G Model
ARTICLE IN PRESS
MAT-6430; No. of Pages 2
Maturitas xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Editorial
Personalized health care for midlife and beyond
The variation in response of patients to different treatments has called for a more tailored approach and personalization of health care [1]. Thus screening, prevention and therapies should be concentrated on those who will benefit and spare interventions with potential risks on those who will not. As worldwide people are living longer this special issue of Maturitas examines a wide spectrum of issues to improve and personalize health care for older people in a series of reviews and original articles O’Caoimh et al. examined short, valid instruments that detect older community-dwellers risk of four adverse outcomes: hospitalisation, functional-decline, institutionalisation and death [2]. Their systematic review found that there was a need to develop and validate short, reliable instruments, with evidence-based cut-offs, to identify community-dwelling older adults “at risk” for multiple potential adverse healthcare outcomes. Most emphasis was on risk of hospitalisation or death with few instruments identifying risk of institutionalisation. They also concluded that it is important that all screening and case-finding instruments are not used in isolation but should be integrated into holistic comprehensive assessment and management pathways. Connected health technologies and integrated care are discussed by Chouvarda et al. [3]. These have the potential to enable disease management outside hospitals and with continuous monitoring fine tune treatment and allow patients to self care and increase collaboration between health professionals. Screening is discussed in two reviews: one on dementia and cognitive decline and the other on biomarkers for osteoarthritis [4,5]. Calza et al. explain the ethical issues of screening for dementia and identify two opposite: [i] identification of cognitive decline due to non-neurological disorders, that might be potentially reversible if early and correctly diagnosed and [ii] identification of people in an asymptomatic phase of a neurodegenerative cognitive disorder [4]. While the first is beneficial, the second is debatable in the absence of any treatment options at present. Osteoarthritis is a chronic debilitating disease which causes pain and limits mobility. Hosnijeh et al. undertook a systematic review of biomarkers for osteoarthritis to identify patients who are at high risk of development or progression of the disease [5]. They conclude that C-terminal telopeptide of collagen type II and cartilage oligomeric protein showed the most promising prognostic value for knee and hip osteoarthritis but that more research is needed. The effects of ageing on the immune system and muscle are examined [6,7]. Immunosenescence refers not only to the alterations produced by chronologic ageing, but also changes due to chronic activation of immune system associated to virus infections
(human immunodeficiency virus, HIV; cytomegalovirus, CMV), inflammatory diseases, cancer or organ transplantation, a process termed “early” or “premature” immunosenescence [6]. Thus immunosenescence is involved in infection, cancer and neurodegenerative and cardiovascular diseases. It limits the response to pathogens and vaccines. Thus research is required to tailor vaccines for older people. Sarcopenia leads reduced mobility, functional impairment and disability. Vitamin D is involved in muscle function and therefore Panagiotis et al. examine its role in sarcopenia [7]. They conclude that current studies provide some evidence that vitamin D supplementation may be beneficial but that more research is needed. Two reviews look at exercise [8,9]. There is a good body of evidence that regular exercise is important for both prevention and management of cardiovascular and other non-communicable diseases, unwanted weight gain, worsening metabolic profile and osteoporosis. Woodward et al. propose an exercise prescription for women that can be easily incorporated into daily living [8]. Hill et al. review the effectiveness of individualized (tailored) home-based exercise programs in reducing falls and improving physical performance among older people living in the community [9]. They found that while these programmes are effective in reducing falls and improving physical performance, they are not for people recently discharged from hospital. Continuing on the theme Anne Ambrose and colleagues explore screening tools and interventions to prevent falls and fractures [10]. They recommend that all adults above 65 years should be screened at least once a year to establish their fall risk profile. Further assessment and treatment should then be tailored to their risk. Challenges in personalized cancer care continue and two cancers are examined: lung cancer which usually has a poor prognosis and breast cancer where there is better survival [11,12]. Carrera and Ormond argue that personalised care for lung care should extend beyond molecular profiling for targeted therapies and include palliative care [11]. Maass et al. in a systematic review, find that long term depression is a significant problem for breast cancer survivors and should be addressed by health professionals [12]. As women age, the prevalence of pelvic floor dysfunction increases. Mannella et al. clearly explain that reconstructive surgery for urinary incontinence or pelvic organ prolapse is particularly important in aging women [13]. Treatment should aim to improve symptoms. The original articles in the issue examine methods for measuring physical activity, smoking cessation, decision making in the
http://dx.doi.org/10.1016/j.maturitas.2015.06.037 0378-5122/© 2015 Published by Elsevier Ireland Ltd.
