Featured Publications
Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions
Tinetti ME, Costello DM, Naik AD, Davenport C, Hernandez-Bigos K, Van Liew JR, Esterson J, Kiwak E, Dindo L. Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions. JAMA Network Open 2021, 4: e211271. PMID: 33760091, PMCID: PMC7991967, DOI: 10.1001/jamanetworkopen.2021.1271.Peer-Reviewed Original ResearchConceptsMultiple chronic conditionsHealth care preferencesHealth care activitiesCare preferencesChronic conditionsCare activitiesOlder adultsRealistic outcome goalsEmergency department visitsHealth care visitsPrimary care practicesCross-sectional studyHealth-related barriersOutcome goalsEligible patientsPain medicationCare visitsDepartment visitsSleep medicationHealth outcome goalsMean ageCare studiesGlucose levelsMAIN OUTCOMEMedicationsDecision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity
Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR, Kelley A, Matlock D, Ouellet J, Rich MW, Schoenborn NL, Tinetti ME. Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity. Journal Of The American Geriatrics Society 2019, 67: 665-673. PMID: 30663782, DOI: 10.1111/jgs.15809.Peer-Reviewed Original ResearchConceptsMultiple chronic conditionsPatients' health prioritiesHealth priorityAmerican Geriatrics SocietyOlder adultsChronic conditionsSpecialty careGeriatrics SocietySystematic reviewHealth trajectoriesOlder peopleAction stepsCareAdultsMultimorbidityCliniciansCommunication scriptsExecutive summaryHealthPotential benefitsAlign decisionsPatientsReviewGeriatriciansCardiologistsAntihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults
Tinetti ME, Han L, Lee DS, McAvay GJ, Peduzzi P, Gross CP, Zhou B, Lin H. Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults. JAMA Internal Medicine 2014, 174: 588-595. PMID: 24567036, PMCID: PMC4136657, DOI: 10.1001/jamainternmed.2013.14764.Peer-Reviewed Original ResearchConceptsSerious fall injuriesAdjusted hazard ratioAntihypertensive medicationsMultiple chronic conditionsFall injuriesAntihypertensive groupHazard ratioOlder adultsChronic conditionsAntihypertensive medication classesStandardized daily doseAntihypertensive medication useCommunity-living adultsPropensity score adjustmentTraumatic brain injuryHealthy older adultsMedication intensityCardiovascular eventsMedication classesDaily doseHip fractureMedication useNationally Representative SampleHead injuryBrain injuryAnti-Hypertensive Medications and Cardiovascular Events in Older Adults with Multiple Chronic Conditions
Tinetti ME, Han L, McAvay GJ, Lee DS, Peduzzi P, Dodson JA, Gross CP, Zhou B, Lin H. Anti-Hypertensive Medications and Cardiovascular Events in Older Adults with Multiple Chronic Conditions. PLOS ONE 2014, 9: e90733. PMID: 24614535, PMCID: PMC3948696, DOI: 10.1371/journal.pone.0090733.Peer-Reviewed Original ResearchConceptsMultiple chronic conditionsAnti-hypertensive treatmentCardiovascular eventsAnti-hypertensive medicationsHigh-intensity groupChronic conditionsOlder adultsHazard ratioPropensity scoreIntensity groupStandardized daily doseCommunity-living participantsPropensity score adjustmentCV eventsMedication intensityLess comorbidityDaily doseRandomized trialsMAIN OUTCOMERepresentative cohortScore adjustmentSurvey cohortRCT resultsCohortMortalityPotential Therapeutic Competition in Community-Living Older Adults in the U.S.: Use of Medications That May Adversely Affect a Coexisting Condition
Lorgunpai SJ, Grammas M, Lee DS, McAvay G, Charpentier P, Tinetti ME. Potential Therapeutic Competition in Community-Living Older Adults in the U.S.: Use of Medications That May Adversely Affect a Coexisting Condition. PLOS ONE 2014, 9: e89447. PMID: 24586786, PMCID: PMC3934884, DOI: 10.1371/journal.pone.0089447.Peer-Reviewed Original ResearchConceptsChronic conditionsMedication classesDisease guidelinesOlder adultsCommunity-living older adultsCross-sectional descriptive studyAdverse medication effectsCommon chronic conditionsMultiple chronic conditionsUse of medicationsClinical outcomesCoexisting conditionsMedication effectsClinical priorityMedicare claimsMedicationsStudy conditionsAdults 65Systematic reviewDescriptive studyPerson interviewsOlder AmericansAdultsFrequency of usePrevalenceEffect of a Restorative Model of Posthospital Home Care on Hospital Readmissions
