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Conflict between science and religion

Many sociologists, like William Bainbridge (1997), argue that the relationship between science and religion is complex and cannot be explained simply by stating that they stand in opposition to each other. There have been developments and changes in both areas that made them seem more compatible than before.

Relationship between science and religion
Religious pluralism and diversity: Some religious subgroups are not as strict about the scripture and dogmas of ancient texts any more. They are open to new ideas both from religion and science. Many changes have happened within traditional religions, which suggests that religions overall can evolve as well. Theology has always had different strands.

New religious movements and New Age movements are more compatible with science than conservative, fundamentalist religions.

Scientists such as Stephen Jay Gould (1999) claim that science and religion are compatible because they deal with different areas of life that do not overlap and can exist side by side.

Science aims to define the evolution and the laws of nature.

Religion is set to define the meaning of life and provide moral guidance and psychological relief.

Deism: According to deists, God created the universe, but then it evolved on its own. Scientists can discover what the workings and laws of this God-created universe are.

Some religions use science as a foundation for their theories.

Scientology, for example, developed the E-meter, which is said to track people’s spiritual progress. However, its validity is questioned.

The existence of scientific paradigms, like gravity, suggests that there are also fundamental, closed rules in science.

Science as a closed system
Though some theorists argue that science is open and critical, science historian Thomas Kuhn (1957) points out that scientific ‘facts’ proven in well-established fields, e.g. geology or physics, are based on shared assumptions – a paradigm.

The paradigm tells scientists about the nature of reality, what questions to answer, what is acceptable as evidence, etc. A scientist who challenges this paradigm may be ridiculed and even shunned by the scientific community. This is what makes science, argues Kuhn, in reality a closed system.


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Science and Religion
TABLE OF CONTENTS
Have science and religion ever been compatible with each other?

According to some beliefs, the two cannot coexist with each other, people choose either one or the other. There have, however, always been scientists who believed in God and religious individuals who supported the development of sciences. We will look at what sociologists hold of the two in relation to each other.

We will start by looking at a summary of science and religion.
Next, we will outline the differences between religion and science in sociology.
Then, we will look at the relationship between science and religion in more detail.
Finally, we will look at sociological perspectives on science and religion.
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Science and religion: a summary
Some sociologists see a clear conflict between science and religion, while others believe in a more compatible relationship between science and religious belief. Karl Popper argues that science is an open belief system based on empirical data collection, continuous criticism and value freedom.

Traditional religions are usually closed belief systems with absolute truths based on God’s words, recorded in ancient texts, rather than on experiments and questioning.

Differences between religion and science in sociology
The table below displays the contrasting characteristics of science and religion, respectively.

Science

Religion

The main concern of science is the physical, while religion focuses on the supernatural world.

Scientific knowledge is gained through empirical methods, such as experiments.

Experiments are standardised, so any scientist, anywhere, can repeat them and confirm or deny the results.

Religion’s basis is faith. Knowledge in religion comes from God (or the gods), whose existence is based on belief rather than empirical evidence.

Religious belief is subjective and cannot be proven (or disproven) by anyone.

Science is an open belief system, while religious beliefs represent a closed one.

Data and information obtained through scientific research are open to testing by other scientists and institutions.

According to Karl Popper (1959), scientists must purposely try to find mistakes in their peers’ research, as this is the only way to ensure scientific facts are correct and unbiased.

Theology teaches that fundamental ideas, figures and knowledge in religion are sacred and should not be criticised by believers.

The scientific knowledge system is ever-evolving, while religious belief is based on an absolute knowledge system.

Scientific knowledge has evolved and improved through the repetition of experiments, challenging previous works, and debates and discussions between many scientists.
The ideas and practices of religious texts are usually seen as stating absolute truths that do not change over time.

Many fundamentalist Christians, for example, reject the scientific concept of evolution and believe that God created the world just as it was written in the Bible more than 2000 years ago.

Scientists aim to be objective and value-free, while religion is a highly subjective belief system.

The personal feelings, values and opinions of scientists must stay out of the scientific process.
The level of participation and commitment in religious practices are highly dependent on personal experience and belief.

Prayer, for example, is a very subjective, personal experience.

Science tries to remain independent of government and state, while religions have historically been, and often still are, closely linked to the state.

Table 1 – Differences between science and religion.

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Conflict between science and religion
Many sociologists, like William Bainbridge (1997), argue that the relationship between science and religion is complex and cannot be explained simply by stating that they stand in opposition to each other. There have been developments and changes in both areas that made them seem more compatible than before.

Relationship between science and religion
Religious pluralism and diversity: Some religious subgroups are not as strict about the scripture and dogmas of ancient texts any more. They are open to new ideas both from religion and science. Many changes have happened within traditional religions, which suggests that religions overall can evolve as well. Theology has always had different strands.

New religious movements and New Age movements are more compatible with science than conservative, fundamentalist religions.

Scientists such as Stephen Jay Gould (1999) claim that science and religion are compatible because they deal with different areas of life that do not overlap and can exist side by side.

Science aims to define the evolution and the laws of nature.

Religion is set to define the meaning of life and provide moral guidance and psychological relief.

Deism: According to deists, God created the universe, but then it evolved on its own. Scientists can discover what the workings and laws of this God-created universe are.

Some religions use science as a foundation for their theories.

Scientology, for example, developed the E-meter, which is said to track people’s spiritual progress. However, its validity is questioned.

The existence of scientific paradigms, like gravity, suggests that there are also fundamental, closed rules in science.


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Fig. 1 – New Age movements are more compatible with science than traditional religions, according to some sociologists.

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Science as a closed system
Though some theorists argue that science is open and critical, science historian Thomas Kuhn (1957) points out that scientific ‘facts’ proven in well-established fields, e.g. geology or physics, are based on shared assumptions – a paradigm.

The paradigm tells scientists about the nature of reality, what questions to answer, what is acceptable as evidence, etc. A scientist who challenges this paradigm may be ridiculed and even shunned by the scientific community. This is what makes science, argues Kuhn, in reality a closed system.

Science and religion: sociological perspectives
How do different sociological perspectives see science as a belief system? You can find the answer below.

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Functionalists on science as a belief system
Robert K. Merton (1973), a functionalist, claims that science only works when supported by other institutions and values, including religious ones. He defines four leading norms that guide scientists in their research under the acronym CUDOS:

Communism: scientific knowledge is the property of the people. Scientists must share their findings with other scientists so that science can evolve.

Universalism: the validity and reliability of scientific knowledge is judged by universal, objective criteria.

Disinterestedness: scientific knowledge must be pursued for its own sake.

