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Geriatric Medicine: Towards Personalized Medicine
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Geriatric Medicine: Towards Personalized Medicine

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: closed (20 October 2024) | Viewed by 5087

Special Issue Editors

Prof. Dr. Barbara C. Van Munster

E-Mail Website
Guest Editor
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
Interests: geriatric medicine; multimorbidity; delirium
Dr. Hanna C. Willems

E-Mail Website
Guest Editor
Department of Internal Medicine and Geriatrics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
Interests: fractures in geriatric patients; vertebral fractures; hip fractures

Special Issue Information

Dear Colleagues,

The field of geriatrics is expanding globally, driven by changing demographics. Older individuals exhibit diverse clinical profiles, marked not only by their advanced age but also by the presence of multiple chronic diseases as well as problems in the functional and psychosocial domain.

As precision medicine and personalized treatment approaches advance rapidly, new possibilities emerge in caring for geriatric patients. Tailoring treatment strategies to each patient's specific health status helps strike the right balance between over-treatment and under-treatment, aligning better with the preferences of elderly individuals.

In this Special Issue, we will explore the current state, challenges, opportunities, perspectives, and research directions within geriatrics, with a particular emphasis on enhancing treatment outcomes and the quality of life for this unique demographic. We encourage clinicians and scientists in the field to submit original articles or reviews that align with these objectives.

Prof. Dr. Barbara C. Van Munster
Dr. Hanna C. Willems
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • geriatrics medicine
  • advance care planning
  • personalized medicine
  • multimorbidity

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (4 papers)