Tinetti ME, Charpentier P, Gottschalk M, Baker DI. Effect of a Restorative Model of Posthospital Home Care on Hospital Readmissions. Journal Of The American Geriatrics Society 2012, 60: 1521-1526. PMID: 22860756, PMCID: PMC4083654, DOI: 10.1111/j.1532-5415.2012.04060.x.Peer-Reviewed Original ResearchConceptsHome care episodeHome careUsual careHospital readmissionCare groupCare episodesCare modelLarge home care agencyUsual home careUsual care groupEmergency department visitsGood functional recoveryChronic care managementHome care practicesGroups of recipientsDepartment visitsAvoidable readmissionsFunctional recoveryRestorative careAcute hospitalsHome care agenciesBehavioral change theoriesMedicare recipientsReadmissionCare managementContribution of Individual Diseases to Death in Older Adults with Multiple Diseases
Tinetti ME, McAvay GJ, Murphy TE, Gross CP, Lin H, Allore HG. Contribution of Individual Diseases to Death in Older Adults with Multiple Diseases. Journal Of The American Geriatrics Society 2012, 60: 1448-1456. PMID: 22734792, PMCID: PMC3419332, DOI: 10.1111/j.1532-5415.2012.04077.x.Peer-Reviewed Original ResearchConceptsOlder adultsSingle underlying causeRespiratory diseaseMedicare Current Beneficiary Survey participantsChronic lower respiratory diseasesUnderlying causeAcute kidney injuryLower respiratory diseaseAverage attributable fractionKidney injuryHazard ratioHeart failureLiver diseaseAcute eventMyocardial infarctionUnintentional injuriesAcute diseaseAttributable fractionNational representative sampleMedicare beneficiariesOlder adults' experiencesDiseaseIndividual diseasesDeathConfidence intervalsContribution of Multiple Chronic Conditions to Universal Health Outcomes
Tinetti ME, McAvay GJ, Chang SS, Newman AB, Fitzpatrick AL, Fried TR, Peduzzi PN. Contribution of Multiple Chronic Conditions to Universal Health Outcomes. Journal Of The American Geriatrics Society 2011, 59: 1686-1691. PMID: 21883118, PMCID: PMC3622699, DOI: 10.1111/j.1532-5415.2011.03573.x.Peer-Reviewed Original ResearchConceptsChronic obstructive pulmonary diseaseUniversal health outcomesHeart failureSelf-rated healthCognitive impairmentHealth outcomesChronic conditionsObstructive pulmonary diseaseCardiovascular Health StudyCommunity-living participantsMultiple chronic conditionsPulmonary diseaseBurden ScaleInstrumental activitiesDaily livingCox modelHealth StudyCare prioritiesMore symptomsIADLsDepressionImpairmentOutcomesOsteoarthritisADLsEffect of Chronic Disease–Related Symptoms and Impairments on Universal Health Outcomes in Older Adults
Tinetti ME, McAvay G, Chang SS, Ning Y, Newman AB, Fitzpatrick A, Fried TR, Harris TB, Nevitt MC, Satterfield S, Yaffe K, Peduzzi P. Effect of Chronic Disease–Related Symptoms and Impairments on Universal Health Outcomes in Older Adults. Journal Of The American Geriatrics Society 2011, 59: 1618-1627. PMID: 21883120, PMCID: PMC3287052, DOI: 10.1111/j.1532-5415.2011.03576.x.Peer-Reviewed Original ResearchConceptsUniversal health outcomesChronic obstructive pulmonary diseaseCardiovascular Health StudyHeart failureDisease-related symptomsEjection fractionHF symptomsSelf-rated healthHealth outcomesChronic diseasesCognitive impairmentObstructive pulmonary diseaseBody Composition StudyTarget of therapyDyspnea scaleExpiratory volumeHazard ratioJoint painPulmonary diseaseInstrumental activitiesDaily livingHealth StudyDisease severitySignificant associationSymptomsHealth Outcome Priorities Among Competing Cardiovascular, Fall Injury, and Medication‐Related Symptom Outcomes
Tinetti ME, McAvay GJ, Fried TR, Allore HG, Salmon JC, Foody JM, Bianco L, Ginter S, Fraenkel L. Health Outcome Priorities Among Competing Cardiovascular, Fall Injury, and Medication‐Related Symptom Outcomes. Journal Of The American Geriatrics Society 2008, 56: 1409-1416. PMID: 18662210, PMCID: PMC3494099, DOI: 10.1111/j.1532-5415.2008.01815.x.Peer-Reviewed Original ResearchMeSH KeywordsAccidental FallsActivities of Daily LivingAgedAlzheimer DiseaseAntihypertensive AgentsAttitude to HealthCardiovascular DiseasesDecision MakingDepressive DisorderFemaleGeriatric AssessmentHealth PrioritiesHealth SurveysHumansIndividualityMaleMobility LimitationPulmonary Disease, Chronic ObstructiveWounds and InjuriesConceptsFall injuriesMedication symptomsAntihypertensive medicationsCardiovascular eventsCardiovascular outcomesChronic obstructive pulmonary diseaseBlood pressure reductionObstructive pulmonary diseaseSerious fall injuriesSymptom-related outcomesPulmonary diseaseSymptom outcomesHigh riskDepressive symptomsLower riskHealth outcomesInterindividual variabilityInjuryIntact personsMedicationsPressure reductionSymptomsRisk estimatesOlder adultsLower cognitionEffect of Dissemination of Evidence in Reducing Injuries from Falls
