrated efficacy of multi-component interventions in preventing falls, and the strong links between falls and disability, we conclude that, in the short run, multi-component fall-prevention efforts would likely have a higher impact than either physical activity or depression screening and treatment. However, longer-term comparisons cannot be made based on the current literature and may differ from short-run conclusions, since increases in longevity may temper the influences of these interventions on prevalence. Additional research is needed to evaluate longer-term outcomes of interventions, including effects on length and quality of life.