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Interview with the honouree: Mary Tinetti

PATRON SAINT'S DAY 2012

PATRON SAINT'S DAY 2012

"We truly can improve older people's quality of life."

Thirty years ago, Mary Tinetti, like most researches, did not jump at the chance to study the problem of falls in older adults. But now she's hooked and has changed the world's perception: falls and other problems older people face deserve a scientific, integrated approach.

"I come from a family of very devout Catholics so they were definitely glad to hear that it was this university to offer me an honorary doctorate," says Mary Tinetti. "I was very surprised. This is my first honorary doctorate and it rewards a kind of life's work of which I am extremely proud."

Tinetti is Gladys Phillips Crofoot Professor of Medicine (Geriatrics), of Epidemiology (Chronic Diseases) and of Public Health at Yale University. She is also the head of the Yale Program on Aging. She is a resounding name in the area of fall prevention, but her interest for the subject was initially cool. "Quite frankly, when my mentor, Dr. T. Franklin Williams, asked me to study the problem of falls in the elderly, I found it not very interesting and even a bit embarassing. Falling was just part of getting old, right? What kind of scientific subject is that? But out of respect for Dr. Williams, I took him up on his request. And I was intrigued almost immediately. The combination of science and working with people - in this case a very complex, diverse audience - became a passion."

"The problems I studied had up until then been ignored. Yet they are common and it has a major impact when our ability to move around decreases or disappears. Mobility is, after all, the key to our participation in the world."

Pioneers

"I set out to find out why people fall, who has a higher chance of falling, and what we can do to prevent falls." After years of studies, Tinetti identified some important 'fall predictors': decreases in blood pressure, muscle weakness, balance problems, medications. She developed efficient and cost-effective prevention and treatment programmes, with encouraging results. The number of 'fallers' declined significantly, as did the risk of severe injury.

"It was very important to make a difference not only in isolated studies, but also in broader clinical practice. I believe it was pioneering work, yes, but I did not do it alone. Without my mentors and colleagues like Dorothy Baker and Margaret Gottschalk, I wouldn't have been able pull it off."

"We have demonstrated that ageing is indeed scientifically accessible. That is perhaps what I am most proud of. We contributed to the growing realisation that we truly can improve older people's quality of life. Falls are not an inevitable part of getting older."

"The head of Medicare, the government insurer that pays for elderly care in the US, said recently that staying active is very important for older people, not only because it prevents heart disease and vascular problems but also because it reduces the risk of falling. It shows how falling has evolved from a totally neglected condition to an important topic, including for policymakers. I am very happy about that."

Mixed feelings

"You know what is so wonderful about science? It just raises more questions. My research on falls has led me to new work, on medications, for instance. Older people often take a lot of pills, but we think too little about the effect this has on their overall condition. Right now, I am focussing primarily on people at risk for both falls and strokes. I am investigating whether it's safer to take more or less blood pressure medication. It is important that we look beyond an individual illness at how all health parameters interact and affect each other. It is an integrated approach."

"I think our kind of research can be useful in a society where, on the one hand, there is a growing awareness that older people are more than just a burden or a drain. On the other hand, stereotypes about ageing still do exist. You might expect me - someone who has studied ageing for years – not to fear my own ageing. But that would not be fair to say. I am afraid to get older, not only physically but also at a social level. Will I still be a valued member of the community? But then I look at my father, who turned 90 with ease and still plays a role in his surroundings. That gives me hope again."