In recent years, research into the fundamental mechanisms of ageing have identified core hallmarks that drive the ageing process, increasing the risk of developing chronic conditions. This is great news for the field of multimorbidity, because it allows us to shed light on an intimate, but – at times - forgotten relationship between ageing and multimorbidity. 

Multimorbidity and ageing: same-same or different? 

Ageing constitutes a process whereby the homeostatic balance of an organism slowly breaks down over time. Physiological deterioration begins as early as 25 years old but rapidly increases during the 6th and 7th decade of life. While internal aging, and thereby our potential lifespan, is driven by our genetic makeup, external aging, and thereby the rate of aging as well as our general quality of life, is driven by environmental factors outside of genetics. 

In recent years, it has become clearer that chronological and biological ageing is different from each other and doesn’t follow each other necessarily. Some older adults live healthily into old age without a scratch, while others die at the start of their senior life, riddled with chronic conditions. The development of chronic conditions, and the state to which an ageing individual is situated in, may be defined as a form of accelerated ageing. The rate of ageing is defined not by our genes, but by our exposure to environmental factors - be it physical activity, smoking, alcohol or even contextual factors such as socioeconomic deprivation, environmental exposures, and working conditions.  

It is clear from this fact that having many chronic conditions early in life – such as having multimorbidity - constitutes a clinical expression of this accelerated ageing cascade with severe and early forms of multimorbidity being explained by high rate of ageing in an individual. Addressing the external rate of ageing may, inversely, also address the problem of multimorbidity. Emergent evidence is starting to confirm this hypothesis. One preprint identified networks of disease combinations that were driven by the hallmarks of ageing. 

The understanding of multimorbidity early in life as an expression of accelerated ageing helps us shed light on multimorbidity as a life course event that needs early intervention. If individuals age rapidly – from their susceptibility to the environment – we are required to ensure proper preventative measures. Moreover, using this approach, we can start to develop methods that can untangle multimorbidity in its many nuances, by using biological age as a marker of severity in multimorbidity – at least from a biological approach. 

However, it isn’t only biological. It is well-established that a socioeconomic gradient drives healthy ageing, and it is horrifyingly similar to the socioeconomic gradient that affects the severity of multimorbidity.  

Gerontology: The Next Frontier for Multimorbidity 

On this basis, I believe that interdisciplinary work between gerontologists, geriatrists and multimorbidity researchers should focus on building bridges on key areas where multimorbidity, gerontology and geriatrics overlap. 

How can we ensure that the patients in the geriatric wards with severe forms of multimorbidity don’t return? It may be a question of slowing down their ageing through multicomponent interventions – diet, physical activity, smoking, alcohol use – while providing them with the right tools to sustain changes rather than focusing on their treatment here-and-now. That would require integrated care approaches. If the socioeconomic gradient drives both multimorbidity and the rate of ageing, the interventional scope may be too narrow and interventions may fail in eliciting the wanted gains, not because they weren’t fruitful, but because they didn’t include socioenvironmental components that also drive the rate of ageing. 

Furthermore, if multimorbidity is an expression of accelerated ageing, we would do best in studying the aspects of ageing itself to figure out how individuals with severe forms of multimorbidity differ from healthy individuals at the same age bracket.

The future of multimorbidity research requires a necessary framework that encompasses a plausible biological explanation of development, while looking at the contextual factors influencing the trajectories of multimorbidity throughout a life course - the hallmarks of ageing is one of those candidates.  

First published: 10 November 2025

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