Tinetti ME, Baker DI, King M, Gottschalk M, Murphy TE, Acampora D, Carlin BP, Leo-Summers L, Allore HG. Effect of Dissemination of Evidence in Reducing Injuries from Falls. New England Journal Of Medicine 2008, 359: 252-261. PMID: 18635430, PMCID: PMC3472807, DOI: 10.1056/nejmoa0801748.Peer-Reviewed Original ResearchConceptsFall-related injuriesSerious fall-related injuriesAdjusted ratesIntervention regionClinical practiceElderly personsPercentage of cliniciansPrimary care cliniciansPrevention of fallsMedical servicesRate of injuryYears of ageEvaluation periodDissemination of evidenceCare cliniciansIntervention visitsOutpatient rehabilitationPreintervention periodFall preventionMorbid conditionsNonrandomized designInjuryReducing InjuryCliniciansRegions of ConnecticutEvaluation of Restorative Care vs Usual Care for Older Adults Receiving an Acute Episode of Home Care
Tinetti ME, Baker D, Gallo WT, Nanda A, Charpentier P, O'Leary J. Evaluation of Restorative Care vs Usual Care for Older Adults Receiving an Acute Episode of Home Care. JAMA 2002, 287: 2098-2105. PMID: 11966384, DOI: 10.1001/jama.287.16.2098.Peer-Reviewed Original ResearchConceptsHome care episodeUsual care patientsCare patientsCare episodesRestorative careCare officesUsual careHome careFunctional statusFunctional declineUsual home careHealth care utilizationSelf-care functionSevere cognitive impairmentReceipt of MedicareHome care servicesAcute episodeBaseline characteristicsOlder patientsCare unitCare utilizationEmergency departmentTotal careHome care agenciesPatientsShared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes.
Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 1995, 273: 1348-53. PMID: 7715059, DOI: 10.1001/jama.273.17.1348.Peer-Reviewed Original ResearchMeSH KeywordsAccidental FallsActivities of Daily LivingAgedAged, 80 and overAnxietyCausalityCognitionCohort StudiesGeriatric AssessmentHearingHumansLogistic ModelsMultivariate AnalysisNeuropsychological TestsNutritional Physiological PhenomenaPhysical FitnessPsychomotor PerformanceRisk FactorsUrinary IncontinenceVision, OcularConceptsUrinary incontinenceGeriatric syndromesMore basic activitiesProportion of participantsRisk factorsIncontinenceDaily livingDepression scoresSyndromeGeneral communityCompensatory abilityArm strengthBasic activitiesSignificant increaseHigh anxietyImpairmentMultiple areasNew HavenYearsParticipantsFallFactorsPredisposesCohortBaselineA Multifactorial Intervention to Reduce the Risk of Falling among Elderly People Living in the Community
Tinetti M, Baker D, McAvay G, Claus E, Garrett P, Gottschalk M, Koch M, Trainor K, Horwitz R. A Multifactorial Intervention to Reduce the Risk of Falling among Elderly People Living in the Community. New England Journal Of Medicine 1994, 331: 821-827. PMID: 8078528, DOI: 10.1056/nejm199409293311301.Peer-Reviewed Original ResearchConceptsRisk factorsIntervention groupControl groupPrescription medicationsAdjusted incidence rate ratioTargeted risk factorsUsual health careElderly peopleRisk factor modificationIncidence rate ratiosUse of sedativesTime of reassessmentYears of ageParticular risk factorsRange of motionProportion of personsPostural hypotensionMultifactorial interventionSerious morbidityExercise programGait impairmentBalance impairmentLeg strengthElderly personsMedications
2024
Patient Priorities–Aligned Care for Older Adults With Multiple Conditions
Tinetti M, Hashmi A, Ng H, Doyle M, Goto T, Esterson J, Naik A, Dindo L, Li F. Patient Priorities–Aligned Care for Older Adults With Multiple Conditions. JAMA Network Open 2024, 7: e2352666. PMID: 38261319, PMCID: PMC10807252, DOI: 10.1001/jamanetworkopen.2023.52666.Peer-Reviewed Original ResearchConceptsPatient Priorities CarePatient-Reported Outcomes Measurement Information SystemPerceived treatment burdenUsual careUC participantsOutcomes Measurement Information SystemPatients' health prioritiesTreatment burden scoresHealth outcome goalsHealth care preferencesMeasurement Information SystemTreatment burdenDecision quality measuresPrescribing decision-makingFollow-upNonrandomized controlled trialsPatient-reported outcomesAlign careCare preferencesPriority careMultisite practiceHealth professionalsHealth priorityChronic conditionsSocial roles
