ILA position on the WHO survey “Global Online Consultation on Research Priority Setting for Healthy Ageing”

Context: the World Health Organization launched public consultations  “Global Online Consultation on Research Priority Setting for Healthy Ageing” - deadline: September 30th 2017. The Longevity community should take part in these consultations, as they will have a significant influence on the national policies and resources allocated for research on aging and longevity.

Action: Please go to https://extranet.who.int/dataform/253249?lang=en and answer in English in your language of choice to answer. We encourage you to provide the WHO with your own ideas, but you may use the ILA position below for inspiration. You can fill the survey in all 6 UN languages.


Priority Area 1: Developing age-friendly environments

Q5. What is the first top priority research question that you would like to add to this area?

The priority should be to make anti-aging therapies and preventive programmes accessible to everybody and in all areas with the goal being that people advancing in age could live independently in all environments and settlement types to the maximal degree possible. Age-friendly environment should include easily accessible qualified medical care services and healthy lifestyle oriented facilities (gyms, beaches, public swimming pools) to facilitate the use of therapies which prevent or treat the diseases of aging.  

Q6. What is the second top priority research question that you would like to add to this area? The authorities of the cities, municipalities and regions should facilitate the development of aging-related clinical trials and medical cohort studies and promote accessibility of corresponding health-maintaining therapies.

Priority Area 2: Aligning health systems to the needs of older populations

Q7. What is the first top priority research question that you would like to add to this area? There should be clinical practice guidelines developed to prevent and treat not only aging-related diseases but aging as a pathological process per se (i.e. clinical practice guidelines for systemic primary prevention in middle and old ages). That would enable medical practitioners to prescribe anti-aging evidence-based lifestyle interventions, supplements, medicines and other therapies, and this would ultimately enable every person to have access to such therapies. Introduction and development of national electronic medical record systems, researchers facilitating access to anonymized medical record databases would ensure better properties of medical advice in terms of effective preventive measures. Ultimately, governments should support the development of AI-based medical information systems, including systems for both research literature and personal medical data analysis.

Q8. What is the second top priority research question that you would like to add to this area? Hospital and healthcare providers should initiate clinical trials on aging-preventive therapies, such as Targeting Aging with Metformin (TAME). Ideally, governments (including health ministries) should also initiate, lead and finance such therapeutical developments involving medical universities and research institutions. Retirement systems may be interested in diversifying their investments into aging-related clinical developments as a way to balance financial risks they already might face due to increasing life expectancy.

Priority Area 3: Developing sustainable and equitable systems for long-term care

Q9. What is the first top priority research question that you would like to add to this area?

It is necessary that elderly people in community care or retirement homes receive, in addition to the necessary care, therapies and lifestyle interventions which can alleviate their health impairment, which are available but often are not being used by medical personnel and social workers in such facilities due to the lack of information and proper clinical practice and other guidelines. For example, there are a number of interventions to improve muscle tone, and walking capacities, some anti-osteoarthritic interventions, which could enable many elderly people suffering from the aging of musculoskeletal system to return to more independent living. Therefore, elderly people's right to health in the care system should not be neglected.

Q10. What is the second top priority research question that you would like to add to this area?

Regulators should facilitate investment into anti-aging therapeutical developments: i) healthcare systems should finance clinical developments and access to anti-aging therapies; ii) retirement systems should also diversify their assets into such solutions; iii) care providers and people in community care and retirement homes should be encouraged to get involved in clinical trials on anti-aging interventions with good ethical profile and high benefit/risk ratio.

Priority Area 4: Improving measurement, monitoring and research for Healthy Ageing

Q11. What is the first top priority research question that you would like to add to this area? Healthy Longevity should gradually replace the concept of Healthy Aging in the priority research agenda as health is the highest value for every individual. Pathogenetic processes of aging, biomarkers of aging, anti-aging biomedical innovations, including new medicine, genetic and cell therapies should become the main focus. It is necessary to move away from disease-specific approaches and develop global long-term-health solutions. Of note, the “Healthy Aging” concept worked well to promote pro-health policies worldwide. However, it does bring complications: a large part of the biomedical research community define aging as a set of pathological processes and even consider it as a disease or a syndrome so “Healthy Aging” is then an oxymoron (an expression that contains something and its contrary). Also, in some languages “healthy aging” is translated as “healthy frailing”.

