Comprehensive Geriatric Assessment and Personalized Medicine

Personalized medicine has led to significant advances in the screening, diagnosis, prognosis, treatment and monitoring of several medical conditions. However, the confounding effect of comorbidities, polypharmacy and interindividual variability in homeostatic capacity on treatment outcomes makes the applicability of personalized medicine in the older patient population problematic. Furthermore, the significance of disease-specific end points, based on objective clinical parameters and biomarkers, is also questionable in frail older patients with poor functional status and limited life expectancy. The assessment of patient-centred end points, such as measures of frailty, independence and self-rated health, might be particularly useful to optimize therapies in this group. However, this can only be accomplished using robust and validated tools to objectively quantify patient-centred end points in clinical practice. This chapter discusses the issues with the routine use of personalized medicine in the older patient population, the importance of assessing patient-centred end points in the context of frailty and disability, the available tools to quantify key components of the comprehensive geriatric assessment (CGA) and their utility in selecting and monitoring specific interventions in this patient group.