Please cite this article in press as: A. Cano, et al., Personalized health care for midlife and beyond, Maturitas (2015), http://dx.doi.org/10.1016/j.maturitas.2015.06.037
G Model MAT-6430; No. of Pages 2
ARTICLE IN PRESS Editorial / Maturitas xxx (2015) xxx–xxx
2
treatment of aortic stenosis and the effect of patient diagnosis on the health of carers [14–17]. Conflict of interest None declared. Contributors All authors contributed equally to writing the editorial. Funding None was sought or secured for writing the editorial. References [1] B. Godman, A.E. Finlayson, P.K. Cheema, et al., Personalizing health care: feasibility and future implications, BMC Med. 13 (11 Aug) (2013) 179, http:// dx.doi.org/10.1186/1741-7015-11-179 [2] 6366 MAT-D-15-00050R1, R. O’Caoimh, N. Cornally, E. Weathers, et al., Risk prediction in the community: a systematic review of case-finding instruments that predict adverse healthcare outcomes in community-dwelling older adult, (2015), [3] 6372 MAT-D-15-00075, I.G. Chouvarda, D.G. Goulis, I. Lambrinoudaki, N. Maglaveras, Connected health and integrated care: towards new models for chronic disease management, . [4] 6415 MAT-D-15-00162R1, L. Calzà, D. Beltrami, G. Gagliardi, et al., Should we screen for cognitive decline and dementia? . [5] 6388 MAT-D-15-00102, S.H. Hosnijeh, J. Runhaar, J.B.J. van Meurs, S.M. Bierma-Zeinstra, Biomarkers for osteoarthritis: can they be used for risk assessment? a systematic review, . [6] 6406 MAT-D-15-00109R1, A. Pera, C. Campos, N. López, et al, Immunosenescence: implications for response to infection and vaccination in older people, . [7] 6371 MAT-D-15-00073, P. Anagnostis, C. Dimopoulou, S. Karras, et al., Sarcopenia in post-menopausal women: is there any role for vitamin D? . [8] 6377 MAT-D-15-00072R1, M.J., Woodward, C.W. Lu, R. Levandowski, et al., The exercise prescription for enhancing overall health of midlife and older women, . [9] 6389 MAT-D-15-00104, K.D. Hill, S.W. Hunter, F.A. Batchelor, et al., Individualized home-based exercise programs for older people to reduce falls and improve physical performance: a systematic review and meta-analysis, . [10] 6389 MAT-D-15-00104 K.D. Hill, S.W. Hunter, F.A. Batchelor, et al., Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. .
[11] MAT-D-15-00219 Review article Falls and Fractures: A systematic approach to screening and prevention Anne Felicia Ambrose, MD, MS doi awaited. [12] 6392MAT-D-15-00088R1, P. Carrera, M. Ormond, Current practice in and considerations for personalized lung cancer care: looking beyond the molecular profile of the patient, . [13] 6394 MAT-D-15-00106R1, S.W.M.C. Maass, C. Roorda, A.J. Berendsen, et al., The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: a systematic review, . [14] MAT-D-15-00202, Special issue: personalized healthcare personalizing pelvic floor reconstructive surgery in aging women Tommaso Simoncini, MD, PhD Jun 08, 2015 Jun 14, 2015 No doi as not yet online. [15] 6387 MAT-D-15-00067R1, A. Godfrey, J. Lara, S. Del Din, et al., iCap: instrumented assessment of physical capability,. [16] MAT-D-15-00114R2, Research paper does quitting smoking decrease the risk of midlife hot flashes? a longitudinal analysis Rebecca Lee Smith, D.V.M., M.S., Ph.D. Apr 07, 2015 Jun 12 (2015) doi awaited. [17] MAT-D-15-00046R1, Research paper determinants in treatment decision-making in older patients with symptomatic severe aortic stenosis Anne Sophie Boureau Feb 18, 2015 Jun 15 (2015) doi awaited.
