Professor Claire Stewart – Written evidence (INQ0046)

Scientific basis

1. How complete is the scientific understanding of the biological processes of ageing and their epidemiologies (including the relative roles of genetics, epigenetics, lifestyle, environment, etc.)?

We are currently scratching the surface in terms of our understanding of the biological process of ageing. The few human studies, which exist have very focussed questions and are either in healthy older people (generally males) or older people with e.g. obesity/diabetes/CV disease. Therefore to think we understand the biology of ageing on a basal level is worrying. The notion that ageing is a single process to be cured, is also going to delay our capability of developing interventions. We need to accept that ageing is a complex process that requires population specific investigations, is we are to develop effective pharma interventions. We do, however, know that lifestyle/environmental factors accelerate/decelerate unhealthy/healthy ageing. Nutrition and physical activity are known to improve functional, health, cognitive indices, regardless of the individual – however, lifestyle changes are difficult to implement, regardless of the benefits.

2. How firm is the scientific basis for public health advice about healthy lifestyles as a way to increase health span, including physical health and mental health? a. What are the practical impediments for this advice being acted on?

It is clear that those in deprived parts of the world have shortened healthspan vs. those in wealthier environments. Further, the incidence of sedentary behaviour/overweight/obesity inclined in a parallel manner to the number of televisions and cars in houses – associated comorbidities of sedentary lifestyles are documented and evidenced, but mindset change is difficult to achieve. In a sense we are tackling the problem after the horse has bolted – education and facilities to support physical activity and healthy eating need to be instilled from a young age, not once we have aged. Education and support are key.

b. Are there examples of good practice in the UK/devolved nations, or elsewhere?

3. Which developments in biomedical science are anticipated in the coming years, in time to contribute to the Government’s aim of five more years of healthy and independent life by 2035? Research areas may include: • Treatments based on new approaches e.g. senolytics, epigenetic therapy

Five more years of healthy independent living by 2035, is a fantastic goal, but not achievable in 15 years. Increased lifespan is very different to increased healthspan and unless individuals engage with healthy lifestyles and these are supported by government and big pharma, the likelihood of having new/repositioned drugs on the market and working for all, in 15 years, is unlikely, given the underpinning mechanisms are not yet known.

Key areas that may improve health, however are:

•        Treatment of co-morbidities and polypharmacy : Needs modelling

•        Diagnostics, particularly early diagnostics for ageing-related diseases : Needs investment

•        Biomarkers for diagnostics and for monitoring effectiveness of treatments: From what samples and attained how?

•        Personalised medicine for ageing-related diseases and multi-morbidities: While medicines are being developed, effective lifestyle interventions should be fostered. Coaching/mentoring/support for the general public should be developed and implemented.

4. How complete is the understanding of behavioural determinants and social determinants of health in old age, and of demographic differences?: We have good evidence of social and behavioural determinants of health and very clear details of demographic differences. How we harness this knowledge and enable/support lifestyle change is a key question.

19 September 2019