Geroscience in the clinic: what longevity medicine offers

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Geroscience in the clinic: what longevity medicine offers today

By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv

Geroscience enters the clinic

Geroscience, the science of aging, is advancing quickly, but its path into the exam room is still a long one. Modern medicine is very good at treating diseases once they have appeared. By contrast, longevity medicine, the medicine of healthy longevity, wants to move the point of intervention earlier.

The goal is to identify biological, metabolic and functional processes before they turn into disease, and to build on them a personal prevention plan that accompanies a person for years. An article in The Lancet Healthy Longevity argued that advanced technology alone is not enough. Instead, structured medical training, the authors wrote, is a prerequisite. It should teach physicians to evaluate new tools with a critical eye and translate them into safe decisions.

What is longevity medicine?

Longevity medicine is an emerging field of preventive, personalized, data-driven medicine. It combines the biology of aging, gerontology and precision medicine. In addition, it draws on genetics and epigenetics, blood biomarkers and measures of physical function. Imaging and machine learning are part of it as well.

The aim is not only to extend lifespan, the number of years we live. Above all, the aim is to extend healthspan: the years in which a person functions well and stays independent and healthy in body, mind and cognition. I have written more about this distinction in my article on longevity medicine and rejuvenation.

In practice, much of the clinical work happens in the field I have worked in for many years: metabolic health, weight, blood sugar and blood lipids. These issues are not a sideline to longevity. On the contrary, they are its core.

Geroscience: age as the main risk factor

The organizing idea of the field comes from geroscience. According to this approach, age is the strongest risk factor for most chronic diseases. Intervening in the aging processes themselves could therefore delay several diseases at once, not just one.

A landmark review in the journal Cell from 2023 defines twelve core hallmarks of aging. They include genomic instability, telomere shortening and epigenetic changes. The list also includes loss of protein balance and disrupted cellular clean-up (autophagy). Furthermore, it includes impaired regulation of the cell’s nutrient sensors and declining mitochondrial function. Alongside these are cellular senescence, stem cell exhaustion and disrupted communication between cells. Finally, the list includes chronic inflammation and changes in the makeup of the gut microbiome.

Which diseases are driven by age?

Age is the most significant risk factor for many chronic diseases. For example:

Cardiovascular disease, type 2 diabetes and metabolic syndrome.
Cancer, dementia and neurodegenerative diseases.
Muscle loss, frailty and osteoporosis.
Weakened immune resilience and loss of functional independence.

That said, precision matters. Chronological age itself is not a disease. And not every test or treatment marketed under the “longevity” label has been shown to improve health or extend life.

Biological age vs. chronological age

Two people of the same age can be in completely different states of health and function. The concept of “biological age” rests on this difference. In other words, it is an attempt to estimate the condition of the body and its pace of aging, beyond the number of years since birth.

To estimate it, clinicians measure metabolic and inflammatory markers and epigenetic changes. They also assess body composition and muscle mass, grip strength, cardiorespiratory fitness, walking speed and balance. Sleep, cognitive function and data from wearable sensors also come into the picture.

Aging clocks: what geroscience does not yet know

“Aging clocks” are not a clinical thermometer. A review by leading researchers in the field notes that epigenetic clocks correlate well with chronological age. However, it is still unclear how well they measure the pace of biological aging, or whether they respond correctly to interventions. I have discussed this further in my article on epigenetic clocks.

So the physician’s role does not end with ordering a test. They need to understand its validity, its limitations and its clinical meaning.

The simple measures that predict the most

Surprisingly, cheap and simple measures of function have shown strong predictive value in large studies.

Grip strength: The PURE study included 139,691 participants from 17 countries. Every 5 kg decrease in grip strength was associated with a higher risk of death from any cause, with a hazard ratio of 1.16 (95% CI: 1.13 to 1.20). Grip strength also predicted mortality better than systolic blood pressure. I have written more about grip strength and longevity in a separate article.

Walking speed: Similarly, a pooled analysis of nine cohort studies included 34,485 people aged 65 and older. Every 0.1 m/s increase in walking speed was associated with a lower risk of death, with a hazard ratio of 0.88 (95% CI: 0.87 to 0.90).

Cardiorespiratory fitness: A study of 122,007 people who underwent exercise treadmill testing compared fitness levels. Low fitness, compared with elite fitness, was associated with a 5.04-fold higher risk of death (95% CI: 4.10 to 6.20). According to the researchers, this risk is comparable to, and even greater than, classic risk factors such as smoking, diabetes and coronary artery disease. There is more on this in my article on aerobic versus strength training.

