Precision Medicine: The Future Management of Geriatric Conditions

  • Bertrand Fougère
  • J. E. Morley
  • H. Arai
  • J. M Bauer
  • R. Bernabei
  • A. Cherubini
  • B. Dong
  • F. C. Martin
  • L. Flicker
  • R. A Merchant
  • L. Rodriguez Mañas
  • J. Woo
  • B. Vellas


A general consensus about the need to manage geriatric conditions in their early phase has emerged following the disappointing results of several therapeutic trials, and as a consequence of accumulating research demonstrating that pathological processes begin years before the appearance of clinical symptoms. Several lessons have been learned from previous prevention trials. The targeted populations were too diverse, the interventions were probably not well-fitted and strong enough, and the time of exposure too short. In this paper, we focus on a new approach (Precision Medicine) that incorporates several components: 1. multi-pronged primary prevention at the population level (vascular and metabolic risk factors, physical activity, cognitive stimulation, and diet), 2. targeting persons at risk identified by specific criteria including biomarkers with the help of primary care health professionals (e.g., weight loss, subjective memory impairment, frailty, sarcopenia), 3. robust and specific interventions for the targeted population (e.g., a multi-domain interventions for a large heterogeneous population vs. interventions that target specific mechanisms of action in at risk populations). This new approach towards the therapy of geriatric conditions requires new concepts that integrate the specialist geriatric and primary care settings and that implements new health technologies. To achieve these goals, efforts must be made by healthcare authorities to maximize change in this field, taking into account the need to balance priorities, needs, and resources.

Key words

Detection geriatric conditions integrated health care interventions older people precision medicine prevention 


  1. 1.
    Van Craen K, Braes T, Wellens N, Denhaerynck K, Flamaing J, Moons P, et al. The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc. 2010 Jan;58(1):83–92.CrossRefPubMedGoogle Scholar
  2. 2.
    Ng TP, Feng L, Nyunt MSZ, Feng L, Niti M, Tan BY, et al. Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial. Am J Med. 2015 Nov;128(11):1225-1236.e1.CrossRefPubMedGoogle Scholar
  3. 3.
    Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, et al. Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial. J Am Med Dir Assoc. 2015 Sep 1;16(9):740–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet Lond Engl. 2015 Jun 6;385(9984):2255–63.CrossRefGoogle Scholar
  5. 5.
    Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel J-P, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet Lond Engl. 2016 May 21;387(10033):2145–54.CrossRefGoogle Scholar
  6. 6.
    World Health Organization. WHO Guidelines on Integrated Care for Older People (ICOPE) [Internet]. WHO. 2017 [cited 2018 Jan 25]. Available from:
  7. 7.
    Tian Q, Price ND, Hood L. Systems cancer medicine: towards realization of predictive, preventive, personalized and participatory (P4) medicine. J Intern Med. 2012 Feb;271(2):111–21.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Cesuroglu T, Syurina E, Feron F, Krumeich A. Other side of the coin for personalised medicine and healthcare: content analysis of “personalised” practices in the literature. BMJ Open. 2016 Jul 13;6(7):e010243.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Morley JE. Geriatricians: The Super Specialists. J Am Geriatr Soc. 2017 Apr;65(4):866–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Rodriguez-Mañas L, Rodríguez-Artalejo F, Sinclair AJ. The Third Transition: The Clinical Evolution Oriented to the Contemporary Older Patient. J Am Med Dir Assoc. 2017 Jan;18(1):8–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Rowe JW, Fulmer T, Fried L. Preparing for Better Health and Health Care for an Aging Population. JAMA. 2016 Sep 26Google Scholar
  12. 12.
    Hshieh TT, Yue J, Oh E, Puelle M, Dowal S, Travison T, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med. 2015 Apr;175(4):512–20.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Morley JE. Frailty screening comes of age. J Nutr Health Aging. 2014 May;18(5):453–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: A review. Eur J Intern Med. 2016 Mar 30Google Scholar
  15. 15.
    Morley JE, Little MO, Berg-Weger M. Rapid Geriatric Assessment: A Tool for Primary Care Physicians. J Am Med Dir Assoc. 2017 Mar 1;18(3):195–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Vellas B, Balardy L, Gillette-Guyonnet S, Abellan Van Kan G, Ghisolfi-Marque A, Subra J, et al. Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST). J Nutr Health Aging. 2013 Jul;17(7):629–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Satake S, Senda K, Hong Y-J, Miura H, Endo H, Sakurai T, et al. Validity of the Kihon Checklist for assessing frailty status. Geriatr Gerontol Int. 2016 Jun;16(6):709–15.CrossRefPubMedGoogle Scholar
  18. 18.
    Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, et al. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001 Dec;49(12):1691–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Hirdes JP, Curtin-Telegdi N, Poss J, Gray L, Berg K, Stolee P, et al. InterRAI Contact Assessment (CA) Form and User’s Manual: A Screening Level Assessment for Emergency Department and Intake from Community/Hospital. interRAI; 2010. 95 p.Google Scholar
  20. 20.
    Philip KE, Alizad V, Oates A, Donkin DB, Pitsillides C, Syddall SP, et al. Development of EASY-Care, for brief standardized assessment of the health and care needs of older people; with latest information about cross-national acceptability. J Am Med Dir Assoc. 2014 Jan;15(1):42–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Beard JR, Bloom DE. Towards a Comprehensive Public Health Response to Population Ageing. Lancet Lond Engl. 2015 Feb 14;385(9968):658–61.CrossRefGoogle Scholar
  22. 22.
    Fulmer T, Mate KS, Berman A. The Age-Friendly Health System Imperative. J Am Geriatr Soc. 2018 Jan;66(1):22–4.CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Bertrand Fougère
    • 1
    • 2
    • 3
  • J. E. Morley
    • 3
  • H. Arai
    • 4
  • J. M Bauer
    • 5
  • R. Bernabei
    • 6
  • A. Cherubini
    • 7
  • B. Dong
    • 8
  • F. C. Martin
    • 9
  • L. Flicker
    • 10
  • R. A Merchant
    • 11
  • L. Rodriguez Mañas
    • 12
  • J. Woo
    • 13
  • B. Vellas
    • 2
    • 14
  1. 1.Tours University Hospital — Division of Geriatric medicine, Bretonneau HospitalTours cedex 9France
  2. 2.Inserm UMR1027Toulouse University III Paul SabatierToulouseFrance
  3. 3.Division of Geriatric MedicineSaint Louis University School of MedicineSt. LouisUSA
  4. 4.National Center for Geriatrics and GerontologyObuJapan
  5. 5.Center for Geriatric MedicineUniversity of HeidelbergHeidelbergGermany
  6. 6.Department of Geriatrics, Neurosciences and OrthopedicsCatholic University of Sacred HeartRomeItaly
  7. 7.Geriatria, Accettazione Geriatrica e Centro di ricerca per l’invecchiamentoIstituto Nazionale di Riposo e Cura per Anziani (IRCCS-INRCA)AnconaItaly
  8. 8.Department of Geriatrics, West China HospitalSichuan UniversityChengduChina
  9. 9.Division of Health and Social Care ResearchKings CollegeLondonUK
  10. 10.Geriatric MedicineUniversity of Western AustraliaPerthAustralia
  11. 11.Division of Geriatric MedicineNational University HospitalSingaporeSingapore
  12. 12.Service of GeriatricsGetafe University HospitalMadridSpain
  13. 13.Chinese University of Hong KongHong KongChina
  14. 14.GérontopôleToulouse University HospitalToulouseFrance

Personalised recommendations