Prof. N. van der Velde PhD

All Publications

Prof. Nathalie van der Velde is a practicing geriatrican since 2010 and director of the geriatric medicine fellowhip of the Academic Medical Center (AMC) of Amsterdam, the Netherlands, since 2014. She also is the principal investigator and leader of the research line person-centered falls & fracture prevention at the AMC. Furthermore, she is co-chairing the Amsterdam Public Health Institutions’ research progamme “Aging and Later Life”.

The ultimate and overall aim of her research line is to clarify and unravel the black box of co-existing, interacting and clustering factors that underlie fall risk in older persons. In order to adequately address optimization of overall fall prevention, much more detailed information per risk factor is needed. Current focus is on medication-related  and cardiovascular fall risk. These are promising and urgent targets, because of the relative strong effect size, the common occurrence and because data on the effectiveness of the intervention are not yet univocal. Furthermore, on pathophysiological and clinical grounds, the effectiveness of respective interventions can be expected to be largely influenced by interacting and clustering effects.

Nathalie van der Velde completed her PhD in 2007 as well as a MsC in Clinical Epidemiology at the Erasmus MC. The topic of her PhD thesis was cardiovascular and drug- related fall incidents. After obtaining her specialisation in Geriatrics (Klinische Geriatrie) and Internal Medicine (Internist ouderengeneeskunde) in 2010, she started as a consultant at the internal medicine - geriatrics department of the AMC combined with a postdoc position at the Erasmus MC. At the Erasmus MC she is uptill now the local project leader of the multi-center B-PROOF study and postdoc for the multi-center IMPROveFALL trial.

Nathalie van der Velde is nationally and internationally active in dissemination of knowledge on falls and fracture risk. Since 2014 she chairs the Dutch SIG on Falls and Fracture prevention and the update on the Dutch Falls Prevention Guideline. Furthermore, since 2016 Nathalie van der Velde chairs the EuGMS Task and Finish group of European fall experts on dissemination and implementation of knowledge on drug-related falls, which is also part of EIP AHA Taskforce synergies: A2 action group Synergy on Falls Prevention. Since 2015 she is also a member of European Special Interest Group Falls and Fracture prevention of EUGMS (European Geriatric Medicine Society). Since 2013 she is a collaborator in several genetic consortia: CHARGE, GEFOS, GIANT. Since 2008 she is a member of the European Academy for Medicine of Ageing (EAMA), a European society set up to teach and address management and research issues on an international level, and to create an international research network in Geriatrics.

 

 

 

 

 

 

Prof. PhD N. van der Velde (Person-centered falls and fracture prevention)

I. Falls and fall-related injury, such as fractures, form a major health care problem in older persons (>65yrs), with a yearly fall rate of 33% and an accompanying injury rate of approximately 20%. These numbers double for the over-80yrs group. Worryingly, fall rates in all age categories have been rising over the last decade and the same holds true for (serious) fall-related injuries such as brain injury or hip fracture. In order to diminish this significant and growing disease burden both in terms of quality of life for the individual patients and in terms of health care costs for the society, it is important to minimize the number of fall incidents. The presences of several individual chronic diseases and certain classes of medication have been associated with an increased fall risk. Since fall-risk factors are so numerous, a complex interaction can be expected. Although diseases such as Parkinson and arthritis, as well as the use of certain drugs (psychotropic and cardiovascular) are well known fall-risk factors, little is known about the effects of chronic disease clusters, and its accompanying medication use, on fall- and fall-related-injury risk. Not only combinations of comorbidity and medication use may affect fall risk and its related injury, but also genetic variations. A person-centered approach in terms of attuning preventive and treatment strategies by incorporating complex patient characteristics will ensue.
II. Cardiovascular disease is a principal contributor to chronic morbidity and loss of wellbeing, and the leading cause of death in older persons. Notwithstanding sufficient evidence that preventive measures in this group are at least as effective as in younger subjects, elderly remain vastly undertreated. Earlier, our group showed that valvular abnormalities, heart-rhythm disorders, poor left-ventricular function, orthostatic hypotension and carotid-sinus hypersensitivity are associated with falls. Cardiovascular disorders are the main cause for unexplained or recurrent falls in elderly. Since standard cardiovascular evaluation is not yet part of the current multifactorial falls guidelines and since studies on how to perform such an analyses effectively in older fallers are currently lacking, it is of highest importance to develop a standardized, evidence-based cardiovascular protocol.
III. Fracture risk is affected by the presence of several individual chronic diseases and classes of medication, which are traditionally assessed individually in the clinical work-up. However, with age, multimorbidity becomes more frequent, together with polypharmacy. Around the age of 65 approximately 55% of community-dwelling older persons have two or more chronic diseases. Nevertheless, up to know, little is known about the effects of chronic disease clusters, and the respective medication use on fracture risk. In addition, the influence of these interactive components on therapeutic response of used medications in fracture care and prevention is unknown. As with falls, again also genetic variations can be expected to influence fracture risk and therapeutic response. Main goal is to develop person-centered, individualized preventive and intervention strategies in fracture care.
IV. Effectiveness of falls and fracture interventions are very much dependent on patient compliance. Incorporating the patient perspective is thus essential. This holds true for geriatric research in general as well as for falls and fracture studies in particular. Especially in this specific group, interventions need to be targeted at optimizing quality of life and thus patient preferences are of great significance. In order to effectively incorporate patient preferences, targeted patient education and emancipation is of major importance. Furthermore, for optimal decision-making in terms of patient preferences, expected effectiveness of particular interventions need to be explicit. Therefore studies specifically addressing the geriatric population are urgently needed in order to gain more knowledge on effectiveness of potential interventions in frail, multimorbid elderly. For patient-centered decision making, time to benefit of the intervention is essential to be included.
 

Faculty
PhD R. Franssen
MD M.J. Henstra
PhD J.L. Parlevliet
E.P. van Poelgeest
PhD H.C. Willems

PhD Students
MEng MSc A.C. Ham
MSc S. Oliai Araghi

• B.A. Damoiseaux-Volman
• K.K. de Wildt
• N. Dormosh
• M.J. Henstra
• M.C. Kranendonk-Koele
• K.J. Ploegmakers
• A.C. Pronk
• L.J. Seppala
• R.A.H. van de Loo
• L. Wang

• AMC
• NIEUWE DEB IND
• Stichting Amsterdams Universititeitsfonds
• ZonMw