Heike Bischoff-Ferrari is Director of the Centre on Aging and Mobility at the University of Zurich, Switzerland. After completing her clinical training at the University of Basel Switzerland, Dr. Bischoff-Ferrari undertook a fellowship at the Department of Rheumatology, Immunology and Allergy at the Brigham and Women’s Hospital in Boston, and was appointed to the faculty at Harvard Medical School from 2002 until 2005. In 2002, she obtained a Master of Public Health Degree in Clinical Effectiveness, and in 2008, a Doctor of Public Health Degree from the Department of Nutrition, Harvard School of Public Health. In 2005 she took a primary faculty appointment at the Department of Rheumatology and Institute of Physical Medicine at the University Hospital in Zurich Switzerland, where she has been Head of Clinical Research since May 2007. In February 2007, she received a Swiss National Foundation Professorship and in September 2009 she started her current position. Dr. Bischoff-Ferrari’s research focuses on improving musculoskeletal health in older individuals, specifically, nutritional and exercise interventions in the prevention of falls, fractures, and osteoarthritis.
Wednesday 03 June 09:30
Personalised medicine in the elderly – how to avoid overtreatment
Personalized medicine offers the potential to tailor treatment using an integrative approach so as to ensure better patient care. Changing population demographics, however, mandate the need to consider issues relevant to the elderly, specifically comorbidity and polypharmacy. A particular concern is the potential for overtreatment and the associated detrimental impact on treatment tolerability and risk of drug-drug interactions, especially among elderly, frail patients. Indeed, current guidelines recommend that evidence for the effectiveness of pharmacological interventions among these individuals may be insufficient to evaluate whether the benefits of pharmacological intervention outweigh the risk of adverse outcomes. Beyond the individual, however, potential overtreatment also poses public health challenges, contributing to excessive healthcare costs and resource use.
In the era of personalized medicine, computerized tools are likely to play a role as a support to decision-making for clinicians caring for elderly patients. Recent examples include FORTA (Fit fOR The Aged), a drug classification system to optimize pharmacotherapy in the elderly, as well as TRIM (Tool to Reduce Inappropriate Medications), a data extraction tool for identifying the risk for side effects and drug-drug interactions among the elderly. Increased opportunities for clinician education and patient feedback are also relevant to the individualization of treatment and optimization of benefit versus risk among the elderly.
Recent guidelines advocate a paradigm shift to predictive, preventive and personalized medicine among the elderly, frail patient, taking into account both health and disease care. The clinical reality, however, is often a semi-personalized approach, involving a compromise between standardization and individualization of treatment.
Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019;23:771-87.
Ernst R, Fischer K, de Godoi Rezende Costa Molino C, Orav EJ, Theiler R, Meyer U, Fischler M, Gagesch M, Ambühl PM, Freystätter G, Egli A, Bischoff-Ferrari HA. Polypharmacy and kidney function in community-dwelling adults age 60 years and older: a prospective observational study. J Am Med Dir Assoc 2019. doi: 10.1016/j.jamda.2019.07.007. [Epub ahead of print]
Bischoff-Ferrari HA, Orav EJ, Abderhalden L, Dawson-Hughes B, Willett WC. Vitamin D supplementation and musculoskeletal health. Lancet Diabetes Endocrinol 2019;7:85.