Organised scepticism: all scientific findings are open to criticism and challenge.

Interpretivists on science as a belief system
Interpretive sociologists argue that all knowledge, including science, is socially constructed. They argue that rather than being objective truth, scientific facts are produced within a paradigm that tells practitioners what they should expect to see and what instruments they ought to use.

Marxists and feminists on science as a belief system
Both Marxist and feminist theorists are critical of science as a belief system. They view science as serving the interests of dominant groups and view scientific developments as being driven by the need for certain types of knowledge.

Modernists on science as a belief system
Modernist Anthony Giddens argues that science is becoming more and more significant in people’s lives, but this is not because of the decline of religion. It is due to the decrease in traditionalism.

Postmodernists on science as a belief system
Theorists who follow the postmodernist tradition, such as Jean-Francois Lyotard (1984), argue that science is based on meta-narratives, which they – in general – reject. They claim that through the meta-narratives and the concept of absolute truth, science also plays a role in the domination and manipulation of the people, just like religion.

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Italian Funeral Traditions ( And still dont die)

Throughout life, there are many different occasions or events that happen that people like to celebrate or commemorate in some way. At the end of life, a funeral takes place and this is both an occasion for mourning and also the celebration of a person’s life. Each culture and religion have their own traditions, customs, and superstitions relating to funerals. The following are some of the customs for funerals in the Italian culture.

Superstitions
One Italian superstition is that the souls of the dead never actually leave the earth. To make sure they leave successfully, the Italians perform a variety of rituals. One of these is burying loved ones with their favorite items. Also, Italians will often not speak the name of a person following their death as they fear it will bring the person back from the dead.
Food
As soon as people hear of a death, they will take food around to the home of the deceased’s family. This food is then both eaten by the family and offered to anyvisiting guests. Typical examples of food gifts include wine, fruit baskets, casseroles, and desserts.

Funeral Posters
In Italy, funerals are usually open to any villagers who want to attend the ceremony and burial. To make sure the locals are aware of the details, it is common for a family in mourning to put up posters advertising the funeral arrangements.

Mourning
In the past, wealthier Italian families would often pay for people to come and wail at the funeral of their loved one. This tradition has declined over the years as modern Italians like to show respect and dignity at a funeral and do not consider wailing a part of this. However, there is still a recognized period of mourning following a death.

Flowers
In many cultures, flowers are an important and symbolic element of a funeral and this is certainly the case in Italy. Not only will flowers adorn the church and the casket, they are also given to the family of the deceased as gifts.

Funeral Services
Catholicism is the predominant religion in Italy, so burial services are in line with Catholic rituals. A full mass with the last rites, a vigil, and a funeral liturgy is the standard procedure. Usually, a eulogy is delivered by a family member or close friend.

The Casket
Most Italians follow the Catholic tradition of having an open casket prior to the funeral. People who visit the deceased will often kiss them on their forehead or cheek. Touching the hand of the deceased is also a sign of respect.

The Funeral Procession
Traditionally, mourners would follow a horse-drawn carriage carrying the casket to the burial site. These days, the casket is likely to be carried in a hearse with mourners following along in their own vehicles.

The Burial Site
Mourners gather around the grave site. Often, each mourner will toss a handful of dirt or a rose over the casket. In Italy, it is quite rare to be buried in the ground due to a lack of space. Instead, graves are stacked in concrete mausoleums.

Funeral Attire
It is traditional for all mourners attending a funeral in Italy to wear black. Historically, the spouse of the deceased will continue to wear black for an extended period as a sign of their mourning. However, in modern Italy, many people choose not to carry out this particular tradition. Like all cultures, Italians have a range of traditions, customs, and superstitions relating to death and funerals. To a certain extent, many of these have changed over time. However, there are still many of the funeral traditions that modern Italians continue to follow.

hardcoreitaluans.blog

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Quali sono i rischi per gli operatori delle pompe funebri

Tutti i defunti sono considerati potenzialmente infettivi per qualsiasi operatore o altra persona (inclusi i familiari) che vengono a contatto diretto con la salma. I dati SIROH – Studio Italiano Rischio Occupazionale da HIV e altri agenti patogeni trasmissibili per via ematica – mostrano che dal 2003 al 2014 il personale coinvolto nella cura e preparazione delle salme è incorso in incidenti con lesioni cutanee, percutanee e mucolitiche ad alto rischio di infezione. Il rischio biologico e di contaminazione nei casi di decessi per cause naturali all’interno delle mura domestiche o in struttura ospedaliera è tra i più elevati.

I rischi più imminenti, per esempio, nella constatazione del decesso riguardano:

L’ispezione del defunto con probabile contatto con i liquidi organici e le feci;
La percolazione derivante da lesioni cutanee o orifizi naturali;
La contaminazione delle superfici esterne (camici, occhiali, mascherine);
La contaminazione accidentale dei moduli e della documentazione utilizzata per la registrazione del decesso.
I rischi comportano l’osservazione e l’attuazione delle procedure corrette al fine di eliminare o contenere qualsiasi potenziale contaminazione. Le misure preventive partono dalla basilare igiene delle mani con il lavaggio delle stesse prima di procedere a qualsiasi adempimento pratico e amministrativo. L’applicazione delle procedure non è garanzia di efficacia e protezione e devono sempre essere affiancate dalla corretta valutazione dei rischi con l’obiettivo di mettere in atto le azioni più opportune di sensibilizzazione e addestramento. Le linee guida, infatti, predispongono anche la realizzazione di percorsi formativi e di aggiornamento per tutti gli addetti ai lavori. Il datore di lavoro, da parte sua, ha il dovere di garantire la salute e la sicurezza dei lavoratori e di mettere a loro disposizione tutti gli strumenti per la formazione e per l’adeguata operatività sul campo.

Le disposizioni messe in atto dal protocollo di prevenzione consistono principalmente in:

Protezione degli occhi: utilizzo di occhiali di II Categoria DPI e occhiali a maschera di III categoria (UNI EN 166);
Protezione delle mucose: visiera di III Categoria (UNI EN 166);
Protezione delle vie respiratorie: mascherine facciali filtranti con o senza valvola (III Categoria), semi-maschera riutilizzabile con filtri (Categoria III), mascherina chirurgica (dispositivo medico)
Protezione del corpo: camice (III Categoria), tuta completa (EN 340);
Protezione delle mani: uso di guanti monouso (III Categoria EN 420);
Protezione degli arti inferiori: uso di copri-scarpe e calzari (di I, II e III categoria EN 340).
Le linee guida indirizzano gli operatori anche nell’impiego di nuove tecnologie e suggeriscono il ricambio delle mansioni nella manipolazione delle salme nelle varie fasi di operatività (tumulazione, estumulazione, interramenti e simili).