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Research

11 pages, 1854 KiB  
Article
Long-Term Outcome of Elderly Patients with Severe Aortic Stenosis Undergoing a Tailored Interventional Treatment Using Frailty-Based Management: Beyond the Five-Year Horizon
by Augusto Esposito, Ilenia Foffa, Paola Quadrelli, Luca Bastiani, Cecilia Vecoli, Serena Del Turco, Sergio Berti and Annamaria Mazzone
J. Pers. Med. 2024, 14(12), 1164; https://doi.org/10.3390/jpm14121164 - 21 Dec 2024
Viewed by 769
Abstract
Background: Elderly patients with severe aortic stenosis (AS) need individualized decision-making in their management in order to benefit in terms of survival and improvement of quality of life. Frailty, a common condition in elderly patients, needs to be considered when weighing treatment options. [...] Read more.
Background: Elderly patients with severe aortic stenosis (AS) need individualized decision-making in their management in order to benefit in terms of survival and improvement of quality of life. Frailty, a common condition in elderly patients, needs to be considered when weighing treatment options. Aim: We aimed to evaluate outcomes including survival and functional parameters according to disability criteria at six years of follow-up in an older population treated for severe AS using a frailty-based management. Methods: We evaluated data derived from a pilot clinical project involving elderly patients with severe AS referred to a tailored management based on classification by Fried’s score into pre-frail, early frail, and frail and a multidimensional geriatric assessment. A Frailty, Inflammation, Malnutrition, and Sarcopenia (FIMS) score was used to predict the risk of mortality at six years of follow-up. Functional status was evaluated by telephonic interview. Results: At six years of follow-up, we found a survival rate of 40%. It was higher in the pre-frail patients (long rank < 0.001) and in the patients who underwent TAVR treatment (long rank < 0.001). The cut-off FIMS score value of ≥1.28 was an independent determinant associated with a higher risk of mortality at six years of follow-up (HR 2.91; CI 95% 1.7–5.1; p-value 0.001). We found a moderate increase of disability levels, malnutrition status, comorbidities, and number of drugs, but none of them self-reported advanced NYHA class III–IV heart failure. Conclusion: An accurate clinical–instrumental and functional geriatric evaluation in an elderly population with AS is required for a non-futile interventional treatment in terms of survival and functional status even in long-term follow-up. Full article
(This article belongs to the Special Issue Geriatric Medicine: Towards Personalized Medicine)
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10 pages, 614 KiB  
Article
Comparative Clinical Characteristics of Frail Older Adults in the Emergency Department: Long-Term Care Hospital versus Community Residence
by Yunhyung Choi, Hosub Chung, Jiyeon Lim, Keon Kim, Sungjin Bae, Yoonhee Choi and Donghoon Lee
J. Pers. Med. 2024, 14(10), 1026; https://doi.org/10.3390/jpm14101026 - 26 Sep 2024
Viewed by 774
Abstract
Background/objective: Older patients from long-term care hospitals (LTCHs) presenting to emergency departments (EDs) exhibit a higher prevalence of frailty than those from the community. However, no study has examined frailty in patients from LTCHs in the ED. This study compared frailty in older [...] Read more.
Background/objective: Older patients from long-term care hospitals (LTCHs) presenting to emergency departments (EDs) exhibit a higher prevalence of frailty than those from the community. However, no study has examined frailty in patients from LTCHs in the ED. This study compared frailty in older patients from LTCHs and the community. Methods: We retrospectively analyzed data from the EDs of three university hospitals between 1 August and 31 October 2023, involving 5908 patients (515 from LTCHs and 5393 from the community). The Korean version of the Clinical Frailty Scale (CFS-K) was used to assess individuals aged 65 and older. We compared clinical characteristics, frailty, length of stay (LOS), and diagnosis between patients from LTCHs (LTCH group) and the community (community group). Results: Among ED patients, 55.0% and 35.2% in the LTCH and the community groups, respectively, were frail (p < 0.001). Of these, 71.7% in the LTCH group were hospitalized compared with 53.1% in the community group (p = 0.001). The odds ratio for in-hospital mortality was 4.910 (95% CI 1.458–16.534, p = 0.010) for frail LTCH patients and 3.748 (95% CI 2.599–5.405, p < 0.001) for frail community patients, compared to non-frail patients. Conclusions: Patients from LTCHs with frailty had higher hospital admission rates and increased in-hospital mortality compared to those in the community at the same frailty level. This study offers essential insights into the characteristics of older patients in LTCHs for healthcare administrators and medical staff worldwide. Full article
(This article belongs to the Special Issue Geriatric Medicine: Towards Personalized Medicine)
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7 pages, 220 KiB  
Communication
Treatment Classification by Intent in Oncology—The Need for Meaningful Definitions: Curative, Palliative and Potentially Life-Prolonging
by Zsolt Fekete, Andrea Fekete and Gabriel Kacsó
J. Pers. Med. 2024, 14(9), 932; https://doi.org/10.3390/jpm14090932 - 31 Aug 2024
Viewed by 1603
Abstract
Background: Realistic cancer treatment goals should be used by health care professionals and communicated to patients, families, and the public. The current nomenclature on this subject is outdated and has not been changed since the advent of modern oncology in the middle of [...] Read more.
Background: Realistic cancer treatment goals should be used by health care professionals and communicated to patients, families, and the public. The current nomenclature on this subject is outdated and has not been changed since the advent of modern oncology in the middle of the 20th century. Methods: Based on the literature we propose a three-tier system composed of curative, palliative, and potentially life-prolonging (PLP) therapies, instead of the current two-tier system of only curative and palliative treatment. Results: The new system introduces the notion of prolonged survival. Furthermore, the negative connotation linked to palliative care is also eliminated in this setting. Conclusion: The current terminology used to describe cancer treatment goals has not been updated since the mid-20th century and it is time for a more modern approach. We propose a three-tier system: (1) curative treatment, (2) palliative care, and (3) potentially life-prolonging therapy. Full article
(This article belongs to the Special Issue Geriatric Medicine: Towards Personalized Medicine)
13 pages, 1084 KiB  
Article
The “Can Do, Do Do” Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service
by Merle R. Schene, Caroline E. Wyers, Johanna H. M. Driessen, Lisanne Vranken, Kenneth Meijer, Joop P. van den Bergh and Hanna C. Willems
J. Pers. Med. 2024, 14(4), 337; https://doi.org/10.3390/jpm14040337 - 23 Mar 2024
Viewed by 1268
Abstract
The “can do, do do” framework combines measures of poor and normal physical capacity (PC, measured by a 6 min walking test, can do/can’t do) and physical activity (PA, measured by accelerometer, do do/don’t do) into four domains and is able to categorize [...] Read more.
The “can do, do do” framework combines measures of poor and normal physical capacity (PC, measured by a 6 min walking test, can do/can’t do) and physical activity (PA, measured by accelerometer, do do/don’t do) into four domains and is able to categorize patient subgroups with distinct clinical characteristics, including fall and fracture risk factors. This study aims to explore the association between domain categorization and prospective fall, fracture, and mortality outcomes. This 6-year prospective study included patients visiting a Fracture Liaison Service with a recent fracture. Outcomes were first fall (at 3 years of follow-up, measured by fall diaries), first subsequent fracture, and mortality (at 6 years). Cumulative incidences of all three outcomes were calculated. The association between domain categorization and time to the three outcomes was assessed by uni- and multivariate Cox proportional hazard analysis with the “can do, do do” group as reference. The physical performance of 400 patients with a recent fracture was assessed (mean age: 64 years; 70.8% female), of whom 61.5%, 20.3%, and 4.9% sustained a first fall, sustained a subsequent fracture, or had died. Domain categorization using the “can do, do do” framework was not associated with time to first fall, subsequent fracture, or mortality in the multivariate Cox regression analysis for all groups. “Can’t do, don’t do” group: hazard ratio [HR] for first fall: 0.75 (95% confidence interval [CI]: 0.45–1.23), first fracture HR: 0.58 (95% CI: 0.24–1.41), and mortality HR: 1.19 (95% CI: 0.54–6.95). Categorizing patients into a two-dimensional framework seems inadequate to study complex, multifactorial outcomes. A personalized approach based on known fall and fracture risk factors might be preferable. Full article
(This article belongs to the Special Issue Geriatric Medicine: Towards Personalized Medicine)
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