Longevity
Long and healthy life
The real question is not only how many years are lived, but how long walking, thinking and independence last.
Definition
What can be done, rather than years counted
Lifespan counts calendar years. Healthspan is the years in which function is preserved: the years when a person can remain at home, walk, and sustain work and relationships. The two do not always progress together. People are living longer, while the years lived with disease and disability may also increase.
Fries set out the principle in 1980: if the onset of chronic disease is delayed more rapidly than the age at death, the period lived with disease is concentrated towards the end of life (compression of morbidity).
The World Health Organization defines healthy ageing by the preservation of functional ability that supports well-being in older age. Functional ability arises from a person’s current intrinsic capacity and their environment. A building with stairs and one with a lift produce different daily experiences for the same body.
VascularVita reads longevity as the preservation of function across organ systems over time, from screening through indicated care.
Focus
Ageing is the common ground of multiple chronic diseases and functional decline.
Geroscience
Why ageing is common ground
Cancer, cardiovascular disease, stroke, diabetes, joint degeneration and memory loss appear to be separate conditions. Calendar age is among the strongest risk factors for most of them.
Geroscience asks whether shared cellular processes of ageing contribute to these conditions simultaneously, requiring a view that extends beyond one organ. In animal studies, interventions that extend lifespan frequently delay several conditions together. Human clinical practice begins with assessment of the individual’s current status, followed by a staged programme of support and indicated treatment based on the needs identified.
Cell
What changes within the cell
López-Otín and colleagues described ageing in 2013 through nine shared cellular processes (hallmarks of ageing). Three further candidates were added in 2023: impaired cellular clearance (macroautophagy), chronic inflammation and disruption of the gut microbiome (dysbiosis).
These processes are interconnected; disruption in one can accelerate others.
- DNA and chromosome ends (telomeres) sustain damage over time.
- The regulation of when genes are switched on and off (epigenetics) shifts.
- Proteins misfold and cellular waste accumulates.
- Nutrient and energy signalling through the mechanistic target of rapamycin (mTOR) and AMP-activated protein kinase (AMPK) becomes dysregulated.
- The cell’s energy-producing structures (mitochondria) lose efficiency.
- Senescent cells, which have stopped dividing, release factors that affect neighbouring cells through the senescence-associated secretory phenotype (SASP).
- The regenerative pool of stem cells contracts and communication between cells deteriorates.
These processes are examined in detail in The nine hallmarks of ageing.
Systems
Organs age together
Ageing progresses across organ systems, at a rate that varies between individuals. Findings commonly encountered in longevity assessment include:
- Metabolism — insulin resistance, glycaemic variability and waist circumference
- Immunity — reduced vaccine response and chronic inflammation
- Muscle and bone — loss of strength and balance, and falls
- Neurological and sensory function — memory, sleep, vision and hearing
- Endocrine function — shifts in hormonal rhythms
- Kidney and lung — reduced filtration and respiratory capacity
- Vascular system — impaired function of the vascular lining (endothelium) and arterial stiffness
Metabolism, immunity, the musculoskeletal and nervous systems, endocrine function, the kidneys and lungs, and the vascular system are organ-specific expressions of the same process. The programme considers the individual’s needs across all systems. Vascular ageing is associated with cardiovascular events and tissue perfusion, while healthspan encompasses function throughout the body.
Person
Intrinsic capacity
The World Health Organization regards intrinsic capacity as the combined physical and mental capacities available to a person at a given time. Cesari and colleagues group it into five domains.
Locomotion and balance
Locomotion. Gait, balance and muscle strength underpin the ability to remain at home and go out independently.
Energy reserve
Vitality. Fatigue, appetite and the capacity to recover.
Cognition
Memory, attention and decision-making are the cognitive aspects of daily tasks.
Psychological capacity
Motivation and mood affect how available capacity is used.
Vision and hearing
Sensory loss increases the risk of falls, isolation and cognitive burden.
The World Health Organization’s Integrated Care for Older People (ICOPE) pathway was developed to identify early decline across these domains. It shows where capacity is decreasing and supports an organised care response. The five-domain framework is described in ICOPE and intrinsic capacity; the individual form is available on the assessment page.
Frailty is related to intrinsic capacity but is measured differently. The Fried phenotype assesses unintentional weight loss, weakness, exhaustion, slow walking and low physical activity together. Intrinsic capacity identifies the domains in decline; frailty indicates the extent to which physiological reserve has been depleted. One or two Fried criteria (prefrailty) constitute an early finding — see frailty and early warning signs.
Daily life
Function and evidence in daily life
Function is the ability to do what a person values: living at home, going out, working and spending time with others. Intrinsic capacity and the environment together determine daily life. Independence, multimorbidity, disability, falls and social participation are considered together in this assessment.
Cellular processes become visible in organs; organ changes reduce capacity; capacity and environment together shape daily function.
Biological age measures, molecular panels and regenerative approaches are frequently discussed in the literature. Translation into clinical practice requires validation studies and human data. Treatment decisions draw on validated evidence and integrated clinical assessment.
Stem-cell and exosome methods remain active areas of research. For the conceptual framework, see what exosomes are and what regenerative medicine is. VascularVita product scope: stem cell and exosome.
Assessment and treatment decisions remain with the physician.
Sources
Scientific basis
Selected references on healthspan, geroscience, cellular hallmarks, inflammation and intrinsic capacity.
- Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med. 1980
- Beard JR, et al. The World report on ageing and health. Lancet. 2016 · WHO — Decade of Healthy Ageing
- Kennedy BK, et al. Geroscience: linking aging to chronic disease. Cell. 2014
- López-Otín C, et al. The hallmarks of aging. Cell. 2013 · PMC3836174
- López-Otín C, et al. Hallmarks of aging: an expanding universe. Cell. 2023
- Franceschi C, et al. Inflamm-aging. Ann N Y Acad Sci. 2000
- Ferrucci L, Fabbri E. Inflammageing. Nat Rev Cardiol. 2018
- Cesari M, et al. Domains supporting intrinsic capacity. J Gerontol A. 2018
- Fried LP, et al. Frailty in older adults. J Gerontol A. 2001
- World Health Organization. ICOPE handbook. 2nd ed. 2024
- Pagani A, et al. Responsible longevity medicine. Longevity. 2025
- High KP. Healthy aging: the promise, and perils, of geroscience. 2025
- Ungvari Z, et al. Mechanisms of vascular aging. Circ Res. 2018
- VascularVita — The nine hallmarks of ageing