2023
Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality
Zogg C, Cooper Z, Peduzzi P, Falvey J, Castillo-Angeles M, Kodadek L, Staudenmayer K, Davis K, Tinetti M, Lichtman J. Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality. JAMA Surgery 2023, 158: e234856. PMID: 37792354, PMCID: PMC10551815, DOI: 10.1001/jamasurg.2023.4856.Peer-Reviewed Original ResearchConceptsHospital-level factorsTraumatic brain injurySevere traumatic brain injuryHospital mortalityTrauma QualityOlder adultsHip fractureComposite scoreHigher risk-adjusted oddsLevel 1 trauma centerIn-Hospital MortalityRisk-adjusted oddsLong-term outcomesMultivariable logistic regressionNontrauma centersTrauma patientsTerm outcomesTrauma centerPrimary diagnosisBrain injuryTrauma systemMAIN OUTCOMEMedicare feeService claimsForms of trauma
2022
Benefits and harms of oral anticoagulants for atrial fibrillation in nursing home residents with advanced dementia
Ouellet GM, O'Leary JR, Leggett CG, Skinner J, Tinetti ME, Cohen AB. Benefits and harms of oral anticoagulants for atrial fibrillation in nursing home residents with advanced dementia. Journal Of The American Geriatrics Society 2022, 71: 561-568. PMID: 36310367, PMCID: PMC9957933, DOI: 10.1111/jgs.18108.Peer-Reviewed Original ResearchConceptsNursing home residentsAtrial fibrillationAdvanced dementiaHome residentsStroke riskLong-stay nursing home residentsMedicare Part D claimsDementia-related mortalityGuideline-recommended thresholdHarms of anticoagulationRetrospective cohort studyMultivariable survival analysisValvular heart diseaseRisk of deathPart D claimsMonths of lifeMinimum Data SetAnticoagulant discontinuationAnticoagulated individualsMean CHAVASc scoreCause mortalityMultivariable adjustmentOral anticoagulantsCohort study
2019
Challenges and strategies in patients’ health priorities-aligned decision-making for older adults with multiple chronic conditions
Tinetti M, Dindo L, Smith CD, Blaum C, Costello D, Ouellet G, Rosen J, Hernandez-Bigos K, Geda M, Naik A. Challenges and strategies in patients’ health priorities-aligned decision-making for older adults with multiple chronic conditions. PLOS ONE 2019, 14: e0218249. PMID: 31181117, PMCID: PMC6557523, DOI: 10.1371/journal.pone.0218249.Peer-Reviewed Original ResearchConceptsPatients' health prioritiesMultiple chronic conditionsHealth priorityChronic conditionsPatient prioritiesPatient Priorities CarePrimary care cliniciansCare of patientsCare cliniciansPrimary carePatient outcomesCardiology practicePatientsCare optionsCare PilotCliniciansOlder adultsSerial trialsCarePriority careImplementation teamQualitative studyMultiple conditionsAdditional settingsMultiplicity of problems
2018
Feasibility of Implementing Patient Priorities Care for Older Adults with Multiple Chronic Conditions
Blaum CS, Rosen J, Naik AD, Smith CD, Dindo L, Vo L, Hernandez‐Bigos K, Esterson J, Geda M, Ferris R, Costello D, Acampora D, Meehan T, Tinetti ME. Feasibility of Implementing Patient Priorities Care for Older Adults with Multiple Chronic Conditions. Journal Of The American Geriatrics Society 2018, 66: 2009-2016. PMID: 30281777, PMCID: PMC7015118, DOI: 10.1111/jgs.15465.Peer-Reviewed Original ResearchConceptsPatient Priorities CarePrimary care providersMultiple chronic conditionsOlder adultsChronic conditionsElectronic health record supportStudy-Act cyclesImplementation feasibility studyClinical championsHealth outcome goalsPrimary careClinicians' perceptionsTreatment decisionsPatient prioritiesClinic workflowClinician concernsCardiology practiceCare providersPDSA cyclesEHR documentationClinical settingHealthcare preferencesPriority discussionInterprofessional communicationClinicians
2016
Patient Priority–Directed Decision Making and Care for Older Adults with Multiple Chronic Conditions
Tinetti ME, Esterson J, Ferris R, Posner P, Blaum CS. Patient Priority–Directed Decision Making and Care for Older Adults with Multiple Chronic Conditions. Clinics In Geriatric Medicine 2016, 32: 261-275. PMID: 27113145, DOI: 10.1016/j.cger.2016.01.012.Peer-Reviewed Original Research