For a 75-year-old with high blood pressure, the risk of death or serious
disability resulting from a fall is just as high as the risk of death or
serious disability caused by a stroke. But a generation ago, doctors
thought of falling as an inevitable risk, not something they could do
anything to prevent as part of caring for patients.
That's how Mary Tinetti, a geriatrician at Yale med school, laid things
out for us when we got her on the phone to chat about the MacArthur
genius grant she just won. (Here's a complete list of this year's
winners, including several health-care geniuses.)
In the decades since Tinetti did her first research on the subject, she
and her colleagues have gone on to show that there are clear factors
that increase the risk of falls - things like muscle weakness, balance
problems and taking multiple medications. What's more, they found, by
addressing these issues, doctors can reduce seniors' risk of falls by
about 30%.
Still, not all patients get screened for these risk factors. Doctors
don't get paid much for spending time diagnosing and treating these risk
factors. And they don't fit into the disease/specialist model of health
care, which tends to focus on things like heart attacks and strokes.
"What needs to be done is very simple," she told us. "Figuring out how
to do it is the complex piece."
As a MacArthur Fellow, Tinetti gets $500,000 with no strings attached.
She says she plans to use the money to look more broadly at how to look
beyond single diseases to try use broader measures of well-being to
guide treatment of the elderly.
"What became obvious to me as I was doing the work on falls is the big
problem with older people is they don't have a single disease, they have
multiple diseases," she said. "All of our decision-making is based on
what's best for a single disease, not what's best for an individual
patient. What I'm interested in is how we can figure out what's best for
patients with multiple diseases so we can maximize benefits and minimize
harms."
From: The Wall Street Journal, by Jacob Goldstein
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP
