Report From Prestigious NIA-Funded Conference Looks to Biological “Pillars of Aging” for Better Grasp of Health

Long-term care for older adults has long focused on preventing and treating chronic diseases and the conditions that come with them. But now, geriatrics researchers and clinicians hope a new understanding—one honed at a prestigious conference hosted by the American Geriatrics Society (AGS) and the National Institute on Aging (NIA), with support from The John A. Hartford Foundation—can lead to better and more effective interventions by targeting the aging process itself rather than discrete conditions or concerns.

“Aging is complex and varies from one person to the next, but there’s a growing body of evidence that aging itself is driven by interconnected biological factors we call ‘hallmarks’ or ‘pillars,’” said Christopher Carpenter, MD, MSc, FACEP, FAAEM, AGSF, one of the coauthors of a report on the conference. “We believe disrupting these hallmarks—which cover everything from the stability of our genes to ways our cells communicate—can contribute to chronic disease and frailty, which is why a better understanding of how they work is so important.”

Convened in 2016 as the second conference in a 3-part series for recipients of the NIA’s Grants for Early Medical/Surgical Specialists Transition into Aging Research (GEMSSTAR) program, the NIA “U13” conference brought together more than 100 scholars, researchers, and leaders representing 19 medical specialties to stimulate research across the disciplines involved in high-quality, person-centered care. Conference findings, published in the Journal of the American Geriatrics Society (doi:10.1111/jgs.15788), detail how new methods of studying the older-adult population can reveal new tools and accelerate innovative treatments focused on big-picture outcomes important to people’s lives, such as function and independence.

Rather than beginning with the discrete health conditions and concerns common among older adults, conference organizers took the unique approach of focusing on aging itself as a primary factor impacting multiple chronic diseases and declining resilience. In doing so, GEMSSTAR scholars advanced our understanding of the concept that targeting age-related mechanisms might delay, prevent, or even reverse geriatric syndromes, age-related chronic diseases, and declines in resilience. Conference sessions also focused on new methods and strategies for studying these aspects of aging and reviewed the challenges of studying age when older people often have been excluded from medical research.

Major themes that emerged from the conference include a need for increased attention to:

The study of our human population as it ages. Most clinical trials overlook people who have chronic diseases. However, researchers now understand the importance of ensuring pragmatic clinical trials reflect the full spectrum of health for older adults, particularly those who are frail (and likely to live with the conditions under study). 

The need for new tools to help older adults and caregivers adapt to changing health needs. Studying the biology of aging could yield even more approaches to aging-related disease prevention or treatment for geriatrics experts who will be needed in greater numbers as the world continues to age. For example, a better understanding of the interaction between resilience, metabolism, and inflammation could help uncover how many common medicines prescribed for these conditions might support general health as we age.

The importance of accelerating how we translate research into promising clinical practice. Conference workshops also focused on ways to make aging research actionable for clinical studies and clinical practice. Suggestions included integrating aging concepts into research conducted by “subspecialists” in particular areas of medicine and creating a national, diverse “geroscience biobank” attuned to exploring multimorbidity and frailty in particular.

Supporting the future of aging research. As more people benefit from increased longevity, specialty clinician-investigators must be empowered to contribute to the evolution of aging research. Collaboration will be particularly important, said Evan Hadley, MD, director of the Division of Geriatrics and Clinical Gerontology at the NIA, in his closing remarks for the GEMSSTAR U13 conference. Dr Hadley emphasized that partnering across disciplines previously seen as independent will be important to future progress.