Precision medicine for older adults with multimorbidity through a whole-person and palliative care approach

As populations age globally, multimorbidity, defined as the coexistence of two or more chronic conditions, has become highly prevalent. While precision medicine holds promise for tailoring interventions based on genetics, environment, lifestyle, and other individual characteristics, its application in older adults with multimorbidity remains limited largely narrowly biomedical, disease-specific, and insufficiently aligned with palliative care principles. Such approaches are poorly suited to the complexity, vulnerability, prognostic uncertainty, and existential challenges characteristic of aging with multimorbidity, particularly in the context of serious illness. We argue that precision medicine must evolve into precision whole-person care by explicitly integrating palliative care principles, including goal-concordant care, relief of suffering, and preservation of dignity. This expanded model incorporates biological, psychosocial, and spiritual domains as measurable and actionable determinants of health. To promote a truly patient-centered, whole-person approach to precision medicine, all the dimensions of wellbeing should be recognized and integrated as key components of precision care. We synthesize evidence on multimorbidity, precision palliative care, and aging, and propose a multidimensional biopsychosocial-spiritual framework to guide the implementation of precision medicine in older adults, examine ethical and clinical implications; and suggest future research directions. Precision medicine from a whole person approach that recognizes and incorporates psychosocial-spiritual dimensions of wellbeing may better align care with patient values, enhance dignity, reduce burdensome or non-beneficial interventions, and optimize outcomes that matter most to older adults living with multiple chronic illnesses.