Healthy Aging is a Harmful Concept that will Misdirect Research Efforts

"Healthy aging" is a popular concept in the research community. It is the idea that aging is somehow separate from age-related disease, and if we could just effectively treat age-related disease, then people would have a healthier old age, but the shape and length of life would be much the same. This is very wrong-headed. Aging (whatever parts of the decline one is willing to say are not age-related disease) and age-related diseases (the large declines in function that everyone acknowledges are bad) arise from the same underlying mechanisms, the accumulation of cell and tissue damage and the consequences of that damage. The only difference is a matter of degree.

Trying to cure age-related disease without repairing the underlying damage that causes aging is futile. We know it is futile because this is exactly the strategy that the scientific and medical community have been following, at enormous expense and investment of time, in past decades. There is only marginal, incremental progress to show for this effort. Yet as soon as just one method of repairing damage, the clearance of senescent cells, started development in earnest, less than a decade ago, it resulted in easily obtained benefits in animal studies. Now the effects of senolytic drugs to selectively kill senescent cells threaten to be much larger and more reliable in the treatment of age-related disease and dysfunction than anything achieved to date by the rest of the field of medicine.

This open access paper, in which the authors give a summary of the present lack of good biomarkers for aging, is an example of the way in which the concept of healthy aging steers research strategy in the wrong direction. Researchers invested in this concept will try to square the circle, in search of ways to distinguish age-related disease from aging. They will draw lines and declare some of aging, and the suffering and declining function it causes, to be completely acceptable and thus not worthy of treatment. This is all madness, and the concept of healthy aging should be consigned to the pit, never to be seen again.

Hallmarks of senescence and aging

Every living organism lives in a permanent struggle with extrinsic and intrinsic agents that can damage it. Without its own repair mechanisms, life of living creatures would be extremely short, since the accumulation of harmful substances would damage the cellular elements, their function, which would ultimately result in damage to the various tissues and accelerated aging of the entire organism. Most of the aging definition involves a gradual, heterogeneous impair in the structure, function, and maintenance of repair systems of various organs and an increased inclination to various diseases. One could say that the age/aging phases are easy to recognize, but the mechanisms responsible for the aging process are difficult to define and harder to prove. Technological progress has established various methodological approaches to detect some cellular and molecular mechanisms associated with aging. Among others, scientists have focused recently on senescence (cellular aging, biological aging) mechanisms as one of the key factor in a complex aging process.

Aging is an intrinsic feature of all living beings. The complex process of biological aging is the result of genetic and, to a greater extent, environmental factors and time. It occurs heterogeneously across multiple cells and tissues. As the rate of aging is not the same in all humans, the biological age does not have to be in accordance with the chronological age. Many age-associated changes and hallmarks are evident in the human body. In the background of all the changes that occur during aging are three key factors - inflammation, immune aging, and senescence.

In order to examine why and how people become old with different rate, it is necessary to define the primary indicators/biomarkers of the healthy aging process. Only in this way it will be possible to distinguish the phenomenon of aging due to the processes caused by various diseases that are commonly associated with the aging process. In this sense, the scientific community is continually investing great efforts in discovering such biomarkers.

According to the American Federation for Aging Research recommendations, aging biomarkers should meet several criteria. They have to: 1. predict the rate of aging (correlate with aging); 2. monitor a basic process that underlies the aging process (determine "healthy aging", not the effects of disease); 3. be able to be tested repeatedly without harming the person; 4. be applicable to humans and animals. However, currently, there is no biomarker that would meet all of these criteria. Currently, due to the stated fact that many of the hallmarks of aging do not meet biomarker definition criteria, it may be better to use terms a) hallmarks of senescent cells or hallmarks of aging or b) possible biomarkers of senescence.

Thus in summary, there are currently no standardized biomarkers of cellular aging process or the healthy aging of the organism. Biomarkers described in literature do not meet all criteria of an ideal aging biomarker and actually represent various hallmarks of the aging process. Most biomarkers currently being examined as senescence or aging biomarkers are related to age-related illnesses rather than the process of healthy aging. As the effector mechanisms of senescence are neither necessarily specific to senescence nor present in all forms of senescence (the rate of senescence is not the same for all types of cells), the interpretation of existing biomarkers of senescence (for now the hallmarks or possible biomarkers) should be context dependent. Additionally, a combination of multiple biomarkers should be used.

Detection of biomarkers, in particular their quantification and validation, are necessary for understanding the senescence processes (diagnostic biomarkers), monitoring of the rate of senescence (prognostic and predictive biomarkers) and the possible use of appropriate therapy intervention (pharmacodynamic biomarkers). The identification and selection of reliable biomarkers, and the use of reproducible methods could help to better understanding of complex web of senescence and aging processes, but it will also open some new questions. Despite new findings at the cellular and molecular level the understanding the aging process is still limited.

Comments

They might as well call it "Healthy dying."

Posted by: Corbin at August 19th, 2019 4:30 PM

Healthy ageing is such a bizarre concept; aging in a biological sense is literally defined as the time dependent decline in an organism's capacity to sustain homeostasis, which is to say remain in good health.