Fonte : istitutoceleriloveri.it

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Cremazione come avviene?

L’elemento centrale del processo di cremazione è il forno crematorio, una struttura in grado di trattare i resti dei corpi umani ad alte temperature, accelerando in tal modo l’ottenimento del risultato desiderato.

Il forno crematorio è generalmente realizzato sovrapponendo due distinte parti dell’impianto, separate l’una dall’altra con del materiale refrattario. La combustione potrà invece avvenire ricorrendo a diversi sistemi, come ad esmepio l’arroventamento delle pareti del forno attraverso l’uso di resistenze elettriche o di gas, o ancora tramite il ricorso alla fiamma diretta. In ogni caso, le temperature che si raggiungono all’interno della struttura saranno in grado di raggiungere i 900 – 1.000 gradi.

La cremazione avviene immettendo nel forno crematorio la bara con la salma: posizionata su una superficie piana, la bara viene poi condotta all’interno del forno attraverso delle guide metalliche che la spingono nella parte superiore dell’impianto.

In questo modo il corpo del defunto e la bara prendono rapidamente fuoco, e le cenere e le ossa calcificate potranno cadranno nella parte inferiore del forno, dove giungerà a compimento la combustione.

Grazie alla presenza di un idoneo sistema di ventilazione, la circolazione dell’aria (e quindi dell’ossigeno) necessaria per la combustione sarà garantita per l’intera durata del processo, il quale sarà comunque sottoposto a periodico monitoraggio da parte degli operatori, che potranno controllare l’evoluzione dello stesso attraverso degli appositi spioncini posizionati sulle pareti del forno.

Dopo qualche ora, concluso il processo, i resti verranno spinti all’esterno dell’impianto, lungo una zona di raffreddamento. In tale zona le ceneri verranno raccolte e poste su un setaccio a vibrazione, che potrà eliminare le polveri più fini,  conservando solamente quei resti che andranno poi a subire l’ultimissima fase del trattamento.

Come abbiamo avuto modo di riassumere nelle righe precedenti, i resti vengono ulteriormente trattati con un’ultima fase nel processo: una calamita separerà infatti il materiale metallico contenuto nelle ceneri (chiodi della bara, protesi, ecc.) consentendo di individuare le effettive ceneri da raccogliere e sigillare all’interno di un’urna, che verrà poi consegnata ai parenti. Si tenga conto che la legislazione italiana vigente non permette la dispersione “libera” delle ceneri: ne parleremo in un separato focus.

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Aprire un’agenzia funebre?

Si tratta di un settore dalle altissime potenzialità ma non è così semplice poter avviare un’attività del genere. E’ necessario sviluppare un lato altamente professionale e al tempo stesso anche sensibile. Non si tratta di vendere semplici beni e servizi ma di aiutare persone in un momento non facile della propria esistenza. Quando viene a mancare una persona cara, è fondamentale che nel più breve tempo possibile, siano svolte precise operazioni. L’agenzia funebre si occupa del disbrigo delle prime pratiche e interviene con puntualità e professionalità per organizzare al meglio un funerale. Dobbiamo quindi conoscere alla perfezione il nostro ambiente di lavoro, tutti gli aspetti burocratici da seguire così come i ruoli e i compiti stabiliti. Analizziamo cosa è necessario fare per poter avviare con successo un’agenzia di onoranze funebri e come poter gestire al meglio questa attività.

Uno sguardo sul settore delle pompe funebri oggi
I servizi funebri rappresentano una colonna stabile dell’economia: il numero dei decessi in Italia è aumentato a circa 650 mila unità l’anno, per questo si parla di un vero e proprio business di oltre 1,8 miliardi di euro che fornisce lavoro a circa 25 mila occupati diretti e altrettanti nell’indotto.

Nonostante tutto, questo settore è alle prese con gli stessi problemi di altri settori:

potere d’acquisto piu’ basso da parte degli italiani;
concorrenza delle imprese low-cost;
normative locali non allineate.
Un settore che conta 6 mila imprese di onoranze funebri, il doppio di quelle censite 15 anni fa ma che sta registrando un calo dei fatturati, sia perché le famiglie spendono meno per onorare i defunti, tagliando non tanto i servizi quanto le forniture (cofani e urne low cost), sia perché si va diffondendo sempre più la pratica della cremazione (decisamente più economica rispetto alla classica sepoltura).

La cremazione sta crescendo in Italia a ritmi superiori al +10% l’anno ed è l’opzione prescelta oggi per un funerale su quattro (con punte dell’80%), in tutta la regione Lombardia, e il minimo (2,5% dei decessi) in Sicilia. Si sta sviluppando anche il business delle cerimonie laiche e delle case funerarie (funeral house), inesistenti fino a pochi anni fa, oggi circa 300 attive in Italia (tutte concentrate al Nord).

C’è una domanda in forte crescita di spazi laici per il commiato dove consentire a parenti e conoscenti di stare vicino al defunto prima dell’addio definitivo e c’è richiesta di nuovi servizi di tanato prassi e imbalsamazione, così come di pacchetti completi “chiavi in mano”, perché la famiglia colta da un lutto vuole affrontare il trauma, non la burocrazia.

E’ ovvio che se da un lato non mancano le opportunità di guadagno, dall’altro è opportuno valutare i cambiamenti di domanda da parte della clientela così come anche l’aspetto fortemente competitivo legato a questo settore. Tante sono le attività presenti sul nostro territorio così come tanti i servizi diversificati che valorizzano/specializzano una determinata attività.

I servizi funebri sono una struttura economica a tutti gli effetti e come tale non possono assolutamente sottrarsi alle leggi di mercato. Chi vuole sopravvivere in questo settore deve necessariamente mettere in campo strategie per essere competitivi, cioè utilizzare una parte del proprio budget ad azioni di marketing utili per dar vita a nuove idee, generare fiducia nel brand, stabilire un legame con il territorio e incrementare il proprio business. Si vedono sfide e opportunità legate alla digitalizzazione, alle nuove mode social e al marketing 4.0 ed è evidente di come questa attività sia profondamente cambiata negli anni (vi segnaliamo questo articolo che affronta questo argomento nello specifico: Marketing Onoranze Funebri per aumentare il fatturato).

Requisiti e documentazione necessaria per aprire agenzia funebre o centro servizi funerari
Vediamo cosa dobbiamo fare per creare un’attività funebre.

