How can precision health care contribute to healthy aging?

Abstract

The future of medicine will be closely linked to technological progress, to the great benefit of aging adults. Increasing knowledge in fields encompassing biology, physiology and functioning of the aging process, combined with the early detection of non-clinically apparent but significant changes will make it possible to promote healthy aging. The analysis of survival curves from the past two centuries clearly demonstrates that the decrease in child mortality is a key element explaining the amazing increase in life expectancy. It has now been proven that the increase in life expectancy worldwide, for both sexes, actually started back in the 19th century, rising from 52 years in the 1950s, to over 72 years today. This fantastic achievement is linked to tremendous progress in medicine, particularly after the mid-19th century, with the discovery and implementation of anesthesia (1850), insulin (1922), antibiotics (1928), and aspirin (1950), among others. Among these landmark discoveries, blood transfusion (1913) and vaccines (1955) are the two medical advancements that have saved the greatest number of lives, with an estimated billion lives saved by each. Beyond these purely numerical aspects of medical progress, technology began to enhance the impact of medicine on longevity, with the advent of cardio-pulmonary resuscitation (1957), hemodialysis (1957) and pacemakers (1980), among many other advanced technologies. Since 2000, progress in bioengineering has included techniques and technologies such as robotic surgery (2003), nanotechnology (2003), big data (2010), brain and genetic mapping (2013)1 and indeed, artificial intelligence (2019). This crucial progress easily explains the growth of the world's population, which will rise from less than 1 billion in 1800, to 6 billion in 1999, and probably reaching 10 billion by 2050. In this context, it is essential to stress that adults over 65 years will represent one fifth of the world population (i.e. 2 billion individuals). Bearing in mind that 80% of them will live in developing and moderately developed countries, it is evident that the health care challenges, in a constrained economy, will be extremely burdensome. This is why it is urgent to enhance our understanding of the aging process, and to integrate it into a life-course approach. Indeed, all the periods of life are important, as stressed by the 2015 WHO definition of healthy aging, namely: “Developing and maintaining functional ability to preserve well-being until old age”.2 This shift in the definition of healthy aging clearly introduces the classical, but too often forgotten link between disease and function. These two are intricately linked, as illustrated by the coexistence of the ICD 11 (International Classification of Diseases)3 and the ICF (International Classification of Functions).4 This also testifies to the importance of controlling the disability process, which too often leads to dependency in old age, with all its personal and societal consequences. Precision medicine, personalized medicine and high-definition medicine are concepts that recently emerged hand in hand with the outstanding progress in biotechnology and human omics.5 Precision medicine is an innovative approach to tailoring disease prevention and treatment that considers differences in people's genes, environments, and lifestyles. In other words, precision medicine targets “the right treatment for the right patient at the right time”.6 This innovative approach is essential for a selected, and often quite limited population of individuals who would benefit from targeted, and generally quite costly treatments. The role of precision medicine is essential to fight against rare disease, for example by making it possible to discover gene therapy for Duchenne muscular dystrophy (for which FDA treatment approval was received in 2023). However, this type of highly specific medicine will certainly compound existing health care inequalities (in terms of acce