EditorialPatient-Centered (P4) Medicine and the Older Person
Section snippets
Personalized Medicine and Dementia
Diagnosis and management of dementia has shown an accelerated course toward personalized diagnosis but a virtual lack of understanding of personalized management. A part of this has been the push to make Alzheimer disease the equivalent of all dementia.4 In personalized medicine, it is important to recognize that there are over 100 causes of cognitive dysfunction. Most importantly, there needs to be early recognition of reversible causes of cognitive dysfunction, for example, hearing loss,
Personalized Medicine for Chronic Obstructive Pulmonary Disease (COPD)
Personalized medicine in COPD begins by using patient-reported outcomes, for example, COPD assessment test32 or the EXAcerbations of Chronic pulmonary disease Tool.33 These allow patient-directed care to the symptoms most important to them and the development of specific disease phenotypes.
The management of COPD requires a focus on and treatment of comorbidities.34 Chronic postnasal drip due to allergic sinusitis represents a major treatable cause of chronic cough, wheezing, and dyspnea with
Pharmacologic Products and Precision Medicine
It is becoming clear that a number of drugs need to be tailored to individuals with a specific genotype. As an example, women with ovarian cancer with BRCA1 and BRCA2 mutations appear to be particularly responsive to cisplatinum.44 Molecular profiling in non–small cell lung cancer is an ideal version of precision medicine. Cancers with a rearrangement of the ALK gene are rare (<5%) but can be treated by drugs such as crizotinib that blocks the kinase activity of a fusion gene formed by ALK and
Patient-Centered Diagnosis and Management of Frailty and Sarcopenia
At St. Louis University, we have developed a computer algorithm to diagnose and manage the geriatric giants—frailty, sarcopenia, anorexia of aging and cognitive decline.53, 54, 55 This represents a patient-centered nondisease approach to caring for older persons. For frailty (FRAIL) and sarcopenia (SARC-F), simple screening tools identify people who are at risk for future disability, hospitalization, and mortality.55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65 Similarly, the anorexia of aging is
Conclusion
At present, patient-centered medicine in geriatrics is mainly focused on the identification and appropriate treatment of geriatric syndromes. This issue of the Journal contains a simplistic approach to the implementation of the person-centered medical care model in a skilled nursing facility.92 In the future, we can expect to see more focus on genomics and proteomics in dementia, as pointed out in this article, and in the nutriomic area for nutrition and sarcopenia.93, 94 An area in which P4
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Motoneuron loss is associated with sarcopenia
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Predictors of skeletal muscle mass in elderly men and women
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Nutritional supplementation and sarcopenia: The evidence grows
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Anorexia of aging: A true geriatric syndrome
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Effect of liquid dietary supplements on energy intake in the elderly
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Nutrigenomics: From molecular nutrition to prevention of disease
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Frailty, diabetes, and mortality in middle-aged African Americans
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Cited by (20)
Haemodynamic frailty – A risk factor for acute kidney injury in the elderly
2021, Ageing Research ReviewsCitation Excerpt :We have highlighted how a relative inability to effectively sustain water balance represents a central aspect of HDF in the elderly which can predispose or sensitize individuals to pre-renal and intrinsic AKI. Accordingly, accurate assessment of hydration status would provide a unique window of opportunity for patient-centred precision and preventive (P4) medicine aimed at attenuating HDF (Morley and Vellas, 2017). Pre-emptive diagnosis of risk is a tool for double edged intervention.
Physical Frailty: A Biological Marker of Aging?
2020, Journal of Nutrition, Health and AgingPhysical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management
2019, Journal of Nutrition, Health and AgingPatient-Centered Care and Cognitive Dysfunction
2018, Clinics in Geriatric MedicineDysphagia, Dementia and Frailty
2018, Journal of Nutrition, Health and AgingClinical Update on Nursing Home Medicine: 2017
2017, Journal of the American Medical Directors AssociationCitation Excerpt :It is clear that the diagnosis and management of dementia is extremely complicated and that appropriate management can slow or reverse its course. This is a clear example where computer assisted patient centered approach (P4 medicine) will be the appropriate paradigm137 (www.dementiaacademy.co.uk). In the past 10 years, the emphasis on a standardized and scientific approach to chronic wound care has greatly increased.