COMMENT
Studies of ageing have tended to focus on lifespan rather than on years of good health.© 2 0 1 8 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d . a network of academic and industry scientists, clinicians and regulators called COST Action BM1402: MouseAGE. The network, which is funded by the European Union, has worked with other experts in these domains worldwide.
MATURING FIELDOver the past decade, understanding of the physiological changes that occur as people age has improved a great deal.Common mechanisms seem to underpin several age-related diseases, including diabetes, Parkinson's disease and Alzheimer's. A review of more than 400 studies of people and animal models indicates that similar mechanisms underlie six conditions 2 . These can involve DNA damage, such as that caused by free radicals; cellular senescence (in which cells stop dividing and start secreting inflammatory factors); or inflammation and autophagy (the degradation of organelles, misfolded proteins and so on) 2 .This may explain why people over 65 are at a higher risk than younger people of developing more than one disease at the same time. In the United States, 7 out of 10 people over 65 with diabetes will die of heart disease, for instance.It is also becoming clear that one agerelated disease can accelerate the onset of others. A 2014 study 3 showed that people older than 75 who already had diabetes, say, were more than twice as likely to develop another disease over the next three years than those who were healthy at the beginning of the study.Also, between one-quarter and half of people over the age of 80 become frail. The accumulation of deficits makes it harder for them to recover from an infection, fall or other minor stressor 4 . It is unclear whether multimorbidity leads to frailty or vice versa, or whether they are independent.Until now, ageing research has focused mainly on single diseases, or on delaying death. This means that the fundamental mechanisms of ageing as targets for the treatment or prevention of several age-related conditions are being missed. What's more, patients with multimorbidity are being exposed to many drugs at once, often with adverse effects 5 .
THREE STEPS TO TRANSLATIONResearch in mice over the past few years suggests that it might be possible to delay the decline of many tissues and the onset of disease. Drugs such as rapamycin, metformin or senolytics (which remove senescent cells), can slow the development of cataracts, osteoarthritis, osteoporosis, the loss of muscle mass and can improve cardiac function 2,6-8 .If these are to become useful in people, three advances must be made. There is no standardized definition of multimorbidity. Some researchers use the term to describe the co-occurrence of 2 diseases, some 5, others 13 and so on. This makes it hard to compare studies and to establish which diseases have a higher chance of occurring together.Agreeing to a definition will require:working out which of the 5 o...