Bringing Geroscience into the Mainstream: From Education to Clinical Practice, What Will It Take?

Advancing geroscience requires collaboration among clinicians, biologists, trialists, and other experts (1), yet these disciplines seldom interact. Moreover, there is a shortage of individuals trained in translational geroscience (2). During the Fourth Geroscience Summit, Geroscience for the Next Generation (National Institutes of Health, April 24–26, 2023), a session addressed training a workforce to shift from the traditional, disease-focused silo-based practice of medicine to targeting biological aging pathways that contribute to multimorbidity and loss of function. A description of the National Institute on Aging (NIA)-funded Geroscience Education and Training Network (R25AG073119) and broader issues about the importance of, and obstacles to, geroscience education were also addressed. Despite exponential growth in peer-reviewed articles on geroscience, the term “geroscience” is only familiar to a few hundred people actively working in the field. In fact, most people, including clinicians involved in the care of older adults, are still unfamiliar with the concept of targeting the biology of aging to prevent, delay, or cure diseases whose incidence increases with advancing age. This is problematic because aging represents the major risk factor for most chronic diseases and therefore, gerotherapeutics, interventions that target biological pathways implicated in aging and chronic diseases, need to be at the forefront of aging research, clinical trials, clinical care, and discussions of health policy. A gerotherapeutic can involve any intervention that has a positive effect on biological aging pathways and includes pharmaceutical, social, and behavioral interventions (eg, exercise or caloric restriction(definition)). If successful, gerotherapeutics will have a great impact on human health, quality of life, and the economy (3). Scientists at academic institutions must collaborate with diverse groups (eg, nonprofit organizations, health advocacy groups, the media, industry, government, and policymakers) to widely promote geroscience, establishing it as a recognized concept among healthcare providers, educators, politicians, and the public. Initial strategies have focused on broadening the concept across scientific disciplines, with a focus on biomedical areas of research directly relevant to age-associated diseases. Within the scientific community, geroscience has been embraced particularly in fields where dedicated champions of geroscience are embedded in the research community. Identifying geroscience champions within communities in the general public will be critical to help with consistent, sustained messaging. Common misconceptions about geroscience will need to be addressed while being transparent about uncertainties or limitations. Key terms including geroscience, antiaging, healthspan(definition), lifespan, and longevity will need to be clearly defined. Partnerships with experts in survey methods and communication strategies with well-established connections to key stakeholders are crucial to expanding geroscience to the public. Engaging the lay public will likely require a larger mass media campaign with public service announcements and disseminating educational materials through online platforms, including social media. Using targeted approaches by defining the audience (eg, older vs younger adults), being inclusive, and making communications concise (ie, messaging that consumers and policymakers can digest quickly and put into action) are all important points to consider. Informing the public of initiatives where they can be involved as citizen scientists has potential to foster a sense of participation and ownership in geroscience. The Fourth Geroscience Summit organizers’ efforts to achieve this were well-apparent in their invitation of the American Association of Retired Persons (AARP) to participate in presentations and discussions at the summit. Geroscience aims to distinguish its efforts from those of pseudoscientists and direct-to-consumer marketing a “cure for aging.” The field recognizes that aging is not a disease and older adults are not sick people in need of a “cure.” They are, however, at an increased risk for common geriatric syndromes and chronic diseases, with many becoming frail, losing independence, and having decreased quality of life. The heterogeneity of trajectories of health, disease, and disability in aging has often been attributed to fixed or hard-to-modify factors such as genes and environment (4). Recognizing biological aging as a modifiable risk factor for interindividual heterogeneity with aging provides an opportunity to intervene to increase the healthspan, or healthy years of life, of older adults. The goals of geroscience must also align with “what matters” to older adults: staying physically and mentally healthy, maintaining function and independence (5). Geroscience aspires to increase the human healthspan by targeting biological aging to decrease the period of illness and disability at the end of life. Extending the healthspan by targeting biological pathways shared between aging and chronic diseases has the potential to revolutionize the health of older adults. This paradigm shift, based on the identification of biological pathways at play in both aging and chronic diseases, is comparable to the paradigm shift that happened in medicine upon the discovery that microorganisms were at the root of infectious diseases. Targeting microorganisms through vaccination, antibiotics, clean food and water, and sanitation practices, as opposed to merely focusing on symptoms of infection such as fever, all arose from scientific discovery. Such discoveries greatly diminished death from infections, increasing the human lifespan from four decades to seven or eight decades, on average. Parallels can thus be drawn to past biomedical advances that have improved human health based on scientific hypotheses (eg, the Geroscience Hypothesis vs the Germ Theory). Well-designed clinical trials