We hit the jackpot! This year we had a trifecta of terrific grantees who had the honor of delivering awards lectures at the GSA Annual meeting:

  • Mathy Mezey, EdD, RN, FAAN, New York University, Donald P. Kent Award
  • Mary E. Tinetti, MD, Yale University, Maxwell A. Pollack Award for Productive Aging
  • Lewis Lipsitz, MD, Hebrew Senior Life, Harvard University, Joseph T. Freeman Award

We wrote a bit about each of these outstanding researchers last year when they won their awards. Here, we share ideas from each of their lectures with those of you unable to attend the meeting.

Dr. Mathy Mezey (left) speaks with Dr. Claire Fagin (right) during the BAGNC Leadership Conference.

Dr. Mezey gave us a broad perspective on her career’s work in aging and geriatrics, stretching from her groundbreaking work on physical assessment in older adults, to her work on the teaching nursing home, to her national leadership of the Hartford Geriatric Nursing Institute at NYU. Like us, Mathy seemed perplexed that despite the fact that older adults are the major “customers” of the health care system, geriatrics has not caught on as she expected at the beginning of her career in the 1960s and ’70s. Mezey argued that one of the best ways to address the burning need for geriatrics experts is to ensure the competence of the generalist workforce. In her view, things like the AACN competencies at the baccalaureate level give “real teeth” through the accreditation process, making sure that entry-level nursing professionals have necessary competence. (I only wish we had these teeth in medicine and social work!) At the graduate level, the AACN APRN/CS adult-gerontology competencies will soon drive the spread of geriatric skills into a much broader swath of practitioners than ever before.

However, she noted, the work to ensure that current practitioners are competent and using appropriate models of care is at a much more preliminary stage. NICHE still needs to grow to ensure that all hospital nurses get the support they need to deliver quality care. Similarly, HGNI’s outreach to specialty nursing societies is only scratching the surface. For example, only 4,000 of 89,000 critical nurses have completed the online training course on older adults developed through the Atlantic Philanthropies “REASON” project.

Dr. Mary Tinetti (right) with her daughter, Julia (left), and a friend (center).

Moving from nursing to medicine, in her Pollack Award lecture, “Falls in Older Adults: Translating Research to Practice and Policy,” Dr. Mary Tinetti gave an overview of her groundbreaking work in falls research and prevention. Research over nearly a decade showed that falls are common, have major health consequences, and cost the health system thousands of dollars. Each year, 30 percent of older adults age 70 and older fall, with that percentage rising with age. One in 10 of those falls results in serious injury. Dr. Tinetti hypothesized that a multifactorial intervention that improved older adults’ strength and balance, addressed vision problems, removed psychoactive medications (which can cause dizziness), and removed or reduced tripping hazards in the home would reduce falls.

She was right. The 1992-1996 FICSIT study found that the intervention reduced falling by 25 percent over usual care. The next step? Making falls screening and prevention part of geriatric care nationwide. Changing practice is labor-intensive, requiring outreach to different care settings such as doctors offices, home health agencies, senior centers, and rehab facilities. Dr. Tinetti is also committed to changing health policy to focus on fall prevention, through a multi-pronged strategy including financial incentives and penalties, regulatory oversight, and quality reporting for doctors offices and hospitals. “In retrospect,” she said, “collecting the data was the easy part!”

Dr. Lewis Lipsitz with his wife, Louise

Dr. Lewis Lipsitz, like Dr. Tinetti, has also spent much of his career investigating falling in older adults. Titled “Aging, Angiopathy, and Adaptation: Lessons from the Other End of the Stethoscope,” Dr. Lipsitz’s lecture provided attendees with an overview of the complex biological underpinnings of falls and fainting, also called syncope, in older adults. Like falls more generally, syncope is a multifactorial syndrome of aging. It is often difficult to pinpoint a cause. One culprit is a sudden drop in blood pressure, common in older adults after eating or upon standing up. Although many professionals may be concerned that the side effects of tightly managing blood pressure might lead to more syncope events, Dr. Lipsitz has found that “the higher you are, the further you fall.” In other words, better blood pressure control that lowers chronic blood pressure may in fact reduce fainting spells by virtue of lowering the baseline blood pressure from which people fall when they stand, eat, or bend over.

Dr. Lipsitz also believes that low blood flow to the brain can contribute to an increased risk of falling. It often manifests itself as a geriatric syndrome of slow gait, depression or difficulty in executive brain function, and syncope. Interestingly, knowing that increasing input to the nervous system may help the body compensate for deteriorating balance, Dr. Lipsitz has proposed an unusual solution for frequent falls: “stochastic resonance” insoles for elders. Apparently shoe insoles that buzz at random intervals, so gently as to be consciously imperceptible, can add a neurological stimulus that reduces falls.

With Thanksgiving nearly upon us, we are thankful that these three brilliant researchers, along with many colleagues, are walking with us on the path to improving health care for older Americans. If we stumble, we might give vibrating insoles a try!