Mary E Tinetti
Biographic Data
| ID | 123797 |
|---|---|
| NAME | Mary E Tinetti |
| GIVEN NAMES | Mary E |
| FAMILY NAME | Tinetti |
| SIGNATURE | TINETTI M E |
| AFFILIATIONS | Yale University |
| ORCID | 0000-0003-0940-9702 |
| VERIFIED | Yes |
| TOTAL WORKS | 23 |
| TOTAL CITATIONS | 36 |
| AUTHOR COUNT | 23 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1986 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 3 |
Exploring the Acceptability and Feasibility of a Self-directed Approach to Identifying Health Priorities in a Sample of Southern Older African American Adults with Multiple Chronic Conditions
OBJECTIVES: To evaluate the cultural acceptability and feasibility of the self-directed "My Health Priorities" (MHP) web-based program in older Southern African Americans (AAs) with multiple chronic conditions (MCCs) and their family caregivers (FCGs). DESIGN: A multi-method formative evaluation study (NIH Stage 1a) to explore patients' and FCGs' experiences with the MHP web-based program, a component of the patient priorities care approach. Inte…
Carta of Florence Against Ageism
What Matters” in the Emergency Department
OBJECTIVE: To describe "What Matters" to older adults seeking emergency department (ED) care and to identify patient characteristics associated with meeting desired outcomes. BACKGROUND: As part of the 4Ms framework, identifying "What Matters" has been captured across healthcare settings, yet limited attention has been directed to older adults in the ED. METHODS: We performed a secondary analysis of a multicenter prospective observational study. …
Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions
Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians
Risk Stratification in Older Patients With Acute Myocardial Infarction
Physicians reported limitations of available risk models when applied to older adults with AMI. New models are needed to guide AMI treatment in this population
Research on Multiple Chronic Conditions
In this special issue of Medical Care, researchers from the Multiple Chronic Conditions (MCC) Research Network, funded by the Agency for Healthcare Research and Quality (AHRQ), share important findings and suggest topics for future research on persons with MCC. This issue of Medical Care includes a theoretical framework for conducting research on MCC, a review of existing MCC research methods and methodological gaps to be addressed, and the resul…
Effect of β-Blockers on Cardiac and Pulmonary Events and Death in Older Adults With Cardiovascular Disease and Chronic Obstructive Pulmonary Disease
CONTEXT: In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger or without multimorbidity. Furthermore, medications given for one condition may adversely affect other outcomes. β-Blocker use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation. OBJECTIVE: To determine the effect of β-blocker use on cardiac and pulmonary ou…
A Method for Partitioning the Attributable Fraction of Multiple Time-Dependent Coexisting Risk Factors for an Adverse Health Outcome
Objectives. We decomposed the total effect of coexisting diseases on a timed occurrence of an adverse outcome into additive effects from individual diseases. Methods. In a cohort of older adults enrolled in the Precipitating Events Project in New Haven County, Connecticut, we assessed a longitudinal extension of the average attributable fraction method (LE-AAF) to estimate the additive and order-free contributions of multiple diseases to the time…
Designing Health Care for the Most Common Chronic Condition—Multimorbidity
The most common chronic condition experienced by adults is multimorbidity, the coexistence of multiple chronic diseases or conditions. In patients with coronary disease, for example, it is the sole condition in only 17% of cases.1 Almost 3 in 4 individuals aged 65 years and older have multiple chronic conditions, as do 1 in 4 adults younger than 65 years who receive health care.2 Adults with multiple chronic conditions are the major users of heal…
Assessing Multiple Medication Use With Probabilities of Benefits and Harms
The framework proposed provides a simple method for considering the trade-offs involved in prescribing multiple medications. It can be adapted to include additional parameters representing severity of condition, prioritization of outcomes, patient preferences, dosages, and medication interactions. Inconsistent reporting in the medical literature of data about benefits and harms of medications, dosages, and interactions constitutes its primary lim…
Geriatric Syndromes: Clinical, Research, and Policy Implications of a Core Geriatric Concept
Geriatricians have embraced the term “geriatric syndrome,” using it extensively to highlight the unique features of common health conditions in older people. Geriatric syndromes, such as delirium, falls, incontinence, and frailty, are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept has remained poorly defined. This article reviews criteria for defining ger…
The Role of Pain in the Recovery of Instrumental and Social Functioning After Hip Fracture
Interventions to control pain may enhance functional status after hip fracture; however, pain relief must be maintained to sustain recovery. Attention to the complex relationships among pain, depressive symptoms, and physical impairments should inform intervention development
Modifiable Impairments Predict Progressive Disability Among Older Persons