Primo passo: è necessario presentare la SCIA (Segnalazione Certificata di Inizio Attività) al SUAP (Sportello Unico per le Attività Produttive) del comune nel quale si intende avviare.

La presentazione della SCIA consente di erogare i propri servizi sull’intero territorio regionale. Si tratta di una dichiarazione per modificare, trasferire, chiudere o iniziare un’attività produttiva ed ha effetti immediati, cioè l’imprenditore può teoricamente iniziare a lavorare dalla data presentata sulla dichiarazione.

Gli enti competenti hanno 60 giorni per verificare le informazioni fornite e possono adottare provvedimenti solamente in caso di inidoneità perché vale il silenzio assenso. La SCIA compilata va inviata al Comune anche per via telematica se si è in grado, il quale Comune entro 30 giorni li deve comunicare alla ASL territoriale che deve effettuare le opportune verifiche per concedere o meno l’autorizzazione.

I requisiti necessari possono essere suddivisi in 2 categorie: requisiti soggettivi e oggettivi.

1) Requisiti soggettivi:

possedere i requisiti previsti dalla normativa antimafia;
designare un direttore tecnico responsabile dell’attività funebre, per svolgere le pratiche amministrative e la trattazione degli affari;
scegliere almeno quattro operatori funebri o necrofori come previsto dal Regolamento. Gli operatori funebri devono essere assunti con regolare contratto di lavoro stipulato direttamente con chi avvia l’attività. In alternativa possono essere assunti anche attraverso consorzi o contratti di agenzia.
Sia per il direttore tecnico che per gli operatori funebri e necrofori è previsto un percorso formativo obbligatorio. I corsi professionali migliorano le competenze professionali di coloro che operano o che intendono operare in questo settore e permettono l’acquisizione del previsto titolo professionale, indispensabile per poter accendere un corretto rapporto di lavoro con imprese funebri.

2) Requisiti oggettivi:

Il locale dove si svolge il servizio funebre deve avere una destinazione d’uso compatibile con quella prevista dal piano urbanistico comunale. Deve rispettare le norme e le prescrizioni specifiche dell’attività, per esempio quelle in materia di urbanistica, igiene pubblica, igiene edilizia, tutela ambientale, tutela della salute nei luoghi di lavoro, sicurezza alimentare, regolamenti locali di polizia urbana annonaria.

L’attività deve avere:

una sede commerciale idonea, dedicata al disbrigo delle pratiche amministrative, alla vendita di casse ed articoli funebri e a ogni altra attività connessa al funerale;
almeno un’auto funebre conforme al Regolamento Regionale e un’adeguata autorimessa.
Le imprese funebri possono anche avvalersi della collaborazione di altre agenzie, ossia funzionare come attività di centro servizio funebre. In questo caso devono comunicarlo nel proprio oggetto sociale ed è necessario che siano in possesso di particolari requisiti disciplinati da alcune norme ISO e UNI.

Se si vuole gestire anche sale del commiato, dopo aver avviato l’attività di agenzia funebre è necessario richiedere l’autorizzazione per la gestione di suddette sale.

L’autocertificazione dei requisiti morali di altri soggetti deve essere allegata alla documentazione se, oltre al richiedente, ci sono altri soggetti tenuti alla dichiarazione di possesso dei requisiti soggettivi morali.

La copia dei formali contratti stipulati con società terze deve essere allegata alla documentazione se il richiedente non possiede direttamente la rimessa e/o le autofunebri e/o gli operatori funebri.

L’elenco, la tipologia delle autofunebri e la copia dei libretti di idoneità devono essere allegati alla documentazione se la società richiedente possiede autofunebri.

La nomina degli operatori funebri deve essere allegata alla documentazione se i soggetti hanno stipulato regolare contratto di lavoro con il richiedente.

Gli ultimi passi per iniziare a lavorare si possono velocizzare grazie ad una comunicazione unica che informa telematicamente tutti gli enti preposti dell’inizio attività. Bisogna compilare il modello di inizio attività e aprire la partita Iva presso l’agenzia delle entrate, i contribuenti tenuti all’iscrizione nel registro delle imprese o in quello delle notizie economiche e amministrative (REA) devono usare la comunicazione unica.

A questo punto bisogna andare alla camera di commercio e iscriversi nel registro pubblico delle imprese. E’ un’operazione molto veloce e diretta.

Per l’invio telematico è sufficiente un’abilitazione, una casella di posta elettronica certificata e una firma digitale (si può far riferimento a un patronato o un commercialista).

Spese da affrontare
Argomento alquanto delicato. Tutto dipende dai servizi che eroghiamo e da come gestiamo un servizio di onoranze funebri. Due possono essere le possibili soluzioni:

Semplice Agenzia Funebre che si appoggia a un centro servizi in toto o solo in parte (dipende da cosa eroga);
Centro servizi funebri.
Per quanto riguarda l’agenzia funebre è sufficiente avere una sede legale, un catalogo e appoggiarsi a un centro servizi che eroga tutto il necessario per un funerale. I costi di investimento sono minimi:

costi di avvio attività e apertura p.iva;
costi relativi alla formazione professionalizzante (Direttore Tecnico)
costi relativi alla sede prescelta soggetta o meno a un canone mensile di locazione e alle eventuali spese connesse;
costi legati alla promozione/marketing.
Volendo possiamo evitare le spese legate all’acquisto di un carro funebre e anche all’assunzione di personale affidandoci in parte o completamente a uno o più centro servizi. In questo modo ci occuperemo solo della gestione con il cliente o al massimo degli aspetti burocratici da seguire quando si affronta un funerale.

Lo svantaggio è ovviamente legato a una marginalità di guadagno decisamente bassa visto che si dovranno coprire tutti i servizi e il personale messi a disposizione da una ditta esterna. E’ necessario quindi puntare molto sulla promozione, il passaparola e una buona rete di contatti per avere un ritorno che ci permetta di mantenere viva la nostra attività.

Per quanto riguarda invece l’apertura di un centro servizi funebri, le spese da affrontare sono piuttosto importanti: servono infatti ampi locali per poter immagazzinare l’attrezzatura necessaria e mezzi di trasporto speciali (che hanno costi abbastanza ingenti), senza parlare poi del personale.

Quindi, a meno che non si disponga di un buon capitale di partenza, è necessario affidarsi a istituti di credito, banche o finanziarie che siano. Al fine di ottenere i finanziamenti richiesti, si dovrà dimostrare di sostenere le spese e ottenere il giusto ritorno economico. Un buon progetto imprenditoriale, sostenuto da un business plan ben strutturato, rappresenterà un buon biglietto da visita con cui presentarsi.

