Laboratory diagnosis and geriatrics: more than just reference intervals for the elderly

Area of Science:

• Geriatric Medicine
• Laboratory Science
• Clinical Diagnostics

Background:

• Elderly individuals are often viewed as biological outliers, complicating standard laboratory testing reference groups.
• Maintaining quality of life is paramount in geriatrics, necessitating therapeutic compromises and focus on remaining functional capacities.
• Challenges in laboratory testing for the elderly include pre-analytical phase issues, lack of harmonization, and difficulties with point-of-care testing.

Purpose of the Study:

• To highlight the diagnostic challenges in geriatric laboratory medicine.
• To advocate for a paradigm shift towards individualized patient monitoring over traditional statistical evidence.
• To emphasize the importance of assessing clinical individuality and remaining organ function in elderly patients.

Main Methods:

• The study reviews existing literature and clinical practices in geriatric laboratory medicine.
• It discusses the limitations of current laboratory testing methodologies for the elderly population.
• It explores the impact of multi-morbidity, multi-aetiology, and cognitive/physical decline on diagnostic information.

Main Results:

• Standard laboratory reference groups are often inappropriate for the elderly.
• Individual monitoring requires stable, high-quality laboratory analyses, particularly addressing the pre-analytical phase.
• Degradation of clinical information due to cognitive or physical decline complicates diagnosis in older adults.

Conclusions:

• Geriatric laboratory medicine requires a paradigm shift, prioritizing individual patient data over population-based statistics.
• Understanding "clinical individuality" and its temporal risk is more critical than differentiating physiology from pathology.
• Focus should be on assessing remaining functional capacities to guide supportive and palliative care in the elderly.