Five prevalent and potentially modifiable impairments explained much of the progressive disability experienced. Given the priority that older patients place on function as a health outcome, these impairments should be routinely assessed and modified
Environmental Hazards and the Risk of Nonsyncopal Falls in the Homes of Community-Living Older Persons
BACKGROUND: Identifying and eliminating environmental hazards in the home has high face validity but little empirical support for fall prevention. OBJECTIVE: The objective of this study was to determine whether environmental hazards increase the risk of nonsyncopal falls in the homes of community-living older persons. RESEARCH DESIGN: This was a prospective cohort study. PARTICIPANTS: The study included 1,088 men and women from a probability samp…
A population-based study of environmental hazards in the homes of older persons
OBJECTIVES: This study sought to estimate the population-based prevalence of environmental hazards in the homes of older persons and to determine whether the prevalence of these hazards differs by housing type or by level of disability in terms of activities of daily living (ADLs). METHODS: An environmental assessment was completed in the homes of 1000 persons 72 years and older. Weighted prevalence rates were calculated for each of the potential…
Goal-setting in clinical medicine
The process of setting goals for medical care in the context of chronic disease has received little attention in the medical literature, despite the importance of goal-setting in the achievement of desired outcomes. Using qualitative research methods, this paper develops a theory of goal-setting in the care of patients with dementia. The theory posits several propositions. First, goals are generated from embedded values but are distinct from valu…
Health Care Utilization and Costs in a Medicare Population by Fall Status
OBJECTIVES: The economic impact of trauma in older persons is a matter of increasing concern to public health practitioners and planners, yet it is an issue that has not been widely studied. Available evidence does suggest, however, that falls are the costliest category of injury among older persons. METHODS: This study used data from the Health Care Financing Administration and the Connecticut Long-Term Care Registry to isolate the effects of fa…
Driving Cessation and Increased Depressive Symptoms
OBJECTIVES: The purpose of this study was to determine the association between driving cessation and depressive symptoms among older drivers. Previous efforts in this area have focused on the factors associated with cessation, not the consequences of having stopped. DESIGN: Cohort study SETTING: Urban community PARTICIPANTS: A driving survey was administered in 1989 to surviving noninstitutionalized members of the New Haven Established Population…
Self-efficacy, Physical Decline, and Change in Functioning in Community-Living Elders
This study examines whether high self-efficacy is protective against a decline in functional status in community-residing elderly persons. Data came from a sample of 1,103 subjects aged > or = 72 years who were ambulatory within the household and who received in-home assessments at baseline and 18 months later to obtain information on sociodemographic, psychosocial, and health status variables, including physical performance tests. Functional sta…
The Cost-Effectiveness of a Multifactorial Targeted Prevention Program for Falls Among Community Elderly Persons
OBJECTIVES: Falls and fall injuries are common-potentially preventable-causes of morbidity, functional decline, and increased health-care use among elderly persons. The current analyses, performed on data obtained as part of a randomized controlled trial conducted within a health maintenance organization, describe the costs of a multifactorial, targeted prevention program for falls, present total net health-care costs, estimate the cost per fall …
Predicting Changes in Physical Performance in a High-Functioning Elderly Cohort
BACKGROUND: Performance-based measures of physical performance were examined for an older cohort of relatively high-functioning men and women. Relationships between baseline physical performance and sociodemographic and health status characteristics were also examined. Three-year pattern changes in performance are described, and sociodemographic and health status predictors of change are investigated. METHODS: A cohort of relatively high-function…
Risk Factors for Falls among Elderly Persons Living in the Community
To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telep…
Performance‐Oriented Assessment of Mobility Problems in Elderly Patients
Self-efficacy, Physical Decline, and Change in Functioning in Community-Living Elders
This study examines whether high self-efficacy is protective against a decline in functional status in community-residing elderly persons. Data came from a sample of 1,103 subjects aged > or = 72 years who were ambulatory within the household and who received in-home assessments at baseline and 18 months later to obtain information on sociodemographic, psychosocial, and health status variables, including physical performance tests. Functional sta…
Goal-setting in clinical medicine
The process of setting goals for medical care in the context of chronic disease has received little attention in the medical literature, despite the importance of goal-setting in the achievement of desired outcomes. Using qualitative research methods, this paper develops a theory of goal-setting in the care of patients with dementia. The theory posits several propositions. First, goals are generated from embedded values but are distinct from valu…