Ad ogni modo il consiglio che diamo è quello di preparare sempre un piano di business ben curato e che si basi su una descrizione dettagliata dell’attività e del mercato di riferimento (area geografica, tipologia di clienti, servizi da erogare, competitors, strategia promozionale) così come di un ottimo prospetto economico previsionale che analizzi i costi da sostenere per l’apertura dell’attività, per la gestione e i possibili guadagni almeno per almeno i primi tre anni di attività. Dobbiamo prepararci come si deve per evitare spese impreviste ma soprattutto una cattiva gestione che potrebbe portare al fallimento.

Come iniziare nel modo giusto
Aprire un agenzia funebre non è semplice ma nemmeno impossibile. E’ necessario prepararsi bene e capire tutto ciò che dovremo affrontare per avviare un’attività del genere. E’ un settore che si differenzia per tutta una serie di aspetti: saremo circondati da situazioni spiacevoli e momenti davvero non facili per la nostra clientela (e anche per noi). Dobbiamo essere sensibili ma al tempo stesso professionali, senza farci eccessivamente coinvolgere da tutto ciò che è legato alla perdita di una persona, per quanto difficile possa essere.

E’ un ramo altamente competitivo, a ritmi piuttosto accelerati e soggetti a repentini cambiamenti di domanda da parte della clientela. In poche parole, dobbiamo essere preparati al meglio, con la giusta formazione, essere sempre aggiornati e generare un ottimo piano di business….pensiamoci bene !

Fonte: TSS target solution

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Necrologi virtuali. What the future?

Negli ultimi anni molte agenzie funebri mettono a disposizione un cloud per i necrologi e altri servizi .

Qui prendo spunto tra uno di quelli piu sviluppati.

Infatti AnnunciFunebri.it è un servizio nato per le persone, da persone, pensato per sfruttare le potenzialità della rete a vantaggio dei rapporti umani.

Cerchiamo di coniugare semplicità e innovazione per permettere alle persone di sentirsi più vicine, ovunque si trovino e in qualsiasi momento, senza costi, senza limiti e sempre con discrezione e serietà.

Il servizio, indipendentemente dalla lunghezza del messaggio e da qualsiasi parte del mondo provenga, è sempre gratuito per gli utenti.

E al contempo per i nostri clienti del settore funebre lavoriamo sul loro brand, sulla sua unicità e sulla motivazione d’acquisto. Il nostro metodo è composto da una serie di strategie messe in atto per aumentare la visibilità dell’impresa funebre e renderla oggettivamente diversa dalla concorrenza agli occhi dei propri concittadini.



Pubblicazione e diffusione dell’ANNUNCIO FUNEBRE tramite web e social.
In modi discreti ed efficaci facciamo in modo che l’informazione della morte di una persona si “propaghi” e raggiunga quanti più interessati possibile attraverso il sito dell’impresa funebre, i social network, WhatsApp. Il tutto avviene in una cornice di discrezione senza mai urtare la sensibilità della famiglia.

Raccolta, validazione e gestione dei CORDOGLI ONLINE.
Oggi più che mai rappresentano uno strumento incredibilmente efficace per recapitare alla famiglia del defunto un messaggio di vicinanza o un ricordo legato al caro. Prima di consegnare il cordoglio il nostro staff valida i messaggi ricevuti in modo che alla famiglia non possa mai arrivare un messaggio sbagliato o fuori luogo. Una volta validati, i messaggi vengono recapitati alla famiglia tramite WhatsApp, sms e infine anche in formato cartaceo.

STREAMING DELLA CERIMONIA FUNEBRE.
Sviluppato per dare risposta alle esigenze delle prime case funerarie, questa soluzione si sta rivelando molto efficace anche in chiesa o in cimitero ed è apprezzata dalle persone che non possono essere presenti fisicamente per l’ultimo saluto alla persona cara. L’impresa funebre realizza la ripresa video della cerimonia rendendola disponibile all’interno del proprio sito.

Esistono anche altre modalità e vedremo nel futuro come la tecnologia porterà innovazione in questo settore.

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Saremo in grado di risuscitare i morti?

La definizione di morte è sempre stata molto chiara. Ma se la morte non fosse davvero la fine? Pubblicato nella rivista «Nature», uno studio dirompente che esamina se alcune funzioni potrebbero essere ripristinate molto dopo il decesso sta rendendo indistinto il confine tra vita e morte. Lo studio suscita delle speranza mediche, ma genera anche delle questioni bioetiche. In quale momento un animale, o persino un essere umano, può essere considerato morto?

La morte è ancora reputabile come la fine?

Scienziati dell’Università di Yale hanno risuscitato l’attività cellulare in 32 cervelli provenienti da maiali che erano stati macellati a scopo alimentare 4 ore prima. Hanno collocato i cervelli all’interno di un apparato nel loro laboratorio e hanno iniziato a pompare un sostituto del sangue, appositamente progettato, attraverso gli organi. Hanno sviluppato il cosiddetto sistema BrainEx, impiegato per pompare sostanze nutritive artificiali nella rete vascolare dei cervelli.

Tuttavia, il team di ricerca sottolinea che i cervelli trattati non hanno mostrato alcuna attività elettrica che potrebbe indicare percezione, consapevolezza o coscienza. I cervelli non potevano pensare o sentire nulla, hanno rimarcato i ricercatori. «Definito in termini clinici, questo non è un cervello in vita, ma è un cervello attivo dal punto di vista cellulare», ha dichiarato Zvonimir Vrselja, coautore dello studio e ricercatore associato in neuroscienze alla Yale School of Medicine alla «Reuters».Fondamentalmente, erano ancora dei cervelli morti, quindi perché l’esperimento è importante? Esso propone una reinterpretazione di quanto si sa in merito a come muore il cervello. Finora, la convinzione era che la morte si verificasse velocemente e in modo irreversibile, venendo a mancare la fornitura di ossigeno. Citato dalla «BBC», il ricercatore principale e autore senior Nenad Sestan ha affermato: «La morte cellulare nel cervello si verifica in una finestra temporale più lunga rispetto a quanto si riteneva in precedenza. Ciò che stiamo mostrando è che il processo della morte cellulare è graduale e progressivo e che alcuni di quei processi possono essere posticipati, preservati o persino invertiti». Ha aggiunto: «Non sappiamo ancora se saremo in grado di ripristinare una normale funzione cerebrale».