What a longevity physician needs to learn

The Lancet Healthy Longevity article points to a gap between three groups. First, there are researchers in the biology of aging. Second, there are data and artificial intelligence experts. Third, there are physicians, who make practical decisions for a specific person.

The physician does not need to become a data scientist, but they do need to know how to ask the right questions. Therefore, serious training should cover several areas:

Mechanisms of aging: DNA damage, epigenetic changes, chronic inflammation, mitochondrial function, cellular senescence and loss of muscle mass.
Evaluating biomarkers: In which population was the measure validated? How reproducible is it? And does a change in it predict a meaningful medical outcome?
Responsible use of artificial intelligence: Understanding the quality of the data the algorithm was trained on, the risk of bias, transparency and privacy protection.
Evidence-based preventive medicine: Mastery of the classic risk factors, such as blood pressure, blood lipids, blood sugar, obesity, smoking, nutrition, physical activity and sleep.
Functional assessment: Measuring strength, fitness, balance, mobility, body composition and cognitive function, not just blood tests.
Evaluating interventions: Distinguishing between a treatment with proven benefit and an intervention still under study, even when it gets wide media exposure.

I have written about such training programs in my article on longevity courses for physicians.

More tests do not necessarily mean more health

One of the dangers in this field is the “testing cascade.” First, an advanced test reveals an incidental finding. Then the finding leads to another test, a biopsy or treatment. Yet the finding may never have harmed the person at all.

A systematic review of whole-body MRI included 12 studies and 5,373 people without symptoms. The pooled prevalence of critical or indeterminate incidental findings reached 32.1% (95% CI: 18.3% to 50.1%). In addition, the pooled rate of false-positive findings was 16.0%. Moreover, the reviewers note that long-term validation data is simply lacking.

So a high-quality longevity program is not measured by the number of tests. Instead, it is measured by these questions:

Is the test appropriate for the person’s age, sex and medical history?
How likely is the result to change treatment?
Is there evidence that the change improves health or function?
How much does the benefit outweigh the risk, including overdiagnosis and anxiety?
Is there a structured plan for further workup and follow-up?

The foundations that are already proven

Responsible longevity medicine is not “anti-aging.” Nor does it rely on a miracle supplement or a single test. In most cases, the foundation remains familiar and evidence-based.

For example, the PREDIMED trial included 7,447 participants at high cardiovascular risk. A Mediterranean diet supplemented with extra-virgin olive oil reduced the risk of a major cardiovascular event compared with a low-fat diet, with a hazard ratio of 0.69 (95% CI: 0.53 to 0.91). Likewise, a Mediterranean diet supplemented with nuts showed a similar result: a hazard ratio of 0.72 (95% CI: 0.54 to 0.95).

The foundations include:

A personalized Mediterranean diet and maintaining metabolic health.
Strength training and aerobic activity, and preserving muscle and bone mass.
Adequate sleep and not smoking.
Controlling blood pressure, blood sugar and lipids.
Vaccinations and standard screening tests.
Social connections, a sense of meaning and mental health.
Adapting to life stages, such as menopause, when body composition and metabolic risk change.

The innovation is not in replacing these foundations. Rather, it lies in combining them with precise measurement, early detection and personal follow-up over time.

Geroscience in the clinic: a process, not a day of tests

A serious model starts with an in-depth medical assessment. It covers underlying conditions, family history, medications, nutrition, activity, sleep, mental health and personal goals. Only then does the physician choose tests and build an intervention plan. Finally, follow-up is scheduled that repeats the same measures, to see whether the plan is working.

A review in the journal GeroScience describes setting up longevity clinics in public hospitals. In particular, it emphasizes a multidisciplinary team and a comprehensive clinical assessment to detect early signs of functional decline. It also recommends standardized protocols developed together with research institutions.

On the other hand, a 2025 paper warns of a gap in commercial clinics: the marketing promise sometimes outstrips the strength of the evidence. A clinic’s true value comes from medical interpretation and follow-up, not from its equipment. I have also written about this in my article on longevity clinics and the future of medicine.

The bottom line: geroscience in the service of health

Longevity medicine represents a shift from late treatment of disease to early, personal and ongoing management of health. It has real potential to bring together geroscience, preventive medicine, physical function and artificial intelligence.

Yet that potential will be realized only when skilled professionals use the tools, understanding both what they can do and where they fall short. This is not a promise of life without aging. Instead, it is a professional aspiration to add more years of health, independence and function to life.

The information in this article is general and does not replace personal medical advice. For any decision about tests or treatment, consult a doctor who knows your situation.