Comprehensive Geriatric Assessment and Personalized Medicine

Abstract

There is increasing evidence that personalized medicine, an evolving field where patient management is based on individual genetic, molecular or cellular characteristics, improves the outcome of several disease states, particularly cancer. However, the routine application of personalized medicine in the ever-growing cohort of frail older patients presents significant challenges because of the confounding impact of coexisting disease states, polypharmacy, and interindividual variability in homeostatic capacity and treatment response. Furthermore, the use of conventional, disease-specific, end points, typically investigated in clinical trials conducted in younger and/or healthier subjects, is also questionable in patients with poor functional status and limited life expectancy. In this patient group, the maintenance of independence is key to self-rated health. However, whether measures of independence and quality of life can be used to better select treatment strategies and improve outcomes in older patients remains to be investigated. The development of robust and validated tools to quantify key components of the comprehensive geriatric assessment provides opportunities to (a) design interventions that take into account measures of frailty and functional status and (b) investigate the role of patient-centred end points in monitoring the effects of such interventions. In this context, an age-adapted definition, patient-centred medicine, indicates a management approach primarily based on measures of frailty and quality of life, rather than more fundamental genetic or molecular factors. Research is warranted to investigate whether combining personalized medicine with patient-centred medicine leads to more effective and safe management strategies in old age.