Supposizioni impegnative riguardo al danno cerebrale umano

In un commento di accompagnamento su «Nature», i bioetici Stuart Youngner e Insoo Hyun della Case Western Reserve School of Medicine a Cleveland rilevano che se questo lavoro dovesse portare a migliori tecniche per resuscitare il cervello delle persone, esso potrebbe complicare ulteriormente le decisioni relative a quando espiantare gli organi per il trapianto. Sono preoccupati di ciò che un sistema di supporto vitale per il cervello potrebbe significare per coloro che sono in attesa del trapianto di organi.

I due bioetici incoraggiano un sano dibattito. «A nostro modo di vedere, lo studio BrainEx, e il lavoro successivo che sicuramente verrà ispirato da esso, evidenziano la necessità di una discussione più aperta. Un dibattito che coinvolge chiunque, dai neuroscienziati e dai responsabili delle politiche ai pazienti e al personale medico, potrebbe aiutare a chiarire quali criteri rendono un soggetto idoneo alla donazione degli organi rispetto che non alla rianimazione. Tali discussioni possono anche approfondire in che modo garantire che la donazione di organi possa essere integrata nella cura del fine vita suscitando un livello minimo di controversie».

Concludono: «I ricercatori sono ancora ben lontani dall’essere in grado di ripristinare strutture e funzioni nel cervello di persone che sarebbero oggi dichiarate morte. Ma, a nostro modo di vedere, non è troppo presto per prendere in considerazione come questo tipo di ricerca potrebbe interessare la crescente popolazione di pazienti gravemente malati che sono in attesa di reni, fegati, polmoni o cuori».

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Elaborazione del lutto.

Nell’avvicinarsi alla fine della vita di un proprio caro, bisogna coniugare la speranza con il realismo. La morte è un evento estremamente doloroso; ha bisogno di tempo per essere accettata perché è normale che le emozioni negative siano molto forti.

Il tempo per elaborare la morte è variabile da persona a persona; quando ci si confronta con una malattia grave, è normale mettere in atto dei meccanismi mentali per iniziare ad accettare un lutto. Ci sono delle emozioni che si alternano e che possono ripresentarsi nel tempo, con diversa intensità, e senza un preciso ordine.



Negazione o rifiuto: la morte, prima o dopo che questa sia avvenuta, viene rifiutata, non accettata. La mente, in questo modo, cerca di proteggersi da un’eccessiva ansia e di prendersi il tempo necessario ad organizzarsi, sia praticamente che emotivamente.

Rabbia: si possono manifestare emozioni forti quali rabbia e paura, che esplodono in tutte le direzioni, investendo i familiari, il personale ospedaliero, Dio.

Contrattazione o patteggiamento: quando si inizia a riconoscere ciò che sta capitando o che è già capitato; costituisce il primo vero contatto con il proprio dolore interiore.

Depressione: arriva spesso nel momento in cui si inizia a prendere consapevolezza della perdita di una persona cara. La depressione preparatoria anticipa il timore della morte di una persona cara, come se la mente si stesse preparando. La depressione reattiva nasce quando ci si accorge che molti aspetti della propria vita stanno cambiando e determina un forte senso di impotenza.

Accettazione: ad un certo punto, è normale che anche le emozioni seguano la razionalità. La consapevolezza di ciò che accade può non proteggere completamente dalla rabbia e dalla depressione, ma ne limita l’intensità.



E’ normale avere emozioni molto forti davanti alla morte di una persona cara. La condivisione di queste emozioni difficili con le persone a cui vuoi bene ti può aiutare a reagire positivamente, facendoti sentire meno solo e rendendo questo momento di dolore più accettabile.

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La vita è un film; la morte è una fotografia. – Susan Sontag

Il fotogiornalismo, in particolare, è intrinsecamente legato al soggetto, poiché, sin dal suo inizio, è stato saldamente fondato sulla guerra, con Roger Fenton, Valle dell’ombra della morte, (uno degli oltre trecento catturati durante la guerra di Crimea) la prima rappresentazione iconica di questo tipo. Come tutte le sue immagini, la morte umana non è raffigurata, ma le centinaia di palle di cannone che tappezzano la strada, simboleggiano lo spargimento di sangue che ha avuto luogo lì.

Gli ultimi anni hanno visto immagini sorprendenti che rappresentano la morte di un tipo diverso: quella del nostro pianeta. Poche regioni esemplificano questa distruzione ecologica in modo più vivido della foresta pluviale amazzonica; il più grande del mondo, comprende oltre la metà della restante foresta pluviale della terra, ma è in rapido declino, accelerato in modo drammatico dai recenti incendi che hanno avvolto gran parte della regione.

Fotografo spagnolo Sebastián Liste ha documentato gran parte della devastazione, inclusa questa straordinaria immagine di una chiesa travolta dalle fiamme. Intriso di simbolismo apocalittico: il bagliore infernale delle fiamme che penetrano nell’oscurità; la croce solitaria; agisce sia come un cupo testamento degli incendi, sia come potente metafora della distruzione del nostro pianeta nel suo complesso.

Come abbiamo visto, il rapporto della fotografia con la morte è sia lungo che storico; un rapporto che ha prodotto alcune delle immagini più importanti della storia e che senza dubbio continuerà. L’incombente ineludibilità della morte lo rende un argomento che risuona profondamente con tutti noi.

https://independent-photo.com/it/

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New horizons in life extension, healthspan extension and exceptional longevity.

Age and Ageing
Oxford University Press


Abstract
Many common chronic diseases and syndromes are ageing-related. This raises the prospect that therapeutic agents that target the biological changes of ageing will prevent or delay multiple diseases with a single therapy. Gerotherapeutic drugs are those that target pathways involved in ageing, with the aims of reducing the burden of ageing-related diseases and increasing lifespan and healthspan. The approach to discovering gerotherapeutic drugs is similar to that used to discover drugs for diseases. This includes screening for novel compounds that act on receptors or pathways that influence ageing or repurposing of drugs currently available for other indications. A novel approach involves studying populations with exceptional longevity, in order to identify genes variants linked with longer lifespan and could be targeted by drugs. Metformin, rapamycin and precursors of nicotinamide adenine dinucleotide are amongst the frontrunners of gerotherapeutics that are moving into human clinical trials to evaluate their effects on ageing. There are also increasing numbers of potential gerotherapeutic drugs in the pipeline or being studied in animal models. A key hurdle is designing clinical trials that are both feasible and can provide sufficient clinical evidence to support licencing and marketing of gerotherapeutic drugs.