A population-based study of environmental hazards in the homes of older persons
OBJECTIVES: This study sought to estimate the population-based prevalence of environmental hazards in the homes of older persons and to determine whether the prevalence of these hazards differs by housing type or by level of disability in terms of activities of daily living (ADLs). METHODS: An environmental assessment was completed in the homes of 1000 persons 72 years and older. Weighted prevalence rates were calculated for each of the potential…
Assessing Multiple Medication Use With Probabilities of Benefits and Harms
The framework proposed provides a simple method for considering the trade-offs involved in prescribing multiple medications. It can be adapted to include additional parameters representing severity of condition, prioritization of outcomes, patient preferences, dosages, and medication interactions. Inconsistent reporting in the medical literature of data about benefits and harms of medications, dosages, and interactions constitutes its primary lim…
Performance‐Oriented Assessment of Mobility Problems in Elderly Patients
Risk Factors for Falls among Elderly Persons Living in the Community
To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telep…
Predicting Changes in Physical Performance in a High-Functioning Elderly Cohort
BACKGROUND: Performance-based measures of physical performance were examined for an older cohort of relatively high-functioning men and women. Relationships between baseline physical performance and sociodemographic and health status characteristics were also examined. Three-year pattern changes in performance are described, and sociodemographic and health status predictors of change are investigated. METHODS: A cohort of relatively high-function…
Self-efficacy, Physical Decline, and Change in Functioning in Community-Living Elders
This study examines whether high self-efficacy is protective against a decline in functional status in community-residing elderly persons. Data came from a sample of 1,103 subjects aged > or = 72 years who were ambulatory within the household and who received in-home assessments at baseline and 18 months later to obtain information on sociodemographic, psychosocial, and health status variables, including physical performance tests. Functional sta…
The Cost-Effectiveness of a Multifactorial Targeted Prevention Program for Falls Among Community Elderly Persons
OBJECTIVES: Falls and fall injuries are common-potentially preventable-causes of morbidity, functional decline, and increased health-care use among elderly persons. The current analyses, performed on data obtained as part of a randomized controlled trial conducted within a health maintenance organization, describe the costs of a multifactorial, targeted prevention program for falls, present total net health-care costs, estimate the cost per fall …
Driving Cessation and Increased Depressive Symptoms
OBJECTIVES: The purpose of this study was to determine the association between driving cessation and depressive symptoms among older drivers. Previous efforts in this area have focused on the factors associated with cessation, not the consequences of having stopped. DESIGN: Cohort study SETTING: Urban community PARTICIPANTS: A driving survey was administered in 1989 to surviving noninstitutionalized members of the New Haven Established Population…
Health Care Utilization and Costs in a Medicare Population by Fall Status
OBJECTIVES: The economic impact of trauma in older persons is a matter of increasing concern to public health practitioners and planners, yet it is an issue that has not been widely studied. Available evidence does suggest, however, that falls are the costliest category of injury among older persons. METHODS: This study used data from the Health Care Financing Administration and the Connecticut Long-Term Care Registry to isolate the effects of fa…
A population-based study of environmental hazards in the homes of older persons
OBJECTIVES: This study sought to estimate the population-based prevalence of environmental hazards in the homes of older persons and to determine whether the prevalence of these hazards differs by housing type or by level of disability in terms of activities of daily living (ADLs). METHODS: An environmental assessment was completed in the homes of 1000 persons 72 years and older. Weighted prevalence rates were calculated for each of the potential…
Goal-setting in clinical medicine
The process of setting goals for medical care in the context of chronic disease has received little attention in the medical literature, despite the importance of goal-setting in the achievement of desired outcomes. Using qualitative research methods, this paper develops a theory of goal-setting in the care of patients with dementia. The theory posits several propositions. First, goals are generated from embedded values but are distinct from valu…
Environmental Hazards and the Risk of Nonsyncopal Falls in the Homes of Community-Living Older Persons
BACKGROUND: Identifying and eliminating environmental hazards in the home has high face validity but little empirical support for fall prevention. OBJECTIVE: The objective of this study was to determine whether environmental hazards increase the risk of nonsyncopal falls in the homes of community-living older persons. RESEARCH DESIGN: This was a prospective cohort study. PARTICIPANTS: The study included 1,088 men and women from a probability samp…
