Longevity medicine: personalized prevention, not anti-aging medicine

The literature also calls it healthy longevity medicine. A 2024 review in GeroScience, written by teams from Mayo Clinic, Singapore’s National University Health System and Sheba Medical Center, defines it as integrating geroscience and other disciplines into clinical settings, with the aim of optimizing health throughout life. Geroscience studies the biological processes of aging and how they relate to age-related disease.

The same authors describe how they set up longevity clinics in publicly funded hospitals, and three of their choices say a lot about the approach: a multidisciplinary team (physicians, nurses, dietitians, physiotherapists, mental health professionals, pharmacists); close ties with primary care and specialists, so care can switch to treatment when disease appears; and selective testing, since many tests offered by private clinics do not yet meet their institutions’ criteria.

What it is not

In a 2025 editorial in Aging, researcher Marco Demaria describes the other side of the sector: longevity clinics with annual memberships in the tens of thousands of euros, combining genome sequencing, multi-omics, whole-body imaging and epigenetic tests with infusions, peptides or stem-cell therapies offered with little validation. Many position themselves as wellness providers rather than medical facilities, which keeps them out of rigorous oversight. He also sees a real demand behind them: for proactive, personalized care that health systems have struggled to provide.

So the line does not run between “longevity” and “conventional prevention”. It runs between what has been validated and what has not. A 2026 survey of physicians trained in this approach makes the point: turning geroscience into practice is still held back by a lack of prospective clinical trials, formal training and clinical protocols.

The most solid framework for a longevity consultation does not come from private clinics but from the World Health Organization. WHO defines healthy ageing as the process of developing and maintaining the functional ability that enables well-being in older age. At its core is intrinsic capacity: all the physical and mental capacities a person can draw on.

It breaks down into six domains, which WHO describes as follows.

The framework has a clinical counterpart. WHO’s ICOPE guidelines (Integrated Care for Older People), published in 2017, give health professionals evidence-based recommendations to prevent, slow or reverse declines in older people’s physical and mental capacities: mobility and nutrition, vision and hearing, cognition and depressive symptoms, as well as urinary incontinence, falls and support for caregivers. The ICOPE handbook, in its second edition since 2025, describes care pathways to be adapted to primary care: detect declines in intrinsic capacity, identify social care and support needs, then build a personalized care plan.

ICOPE is designed for older people, but its logic applies much earlier: start from function rather than a score, spot decline early, and tie every finding to an action. To follow function as patients experience it, patient-reported outcome measures (PROMs) provide validated instruments.

The most useful longevity consultation looks, first of all, like an excellent prevention visit. The hospital teams mentioned above combine medical history, physical examination, cognitive, psychological and social assessment, sleep, nutrition, body composition and physical performance: the six-minute walk test, muscle strength and cardiopulmonary exercise testing.

Established risk factors first

The screenings recommended for the patient’s age and sex, vaccinations and routine prevention visits, which our guide to the preventive health check-up covers, remain the foundation. For cardiovascular risk, the 2021 European Society of Cardiology guidelines estimate ten-year risk with SCORE2, and SCORE2-OP in older people. They recommend opportunistic screening for risk factors such as blood pressure or lipids, while noting that its effect on clinical outcomes is uncertain. They also suggest using lifetime risk and benefit estimates in shared decision-making, taking comorbidities, frailty and patient preferences into account.

Cardiorespiratory fitness as a vital sign

In 2016, the American Heart Association made the case for cardiorespiratory fitness as a clinical vital sign. Low fitness is associated with a high risk of cardiovascular disease, all-cause mortality and mortality from several cancers; it is potentially a stronger predictor of mortality than smoking, hypertension, high cholesterol or type 2 diabetes, and adding it to traditional risk factors improves risk reclassification. What VO2 max measures, and how to estimate it in practice, is covered in our article on VO2 max and longevity.

Biological age is a research-grade estimate

Aging clocks fascinate patients. In 2023, the Biomarkers of Aging Consortium wrote in Cell that the lack of standards and consensus on what makes a reliable aging biomarker holds back their validation for clinical use. The 2026 survey cited above notes that these biomarkers are currently more robust as research and monitoring tools than as clinical decision instruments. What a biological age result can and cannot tell is worth explaining before the patient reads it as a diagnosis.

The exhaustive check-up

More tests do not mean more prevention. In 2023, the American College of Radiology stated that the evidence does not justify recommending total body MRI screening for people with no symptoms, risk factors or family history suggesting disease. There is no documented evidence that it prolongs life, and it leads to many non-specific findings followed by unnecessary tests and procedures. The same reasoning applies to every test added to a panel: which decision will it change?

Unvalidated tests

According to Marco Demaria’s editorial, biological age tests based on epigenetics or telomeres are often presented to clients as definitive scores, although their precision and clinical utility are still debated, and multi-omics profiles are handed over without clear actionable meaning. Patients leave with a lot of data and little well-supported advice.

Supplements and off-label drugs

In 2022, the US Preventive Services Task Force found insufficient evidence to assess multivitamins and most single or paired nutrients for preventing cardiovascular disease and cancer, and recommended against beta-carotene and vitamin E for that purpose. As for drugs repurposed against aging, the GeroScience review lists metformin, SGLT2 inhibitors and rapamycin as avenues under study, whose benefits and risks need further research. Outside a validated indication, they belong in clinical trials, not routine care.

Patient expectations

A patient who comes in to “age more slowly” often expects a fast, measurable result. The physician’s job is to reframe the goal: years in good health, preserved function, lower risks, rather than a biological age to bring down. That reframing also protects against disappointment, and against offers that promise more.

Longevity plays out over years. A single measurement says little; a trajectory says more. Longevity follow-up therefore benefits from repeating the same measures, with the same methods, at set intervals: functional capacity, risk factors, cardiorespiratory fitness and what patients report about their health. Real-world data collected between visits completes the picture, provided each data point is tied to a decision. That is the logic of predictive health, which estimates risk from a trend rather than a snapshot.

Every step is discussed with the patient. The ESC guidelines frame lifetime risk and benefit as material for shared decision-making, and in longevity medicine, where many options rest on thin evidence, that conversation also covers the strength of evidence behind each proposal, including the option of doing nothing.

That leaves a practical problem: bringing together data scattered across reports, lab results, measurements and questionnaires. MyTwin for clinicians gathers them in the patient digital twin, which follows patients continuously between visits and alerts the physician only when needed; clinicians choose which modules are active and keep the decisions. MyTwin works with a network of partner physicians who specialize in prevention and longevity.