Gerotherapeutic drugs target ageing pathways to prevent ageing-related diseases and increase lifespan.
Rapamycin, metformin and precursors of NAD are amongst many gerotherapeutic drugs entering the clinical trial phase of drug development.
Licencing of gerotherapeutic drugs will depend on clinical trials that are both feasible and can provide evidence of a primary impact on ageing biology.
Introduction
The majority of people would like to live to the age of 120 years or more if their health remained good and nearly one half would like an unlimited lifespan . About one-third of people would be prepared to take life extension or anti-ageing therapies now.The possibility that a pill might prevent ageing and increase lifespan is tantalising for most people. As a result, anti-ageing and life extension therapies are often the focus for media hype despite the absence of definitive human data.

In this review, the term ‘gerotherapeutics’ is used to refer to drugs that target ageing biology, and that have been developed using similar approaches to those used to develop drugs for diseases. A major scientific endeavour is underway to find biological switches that can manipulate ageing. This research aims to discover new gerotherapeutic drugs that both reduce the burden of ageing-related diseases, and extend lifespan . There are many ageing-related diseases where the incidence increases exponentially throughout old age, including Alzheimer’s disease, some cancers, ischaemic heart disease, ischemic stroke and chronic obstructive pulmonary disease [6]. The biological changes of ageing are a major risk factor these diseases .The hope is that gerotherapeutic drugs might reduce the impact of these ageing-related diseases with a single therapy.

Over the last two decades there has been a marked increase in the number of interventions reported to increase lifespan, and delay ageing and disease, in laboratory animals. However, the development of gerotherapeutic drugs is still in its infancy, and no gerotherapeutic drug has yet been shown to increase human lifespan or been licenced for an indication related to ageing.

‘Anti-ageing’ is a term mostly used to promote products that are not regulated or licenced. There are many drugs, supplements and other treatments that are marketed as anti-ageing and can be accessed direct-to-consumer from pharmacies or online. This global anti-ageing drugs market is estimated to be USD82 billion in 2020 [8]. None of these treatments can support their anti-ageing claims with high quality clinical trials equivalent to those that are required for the registration of drugs for the treatment of individual diseases.

There is very little information about how many people are taking anti-ageing therapies and gerotherapeutic drugs or what they are taking. It is likely that most doctors, including geriatricians, will have some or many patients using these treatments without supervision, so will need to have some knowledge about them.

This is the first review on this topic in Age and Ageing. It focuses on gerotherapeutics that have an established basic scientific foundation and/or where there is the possibility of widespread use in the community. It also provides a summary of how these drugs are being discovered, using traditional drug discovery approaches, repurposing, or by investigating populations with exceptional .


The overall process of drug discovery of gerotherapeutics has so far been similar to that used to discover drugs for the treatment of individual diseases. The foundation for discovering gerotherapeutic drugs is a detailed understanding of the biology of ageing. This knowledge is used to identify ageing pathways and proteins that can be manipulated by drugs [9]. The aim is to find novel compounds that can be protected by patents and then generate profits to offset the substantial costs involved in bringing any new drug to the market.

The biological processes of ageing that are potential targets for gerotherapeutics have been classified into nine groups called the Hallmarks of Ageing. These are currently considered to be the fundamental processes of ageing, or at least reflect the current major domains of research in ageing biology. The Hallmarks are interconnected and integrated. This means that a drug that acts on just one Hallmark can potentially influence the other Hallmarks, and hence the entire ageing process. The Hallmarks of Ageing are a useful platform for grouping gerotherapeutics on the basis of their major mechanisms [9].

Repurposing provides another pathway for drug development. Here, drugs that are already registered for unrelated diseases and have established safety, are tested for additional indications [9]. In the case of gerotherapeutics, an innovative process involving detailed analysis of clinical and preclinical effects on lifespan, healthspan and ageing biology found nine drugs that could potentially be repurposed for their ageing or ‘gerotherapeutic’ effects. These were: sodium-glucose cotransporter-2 (SGLT2) inhibitors, metformin, acarbose, rapamycin/rapalogs, methylene blue, ACEi/ARB, dasatinib (and quercetin), aspirin and N-acetyl cysteine . Metformin, rapamycin and the combination of dasatinib and quercetin have already been extensively studied for their effects on ageing.

As with all drugs, the pivotal step for any gerotherapeutic will be undertaking high quality clinical trials that prove clinical efficacy and acceptable safety, and comply with international regulatory guidelines. The detailed format for clinical trials of gerotherapeutics has not yet been formalised. The primary outcomes should ideally include lifespan, healthspan and ageing-related diseases. In the past the main aim of life extension therapy has been, by definition, to increase life span.

More recently, the value of increasing healthspan, which is the duration of healthy life before the onset of disease or disability, has been emphasised. Recent studies of gerotherapeutics in laboratory animals have been more like to report increases in healthspan measured by latelife health, than increases in lifespan.

Although ageing-related diseases are poorly defined, it is believed that therapies targeting ageing might delay or prevent multiple ageing-related diseases. This will be preferable to the current medical approach of treating each disease individually, with the associated risks of polypharmacy and over-medicalisation . However, due to funding and duration constraints, human clinical trials of gerotherapeutics with the primary outcomes of lifespan and healthspan are unlikely to be feasible. Instead there has been an attempt to develop biomarkers of ageing that reflect ageing biology and can act as surrogate markers for these outcomes in clinical research.Metformin
It may be surprising to many clinicians that metformin, the common anti-diabetic drug that was first available in 1957, is also widely lauded as for its potential effects on ageing.

It was initially proposed that metformin might be a CR-mimetic, a drug that replicates the ageing benefits of caloric restriction without any need to alter diet. Rather than being simply a CR-mimetic, metformin has now been found to have effects on all the Hallmarks of Ageing. Amongst its actions, metformin interacts with mitochondrial complex 1 and activates the AMP-activated protein kinase (AMPK) pathway. This leads to increased insulin sensitivity and decreased mTOR signalling, oxidative stress, genetic instability and inflammation.

As reviewed elsewhere human clinical trials have shown the metformin has many effects apart from managing hyperglycaemia in type 2 diabetes. These include two pivotal clinical trials related to the use of metformin in diabetes: the Diabetes Prevention (DPP) study, which found that metformin prevented type 2 diabetes in non-diabetics; and the UK Prospective Diabetes Study (UKPDS), which found that it reduced cardiovascular outcomes and diabetes related deaths in people with type 2 diabetes. There are many (>250) other studies and systematic reviews concluding that metformin can also reduce mortality, cancers, cardiovascular events, dementia and cognitive impairment.