Antonio Cano ∗ University of Valencia, Pediatrics, Obstetrics and nez 15, 46010 Valencia, Gynecology, Av Blasco Iba˜ Spain Tommaso Simoncini 1 University of Pisa, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Via Roma, 67 Pisa, 56100 Pisa, Italy Margaret Rees Women’s Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK ∗ Corresponding author. Fax: +34 963864815. E-mail addresses: [email protected] (A. Cano), [email protected] (T. Simoncini), [email protected], [email protected] (M. Rees). 1
Fax: +39 050 553410. Available online xxx
Please cite this article in press as: A. Cano, et al., Personalized health care for midlife and beyond, Maturitas (2015), http://dx.doi.org/10.1016/j.maturitas.2015.06.037
ARTICLE IN PRESS
MAT-6430; No. of Pages 2
Maturitas xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Editorial
Personalized health care for midlife and beyond
The variation in response of patients to different treatments has called for a more tailored approach and personalization of health care [1]. Thus screening, prevention and therapies should be concentrated on those who will benefit and spare interventions with potential risks on those who will not. As worldwide people are living longer this special issue of Maturitas examines a wide spectrum of issues to improve and personalize health care for older people in a series of reviews and original articles O’Caoimh et al. examined short, valid instruments that detect older community-dwellers risk of four adverse outcomes: hospitalisation, functional-decline, institutionalisation and death [2]. Their systematic review found that there was a need to develop and validate short, reliable instruments, with evidence-based cut-offs, to identify community-dwelling older adults “at risk” for multiple potential adverse healthcare outcomes. Most emphasis was on risk of hospitalisation or death with few instruments identifying risk of institutionalisation. They also concluded that it is important that all screening and case-finding instruments are not used in isolation but should be integrated into holistic comprehensive assessment and management pathways. Connected health technologies and integrated care are discussed by Chouvarda et al. [3]. These have the potential to enable disease management outside hospitals and with continuous monitoring fine tune treatment and allow patients to self care and increase collaboration between health professionals. Screening is discussed in two reviews: one on dementia and cognitive decline and the other on biomarkers for osteoarthritis [4,5]. Calza et al. explain the ethical issues of screening for dementia and identify two opposite: [i] identification of cognitive decline due to non-neurological disorders, that might be potentially reversible if early and correctly diagnosed and [ii] identification of people in an asymptomatic phase of a neurodegenerative cognitive disorder [4]. While the first is beneficial, the second is debatable in the absence of any treatment options at present. Osteoarthritis is a chronic debilitating disease which causes pain and limits mobility. Hosnijeh et al. undertook a systematic review of biomarkers for osteoarthritis to identify patients who are at high risk of development or progression of the disease [5]. They conclude that C-terminal telopeptide of collagen type II and cartilage oligomeric protein showed the most promising prognostic value for knee and hip osteoarthritis but that more research is needed. The effects of ageing on the immune system and muscle are examined [6,7]. Immunosenescence refers not only to the alterations produced by chronologic ageing, but also changes due to chronic activation of immune system associated to virus infections
(human immunodeficiency virus, HIV; cytomegalovirus, CMV), inflammatory diseases, cancer or organ transplantation, a process termed “early” or “premature” immunosenescence [6]. Thus immunosenescence is involved in infection, cancer and neurodegenerative and cardiovascular diseases. It limits the response to pathogens and vaccines. Thus research is required to tailor vaccines for older people. Sarcopenia leads reduced mobility, functional impairment and disability. Vitamin D is involved in muscle function and therefore Panagiotis et al. examine its role in sarcopenia [7]. They conclude that current studies provide some evidence that vitamin D supplementation may be beneficial but that more research is needed. Two reviews look at exercise [8,9]. There is a good body of evidence that regular exercise is important for both prevention and management of cardiovascular and other non-communicable diseases, unwanted weight gain, worsening metabolic profile and osteoporosis. Woodward et al. propose an exercise prescription for women that can be easily incorporated into daily living [8]. Hill et al. review the effectiveness of individualized (tailored) home-based exercise programs in reducing falls and improving physical performance among older people living in the community [9]. They found that while these programmes are effective in reducing falls and improving physical performance, they are not for people recently discharged from hospital. Continuing on the theme Anne Ambrose and colleagues explore screening tools and interventions to prevent falls and fractures [10]. They recommend that all adults above 65 years should be screened at least once a year to establish their fall risk profile. Further assessment and treatment should then be tailored to their risk. Challenges in personalized cancer care continue and two cancers are examined: lung cancer which usually has a poor prognosis and breast cancer where there is better survival [11,12]. Carrera and Ormond argue that personalised care for lung care should extend beyond molecular profiling for targeted therapies and include palliative care [11]. Maass et al. in a systematic review, find that long term depression is a significant problem for breast cancer survivors and should be addressed by health professionals [12]. As women age, the prevalence of pelvic floor dysfunction increases. Mannella et al. clearly explain that reconstructive surgery for urinary incontinence or pelvic organ prolapse is particularly important in aging women [13]. Treatment should aim to improve symptoms. The original articles in the issue examine methods for measuring physical activity, smoking cessation, decision making in the
http://dx.doi.org/10.1016/j.maturitas.2015.06.037 0378-5122/© 2015 Published by Elsevier Ireland Ltd.
