Encouraging a move toward precision geromedicine

Aging is a heterogeneous, multi-system process driven by the interplay between accumulating molecular damage and the progressive erosion of resilience. While damage accumulates in a ubiquitous and homogeneous fashion, resilience is finite and unequally distributed across physiological systems and individuals, yielding distinct biological trajectories that diverge early in life, giving rise to the individual-specific decline in physiological function and the manifestation of a diverse spectrum of organ-specific diseases, and converge only when multisystem dysregulation overwhelms compensatory capacity. Early deviations in mitochondrial function, proteostasis, inflammation, and metabolic regulation often remain clinically silent, detectable only through gerodiagnostics, longitudinal, sensitive biomarkers of aging. Yet most biomarkers were developed to detect disease rather than quantify aging biology, and their mechanistic specificity declines with advancing multimorbidity. Precision geromedicine therefore requires the integration of gerodiagnostics that capture system-level resilience and stress responsiveness with measures of functional reserve, behavior, physiology, and the exposome, enabling the identification of individualized aging trajectories and the biological pathways that drive them. This combined approach clarifies causal pathways, enables earlier detection of vulnerability and supports individualized gerointerventions that modify aging trajectories rather than specifically but narrowly focusing on individual age-related diseases.