Q12. What is the second top priority research question that you would like to add to this area?

To achieve such major advancements in healthy longevity, it is necessary to support large cohort and other studies of the biomarkers of aging, which are needed to monitor and develop adequate health solutions. While there has been significant progress in this area, especially in frailty biomarkers, consensus on the biomarkers of aging still requires more research. Genetic trait analysis should be integrated into the biomarker systems to significantly contribute to health developments and ensure more effective development of gene therapies and other medical solutions in the near future.

Priority Area 5: Commitment to action on Healthy Ageing in every country

Q13. What is the first top priority research question that you would like to add to this area?

The World Health Organization should form a special unit to ensure global coordination on biomedical research on aging. There should be a global project of aging biomedical research under the aegis of the World Health Organization (perhaps, jointly by Aging and Life Course Department and Noncommunicable Disease division), much as Human Genome project was able to achieve a breakthrough in the development of genetics. There should be an international working group to monitor and set global priorities for both fundamental and translational research on aging and to provide governments with advice and guidance.

Q14. What is the second top priority research question that you would like to add to this area?

The World Health Organization should encourage the WHO parties to invest into biomedical research on aging in accordance with the UN Political Declaration on Noncommunicable Diseases and the UN Sustainable Development Goal 3.b. This could take the following forms:

  • financial support and tax benefits for companies developing new therapies in the areas of aging and longevity, including targeted support of anti-aging clinical trials;
  • encourage medical research institutions to organize and lead basic research and small and large clinical trials in the areas of aging and longevity, including therapies with high potential health benefits, but with expired patents;
  • include biomedical research on health and longevity in national research plans and programs;
  • low-income countries should be involved in multinational research projects and clinical trials to ensure genetic diversity, global R&D cost reduction and expertise transfer.  

Q15. Are there other priority areas or themes, for research that should be added, beyond the 5 listed? Please indicate up to 3. 

The World Health Organization should promote research necessary to include aging into the International Classification of Diseases (ICD). Advanced ageing, or specifically “Senility” already has an ICD-10 code R54 (World Health Organization, 1992). However, this code refers only to late stages of pathogenesis of ageing. Additionally, it is not elaborated enough and, therefore, it is not likely to facilitate the development of new life-saving technologies to address ageing.  ICD11 beta-version includes MJ43 “Old age” instead of ICD10 R54 code. This code is even less functional, as clearly, person’s calendar age is an objective parameter and it cannot be treated as a health condition.

Therefore, there should be a new parent category “Ageing and ageing-related pathological changes and processes” included, which would include both new and old categories as this is allowed  by the new principle introduced in ICD-11 termed “multiple parenting”.

Q16. How important is each criterion in assessing global priority research questions and their fit towards Healthy Ageing?

  • Answerability (will get an answer) 0%
  • Feasibility (can be done in many countries) 0%
  • Applicability (results will matter) 0%
  • Impact on intrinsic capacity and/or functional ability (Healthy Aging will improve) 100%
  • Improving Equity (reducing unfair differences) 0%

Q17. Is there another criterion that should be used to assess global priority research question and their fit towards Healthy Ageing?

Potential to increase healthy lifespan and lifespan in general to maximal number possible in this and forthcoming generations.

Q18. In your opinion which research designs to advance Healthy Ageing would draw the attention of funders the most? (select up to 3).

Please select at most 3 answers

  • multi-country research (comparative research investigating the same topic in many countries)
  • research relevant in specific settings or countries
  • implementation research (explores the challenges that are faced when generalizing smaller scale or laboratory research findings "in the real world")
  • intervention research (examines the effectiveness of different types of interventions to address a problem – “how well does it work”)
  • longitudinal research (research that documents information on the same people repeatedly over a long period of time, to study events throughout lifetimes and to better understand cause and effect)
  • cluster or randomized trials (clinical or community based research design that minimizes bias and includes comparison groups to better determine any effects of the treatment or intervention)
  • basic social science research (research in social science disciplines -- such as anthropology, sociology, political science, geography, demography, economics, etc. -- that advance fundamental knowledge about Healthy Aging)
  • basic science research (research on the physical and the natural world – such as biology, physics, chemistry, earth sciences, etc. -- that advance fundamental knowledge about Healthy Ageing)

Submitted?

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