Posted by: Dylan Mah at August 19th, 2019 5:44 PM

I prefer calling it graceful aging where your health is long but the lifespan is kinda the same. Nevertheless, this article is useful for quotes and arguments this is the important part: "... in summary, there are currently no standardized biomarkers of cellular aging process or the healthy aging of the organism"

And this opening quote "the mechanisms responsible for the aging process are difficult to define and harder to prove"

Posted by: Cuberat at August 20th, 2019 3:21 AM

It's such a blatant contradiction - healthy diminished health. Right up there with honest liars, safe danger and four sided triangles.

Posted by: Arcanyn at August 20th, 2019 6:32 AM

Hi there! Just a 2 cents.

Cuberat is onto something and nails it with the graceful aging - yet not much change in maximal lifespan. Health and Longevity, through related, are 2 elements (of the same), not just 1 (same thing), and have differences. For example, there have been people who were young and died prematurely (I was nearly one of them, thankfully, I survived), - there were Young, biologically speaking (on the dotclock) - and they Still died, young, in their 20-30s...
One organ (critical one) or another failed, and that's the end of it, young/old or not.

It is important to differentiate that from someone living a full healthy life of 90 years, 'healthily aging into very old age' ...and then dying.

In that sense, yes, healthy aging and be uncoupled/differentiated from specie/individual maximal longevity (MLSP, Maximum Lifespan Potential). It is why scientist continue to focus on aging 'healthily' - 'healthy aging'....like it's some 'good' thing....and as others pointed - an oxymoron - you still die one day, that'S the crux of it (they want you to gobble up the hypocrisy) and the 'elephant in the room' they don't want you to see - except...an 15-feetall, 20-feetwide, 4-ton elephant (not a mickeymouse). But they just put it behind the backroom curtains....'it doesn't show...really'....

This kind of 'let's hope they don'T stop the impostor'...(un)transparence is why the general populace of people are thinking they (scientists) think the avg people are that gullible/taking them for low doorknobs. They can see (through) those curtains and by the sheer shape/size of them; that....it must be, an elephant (and a 'quick one' they are trying to fool us with). So who do they think they fool, but themselves. Scientist are not necessarily being bad about that, it's just they are trying to 'make it be 'ok''...when it is. We all die and age. So it's why, it's so infuriating...do we really want to get upset...we die anyway...better your energy/positivity instead of getting riled up because people are trying feed you a hypocritical/lie/bs. They probably think...''whatever...it's all there is to it...you die anyway...so might as well take our d*mn supplements while you (still) can. You just might 'age healthily' and live 3 years-and-a-half extra''.

It's incredible because we would think 'of course, a young person dying prematurely' is obviously 'older' than an old/elder/aged person - who is still age. Nope, it'S more muddied than that. That young person could/is a lot Younger than that old person, except he/she entered 'premature death' from a dysfunctioning organ(s) (premature senscence/exit of cell cycle - suddenly, way in advance of the 'maximum' possible)). Also called, spontaneous senescence, and also, spontaneous apoptosis. Think of it like a 'threshold' - a 'gauge' - a 'barometer'....health has a threshold and once you trespass it - it is loss of homeostasis - whether you are Young or Old. (It's why the confusion and ambiguity between health and aging - as 2 things than just 1 thing; Yet, we can all agree on one thing (at least) if we believe they are 2 things: They Are (Inter)-Related and working in tandem/feeding of each other). You need (to keep your) health for longevity - But, you can be healthy (enough) and have a short longevity - suddenly/abruptly (premature death), because you lose your health and die young (like it almost happened to me).

Just a 2 cents.

Posted by: CANanonymity at August 20th, 2019 6:14 PM

PS: typos sorry,

''let's hope they don't *spot the impostor''
''Scientist are not necessarily being bad about that, it's just they are trying to 'make it be 'ok''...when it *isn't ''
''It's incredible because we would think 'of course, a young person dying prematurely' is obviously 'older' than an old/elder/aged person - who is still *aging ''.

Posted by: CANanonymity at August 20th, 2019 6:52 PM

Aging is obviously separate from age related disease, because frankly very healthy old people look old.

Posted by: NY2LA at August 20th, 2019 9:27 PM

There has yet be "very healthy old people". Every elderly person is suffering from deterioration as a result of the body's normal function (a similar process occurs in every kind of machine with moving parts), but some people get confused by this because of how some age-related conditions are named like diseases, while other age-related health problems are nonsensically considered to be insurmountable (like frailty).

Keep in mind that if a doctor tells an 80 year old that they're "healthy", that doctor is just saying their patient is healthier than the average 80 year old, because the idea of a perfectly healthy biologically 80 year old obviously isn't the reality.

Posted by: Quinn at August 21st, 2019 10:44 AM

@NY2LA
>Aging is obviously separate from age related disease, because frankly very healthy old people look old.

But then what does it mean to look old? Having hey hair or even no hair at all? Losing teeth, wrinkles, age skin spots?

Posted by: Cuberat at August 21st, 2019 12:36 PM

I am suggesting that the appearance of age is a proxy for the intrinsic aging process. I've cited this study before:

Three-dimensional human facial morphologies as robust aging markers
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423077/

Humans have a more complex system of facial muscles for communicating via expression than any other mammals. Therefore, I don't think seeing rejuvenated animal fur tells us much of anything.

Posted by: NY2LA at August 22nd, 2019 12:02 AM

It's possible-in-principle to repair age-related damage in humans, and the on-going rejuvenation research appears to be on the right track, so it's best to wait until the upcoming clinical trial results come in before being overly positive or negative about the early-stage therapies.

Posted by: Quinn at August 22nd, 2019 12:23 AM

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