Laudation for Professor Mary Tinetti
Delivered in Leuven on 2 February 2012 by
Professors Steven Boonen and Koen Milisen, promoters
Your Eminence,
Honourable Rector,
Your Excellencies,
Esteemed Colleagues,
Ladies and Gentlemen
Dear Students,
As the population ages, and as the number of elderly adults increases at an exponential rate, the importance of health care in older age increases with it. So too does the importance of the way health care professionals view and treat common health conditions in older adults – including falls. Dr. Tinetti was the first investigator to show that the risk for falls and injury in older adults can be identified, that falls and injuries often lead to serious adverse outcomes, and that multifactorial risk reduction strategies can prevent falls.
But why would she devote so much of her time and research to a problem that, at first sight, and to many even today, appears to be a relatively minor and inevitable consequence of advanced age?
Because a fall can be a devastating event, approximately 35-to-40 percent of individuals 65 and older experience at least one fall each year. Many of these falls are not harmful, but about 15 percent of them will lead to major injuries such as fractures of the hip or traumatic contusions of the brain. Even in older, healthy individuals, falls have psychological consequences such as fear of falling, which may bring with it loss of confidence, fear of dependence, social isolation and depression. It has become increasingly clear that falls and fall injuries are among the most common causes of functional decline and institutionalisation in older adults. The negative consequences of falls and fall injuries have a major impact, not only from a clinical perspective, as the quality of life of affected individuals often decreases significantly, but also from a societal perspective, as falls and fall injuries impose significant costs on public health services.
Mary Tinetti was among the first to realise the complex nature of falls and their inevitable implications. She recognised the need for effective fall prevention, risk factor assessment, risk factor management, and intervention follow-up. Putting all this into practice would require seamless coordination of care between physicians, nurses, physical therapists, occupational therapists and other medical professionals. But the results were very rewarding. In a landmark study published in the New England Journal of Medicine, Dr. Tinetti was the first to show that properly addressing risk factors leading to falls can decrease falls among older adults by about 30 percent. And so Mary Tinetti would focus her research efforts on understanding and preventing falls – by quantifying relationships between clinical determinants of falls and clinical outcomes like fall-related injuries, and by building on these relationships to develop fall prevention strategies that proved to be both effective and cost-effective. By showing that it is possible, even in old age, to reduce the frequency and severity of falls, Mary Tinetti changed geriatric practice. Her work continues to contribute significantly to the prevention of unnecessary suffering and mortality in older individuals.
It should also be noted that, by advancing this innovative approach to fall prevention and taking into account the clinical burden of a multitude of risk factors, Mary Tinetti not only changed geriatric practice but also set new standards in geriatric research.
With her multidimensional strategies, Mary Tinetti has effectively pushed the field of geriatrics to a more comprehensive understanding of how the ailments of aging can accumulate. Her conceptualisation of falls as a multifactorial geriatric syndrome amenable to multifactorial intervention has been successfully applied to a number of other common geriatric health conditions such as functional decline. And that is why her work on falls continues to have implications that go well beyond falls and fall prevention.
Mary Tinetti has also set an example by showing a deep and enduring commitment to integrating her research findings in health policy. Her collaborative efforts with a number of health and safety organisations, including the National Institute on Aging at the National Institutes of Health and the Food and Drug Administration, have greatly enhanced public awareness and clinical practice around fall prevention.
When older people fall or functionally decline, it is typically due to a combination of many determinants, such as balance, gait, strength, vision, confusion, ... And that is why assessing and managing common geriatric health conditions requires a multifactorial approach tailored to the individual needs of the elderly patient.
What geriatricians have learned from Mary Tinetti’s work is that, as people grow older, they do not become more similar but rather more complex. Complexity is intrinsic to geriatric medicine. As populations age, societies are finally beginning to recognise the complexity of the clinical needs of our older individuals, but also the shortcomings of our current clinical practices. Today, the window of opportunity is open as never before to infusing geriatric principles into health care and medical education.
Taking advantage of this opportunity is perhaps the greatest challenge facing hospitals around the world. Academic geriatrics must take the lead in this, and Dr. Mary Tinetti sets a guiding example.
For these reasons, I ask you, honoured Rector, on the recommendation of the Academic Council, to confer the degree of doctor honoris causa of KU Leuven upon Professor Mary Tinetti.
