The heterogeneity of the older population requires healthcare models responsive to Precision Medicine (MP); a patient-centred model is required to provide adequate care. The Next Generation Promising (NGP) project will improve the identification of genetic, epigenetic and inflammatory biomarkers that will enable better stratification of older people and personalised disease management. This requires advanced statistical techniques for handling big data to identify common patterns that would not be detectable by standard clinical and diagnostic procedures.
The project will study new molecules with senolytic and senomorphic action for therapeutic use in the prevention and treatment of age-related diseases. Biomarkers associated with ageing and age-related diseases will be identified, in order to define a shared approach and plan future implementations, to foster a real sharing of the scientific evidence gathered. The multimorbidity of the elderly affects physical and cognitive performance and compromises the clinical picture. Adopting a complex approach to address it will provide useful data on response to treatment and adverse effects of therapy. Finally, as multidimensional care for older people is necessary, the project will study the effectiveness of assistive technologies in the management of the patient with multimorbidity, defining shared procedures for older patients in the Network.
The aim is to define the data integration framework, bringing together the clinical, functional and socio-economic data included in the Multidimensional Geriatric Assessment, the omics (e.g. genomics, epigenomics, transcriptomics, proteomics and metabolomics), in order to have an assessment of the older individual as a whole and to identify age-related alterations in physiological functions and related biomarkers.
Ageing of the general population is being accompanied by an increase in the coexistence of multiple chronic diseases and functional deficits with compromised quality of life and increased economic burden on healthcare systems. Multimorbidity, frailty and disability represent major sources of clinical complexity in older patients, as they trigger complex drug regimens, increase clinical uncertainty and challenge healthcare systems, which traditionally focus on single clinical conditions.
There is therefore a need for the implementation of Network Medicine (NM) in geriatric medicine that can facilitate the integration of complex information (clinical, functional and biological) to detect disease phenotypes early and contribute to effective prognostic stratification. To this end, the RCR 2022 executive project is based on the hypothesis that several biological, clinical and environmental factors interact in the pathogenesis of multimorbidity and frailty and may help explain their variability in severity and risk in individuals with age-related diseases.
To ensure that the increase in life expectancy is matched by a good state of health and the maintenance of a high quality of life, it is necessary to redefine the measures and resources allocated to the elderly population.
Alongside the clinical and rehabilitative treatment of the specific disease, it is important to improve preventive interventions, with the aim to minimize the main risk factors, even in the complex clinical picture of frail elderly patient with multimorbidity.
The PROMISING project aims to improve the characterization and stratification of the older patients of the Institutes participating in the AGING Network, as well as to develop innovative protocols for clinical evaluation, clinical-epidemiological and rehabilitation research, based on a shared methodological approach, implementing the principles of Precision Medicine in the geriatric-gerontological settings.
The Project lays down the basis for the integration of clinical, functional and socio-economic data with the various omics domains (genomic, epigenomic, transcriptomic, proteomic and metabolomic), in order to specifically characterized each single patients and identify specific age-related alterations of functions and related biomarkers.
From the clinical point of view, PROMISING investigates how multimorbidity impacts on physical and cognitive performance, proposing a care model for elderly patients based on a careful diagnosis and assessment of functional status, following the Personalized Medicine approach. Finally, PROMISING identifies strategies to determine the more appropriate drug and rehabilitation therapy, the individual’s response to treatment and its vulnerability to adverse reactions.
Keeping on and delving into the themes studied during the previous projects, SIRI was aimed at enhancing the synergies among the researchers involved in the Aging Network to obtain results that can be applied to the National Health System to improve care quality for complex older patients. In particular, the following issues were investigated:
Based on the previous research activities carried out by the Aging Network, the IRMA project purpose was to focus on primary issues identified by the ROADMAP project, enhancing biological and data resources available within the Network.
The project contributed to a better characterization of the phenotypes of older population in terms of multimorbidity pattern, polypharmacotherapy profiles and related appropriateness, and frailty condition.
In addition, pilot studies related to tele-health systems for a better management of Covid-19 pandemic were performed to validate the model according to the characteristics of the older population.
This general framework, which provides frailty, sarcopenia and aging models, is complemented by a preclinical study to identify and characterize new chemical compounds with potential senolytic activity that can improve therapy of these conditions. This new knowledge helps target interventions on complex older patients, combining the aging-related aspects with the specialist disciplines available within the Network
Multimorbidity, progressive reduction of autonomy in daily activities, and frailty are the age-related conditions that more than others characterize the clinical and care complexity for older people.
To date, pathophysiological mechanisms and metabolic pathways underlying multimorbidity and frailty are only partially known and the heterogeneity of current clinical definitions of multimorbidity and frailty requires a major standardization effort to guide biogerontological research and the identification of clinically relevant biomarkers.
The interplay between multimorbidity and frailty considerably affects clinical practice, for instance by limiting the applicability of diagnostic-therapeutic guidelines that are usually based on single pathology with inevitable increase in iatrogenic risk related to polypharmacy.
The Aging Network is an extraordinary opportunity to develop new knowledge on these subjects. Therefore, this project was aimed to define a roadmap for research activities conducted within the Aging Network on aging and its main conditions (frailty and multimorbidity)
© RETE AGING IRCCS – VIA S.Margherita, 5 – 60123 ANCONA – CF 93160330424
