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.” Photo Courtesy of the John D. & Catherine T. MacArthur Foundation

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MacArthur Genius Award: Reducing Falls in the Elderly