Modifiable Impairments Predict Progressive Disability Among Older Persons
Five prevalent and potentially modifiable impairments explained much of the progressive disability experienced. Given the priority that older patients place on function as a health outcome, these impairments should be routinely assessed and modified
The Role of Pain in the Recovery of Instrumental and Social Functioning After Hip Fracture
Interventions to control pain may enhance functional status after hip fracture; however, pain relief must be maintained to sustain recovery. Attention to the complex relationships among pain, depressive symptoms, and physical impairments should inform intervention development
Geriatric Syndromes: Clinical, Research, and Policy Implications of a Core Geriatric Concept
Geriatricians have embraced the term “geriatric syndrome,” using it extensively to highlight the unique features of common health conditions in older people. Geriatric syndromes, such as delirium, falls, incontinence, and frailty, are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept has remained poorly defined. This article reviews criteria for defining ger…
Assessing Multiple Medication Use With Probabilities of Benefits and Harms
The framework proposed provides a simple method for considering the trade-offs involved in prescribing multiple medications. It can be adapted to include additional parameters representing severity of condition, prioritization of outcomes, patient preferences, dosages, and medication interactions. Inconsistent reporting in the medical literature of data about benefits and harms of medications, dosages, and interactions constitutes its primary lim…
Designing Health Care for the Most Common Chronic Condition—Multimorbidity
The most common chronic condition experienced by adults is multimorbidity, the coexistence of multiple chronic diseases or conditions. In patients with coronary disease, for example, it is the sole condition in only 17% of cases.1 Almost 3 in 4 individuals aged 65 years and older have multiple chronic conditions, as do 1 in 4 adults younger than 65 years who receive health care.2 Adults with multiple chronic conditions are the major users of heal…
A Method for Partitioning the Attributable Fraction of Multiple Time-Dependent Coexisting Risk Factors for an Adverse Health Outcome
Objectives. We decomposed the total effect of coexisting diseases on a timed occurrence of an adverse outcome into additive effects from individual diseases. Methods. In a cohort of older adults enrolled in the Precipitating Events Project in New Haven County, Connecticut, we assessed a longitudinal extension of the average attributable fraction method (LE-AAF) to estimate the additive and order-free contributions of multiple diseases to the time…
Research on Multiple Chronic Conditions
In this special issue of Medical Care, researchers from the Multiple Chronic Conditions (MCC) Research Network, funded by the Agency for Healthcare Research and Quality (AHRQ), share important findings and suggest topics for future research on persons with MCC. This issue of Medical Care includes a theoretical framework for conducting research on MCC, a review of existing MCC research methods and methodological gaps to be addressed, and the resul…
Effect of β-Blockers on Cardiac and Pulmonary Events and Death in Older Adults With Cardiovascular Disease and Chronic Obstructive Pulmonary Disease
CONTEXT: In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger or without multimorbidity. Furthermore, medications given for one condition may adversely affect other outcomes. β-Blocker use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation. OBJECTIVE: To determine the effect of β-blocker use on cardiac and pulmonary ou…
Risk Stratification in Older Patients With Acute Myocardial Infarction
Physicians reported limitations of available risk models when applied to older adults with AMI. New models are needed to guide AMI treatment in this population
Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions
Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians
Carta of Florence Against Ageism
What Matters” in the Emergency Department
OBJECTIVE: To describe "What Matters" to older adults seeking emergency department (ED) care and to identify patient characteristics associated with meeting desired outcomes. BACKGROUND: As part of the 4Ms framework, identifying "What Matters" has been captured across healthcare settings, yet limited attention has been directed to older adults in the ED. METHODS: We performed a secondary analysis of a multicenter prospective observational study. …
Exploring the Acceptability and Feasibility of a Self-directed Approach to Identifying Health Priorities in a Sample of Southern Older African American Adults with Multiple Chronic Conditions
OBJECTIVES: To evaluate the cultural acceptability and feasibility of the self-directed "My Health Priorities" (MHP) web-based program in older Southern African Americans (AAs) with multiple chronic conditions (MCCs) and their family caregivers (FCGs). DESIGN: A multi-method formative evaluation study (NIH Stage 1a) to explore patients' and FCGs' experiences with the MHP web-based program, a component of the patient priorities care approach. Inte…
Medicine (23 works) · Gerontology (9 works) · Gerontology (8 works) · Chronic Disease Management Strategies (7 works) · Environmental health (6 works) · Frailty in Older Adults (6 works) · Nursing (6 works) · Physical therapy (6 works) · Psychology (6 works) · Balance, Gait, and Falls Prevention (5 works)