Please cite this article in press as: A. Cano, et al., Personalized health care for midlife and beyond, Maturitas (2015), http://dx.doi.org/10.1016/j.maturitas.2015.06.037
G Model MAT-6430; No. of Pages 2
ARTICLE IN PRESS Editorial / Maturitas xxx (2015) xxx–xxx
2
treatment of aortic stenosis and the effect of patient diagnosis on the health of carers [14–17]. Conflict of interest None declared. Contributors All authors contributed equally to writing the editorial. Funding None was sought or secured for writing the editorial. References [1] B. Godman, A.E. Finlayson, P.K. Cheema, et al., Personalizing health care: feasibility and future implications, BMC Med. 13 (11 Aug) (2013) 179, http:// dx.doi.org/10.1186/1741-7015-11-179 [2] 6366 MAT-D-15-00050R1, R. O’Caoimh, N. Cornally, E. Weathers, et al., Risk prediction in the community: a systematic review of case-finding instruments that predict adverse healthcare outcomes in community-dwelling older adult, (2015), [3] 6372 MAT-D-15-00075, I.G. Chouvarda, D.G. Goulis, I. Lambrinoudaki, N. Maglaveras, Connected health and integrated care: towards new models for chronic disease management, . [4] 6415 MAT-D-15-00162R1, L. Calzà, D. Beltrami, G. Gagliardi, et al., Should we screen for cognitive decline and dementia? . [5] 6388 MAT-D-15-00102, S.H. Hosnijeh, J. Runhaar, J.B.J. van Meurs, S.M. Bierma-Zeinstra, Biomarkers for osteoarthritis: can they be used for risk assessment? a systematic review, . [6] 6406 MAT-D-15-00109R1, A. Pera, C. Campos, N. López, et al, Immunosenescence: implications for response to infection and vaccination in older people, . [7] 6371 MAT-D-15-00073, P. Anagnostis, C. Dimopoulou, S. Karras, et al., Sarcopenia in post-menopausal women: is there any role for vitamin D? . [8] 6377 MAT-D-15-00072R1, M.J., Woodward, C.W. Lu, R. Levandowski, et al., The exercise prescription for enhancing overall health of midlife and older women, . [9] 6389 MAT-D-15-00104, K.D. Hill, S.W. Hunter, F.A. Batchelor, et al., Individualized home-based exercise programs for older people to reduce falls and improve physical performance: a systematic review and meta-analysis, . [10] 6389 MAT-D-15-00104 K.D. Hill, S.W. Hunter, F.A. Batchelor, et al., Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. .
[11] MAT-D-15-00219 Review article Falls and Fractures: A systematic approach to screening and prevention Anne Felicia Ambrose, MD, MS doi awaited. [12] 6392MAT-D-15-00088R1, P. Carrera, M. Ormond, Current practice in and considerations for personalized lung cancer care: looking beyond the molecular profile of the patient, . [13] 6394 MAT-D-15-00106R1, S.W.M.C. Maass, C. Roorda, A.J. Berendsen, et al., The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: a systematic review, . [14] MAT-D-15-00202, Special issue: personalized healthcare personalizing pelvic floor reconstructive surgery in aging women Tommaso Simoncini, MD, PhD Jun 08, 2015 Jun 14, 2015 No doi as not yet online. [15] 6387 MAT-D-15-00067R1, A. Godfrey, J. Lara, S. Del Din, et al., iCap: instrumented assessment of physical capability,. [16] MAT-D-15-00114R2, Research paper does quitting smoking decrease the risk of midlife hot flashes? a longitudinal analysis Rebecca Lee Smith, D.V.M., M.S., Ph.D. Apr 07, 2015 Jun 12 (2015) doi awaited. [17] MAT-D-15-00046R1, Research paper determinants in treatment decision-making in older patients with symptomatic severe aortic stenosis Anne Sophie Boureau Feb 18, 2015 Jun 15 (2015) doi awaited.
Antonio Cano ∗ University of Valencia, Pediatrics, Obstetrics and nez 15, 46010 Valencia, Gynecology, Av Blasco Iba˜ Spain Tommaso Simoncini 1 University of Pisa, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Via Roma, 67 Pisa, 56100 Pisa, Italy Margaret Rees Women’s Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK ∗ Corresponding author. Fax: +34 963864815. E-mail addresses: [email protected] (A. Cano), [email protected] (T. Simoncini), [email protected], [email protected] (M. Rees). 1
Fax: +39 050 553410. Available online xxx
Please cite this article in press as: A. Cano, et al., Personalized health care for midlife and beyond, Maturitas (2015), http://dx.doi.org/10.1016/j.maturitas.2015.06.037