This combination of human clinical studies and preclinical data on the ageing effects of metformin, together with its established safety record led to metformin becoming one of the first drugs to be considered for human ageing trials. Led by Nir Barzilai, ‘Targeting Ageing with Metformin’ (TAME) is a 6-year, double blind, randomised, placebo-controlled diet evaluating metformin in 3,000 non-diabetic participants aged 65–80 years of age. Outcomes include age-related diseases and biomarkers of ageing. Although there are already convincing studies of metformin and cardiovascular disease, cancer and cognition [19], the purpose of TAME is to use metformin as a tool that will tie those outcomes in a cluster that will give a green light to study ageing outcomes for other gerotherapeutics in the pipeline.

Rapamycin
Rapamycin, in high doses is an immunosuppressant used in organ transplantation. However, its main physiological main action is to inhibit its eponymous receptor, Mechanistic Target of Rapamycin (MTOR). The MTOR pathway is a nutrient sensing pathway that responds to increased levels of amino acids by increasing protein synthesis via activation of transcription. Inhibition of MTOR by rapamycin leads to a reduction protein synthesis. Rapamycin, like metformin was initially thought to be a CR-mimetic [20] but since has been shown to have effects that are distinct from caloric restriction [21] and influences other Hallmarks of Ageing such as autophagy and stem cells.

Rapamycin increases the lifespan of mice, even when commenced in mid-life and late life. Studies undertaken at the National Institute of Ageing Interventions Testing Program showed that lifespan of mice commenced on rapamycin at the old age of 20 months increased by 9% in females and 14% in males [22], and by 18% in females and 10% in males when started at 9 months [23]. This was associated with lower rates of diseases and age-related pathology.

A small clinical trial in healthy older people aged 70–95 years found that rapamycin was safe over 8 weeks .

A trial of two rapamycin-like drugs (‘rapalogs’) in 264 participants 65 years and older found that they were associated with a reduction in infections, improved influenza vaccination responses and antiviral immunity . In an novel twist, the effect of rapamycin on ageing is also being trialled in companion dogs.

NAD precursors.


NAD is a ubiquitous metabolite involved in many fundamental cellular pathways including those maintaining redox status, DNA repair and bioenergetics. Ageing is associated with reduced levels of NAD in many tissues, and depletion of NAD influence many ageing hallmarks.

Because NAD is a naturally occurring metabolite, there has been considerable interest in establishing the effects of NAD supplementation on ageing. Most studies have used NAD precursors (nicotinamide mononucleotide, NMN; nicotinamide riboside NR and nicotinamide NAM) because of their greater intracellular bioavailability. In vitro and animal experiments have shown that NAD supplementation can prevent or reverse a wide range of age-related pathologies and Hallmarks [30, 31].

Lifespan studies have been undertaken in mice. One study reported an increase in lifespan of 5% when old mice were administered NR in food for 6 weeks , whereas another reported that 62 weeks of supplementation with NAM commenced in midlife did not increase lifespan. Recently the Interventions Testing Program confirmed that NR commenced in midlife or old age had no effect on lifespan.

There are >30 human clinical trials of NR and NMN registered in clinicaltrials.org [28]. To date, published studies of NR have mostly evaluated its bioavailability [33], whereas there have been some recent studies of NMN that have evaluated clinical outcomes in older adults. A 12-week period of treatment with NMN reduced drowsiness and improved leg function in older people [34]. A randomised clinical trial in 25 obese postmenopausal women found that 10 weeks of NMN compared to placebo was associated with improved insulin sensitivity in muscle but not liver or adipose tissue [35]. It should be noted that these are all very small studies where multiple outcomes were evaluated.

Age and Ageing
Oxford University Press
New horizons in life extension, healthspan extension and exceptional longevity
David G Le Couteur and Nir Barzilai

Additional article information

Abstract
Many common chronic diseases and syndromes are ageing-related. This raises the prospect that therapeutic agents that target the biological changes of ageing will prevent or delay multiple diseases with a single therapy. Gerotherapeutic drugs are those that target pathways involved in ageing, with the aims of reducing the burden of ageing-related diseases and increasing lifespan and healthspan. The approach to discovering gerotherapeutic drugs is similar to that used to discover drugs for diseases. This includes screening for novel compounds that act on receptors or pathways that influence ageing or repurposing of drugs currently available for other indications. A novel approach involves studying populations with exceptional longevity, in order to identify genes variants linked with longer lifespan and could be targeted by drugs. Metformin, rapamycin and precursors of nicotinamide adenine dinucleotide are amongst the frontrunners of gerotherapeutics that are moving into human clinical trials to evaluate their effects on ageing. There are also increasing numbers of potential gerotherapeutic drugs in the pipeline or being studied in animal models. A key hurdle is designing clinical trials that are both feasible and can provide sufficient clinical evidence to support licencing and marketing of gerotherapeutic drugs.


Key Points
Gerotherapeutic drugs target ageing pathways to prevent ageing-related diseases and increase lifespan.
Rapamycin, metformin and precursors of NAD are amongst many gerotherapeutic drugs entering the clinical trial phase of drug .

In this review, the term ‘gerotherapeutics’ is used to refer to drugs that target ageing biology, and that have been developed using similar approaches to those used to develop drugs for diseases. A major scientific endeavour is underway to find biological switches that can manipulate ageing. This research aims to discover new gerotherapeutic drugs that both reduce the burden of ageing-related diseases, and extend lifespan [4, 5]. There are many ageing-related diseases where the incidence increases exponentially throughout old age, including Alzheimer’s disease, some cancers, ischaemic heart disease, ischemic stroke and chronic obstructive pulmonary disease [6]. The biological changes of ageing are a major risk factor these diseases [4, 5, 7]. The hope is that gerotherapeutic drugs might reduce the impact of these ageing-related diseases with a single therapy.

Over the last two decades there has been a marked increase in the number of interventions reported to increase lifespan, and delay ageing and disease, in laboratory animals. However, the development of gerotherapeutic drugs is still in its infancy, and no gerotherapeutic drug has yet been shown to increase human lifespan or been licenced for an indication related to ageing.

‘Anti-ageing’ is a term mostly used to promote products that are not regulated or licenced. There are many drugs, supplements and other treatments that are marketed as anti-ageing and can be accessed direct-to-consumer from pharmacies or online. This global anti-ageing drugs market is estimated to be USD82 billion in 2020 [8]. None of these treatments can support their anti-ageing claims with high quality clinical trials equivalent to those that are required for the registration of drugs for the treatment of individual diseases.

There is very little information about how many people are taking anti-ageing therapies and gerotherapeutic drugs or what they are taking. It is likely that most doctors, including geriatricians, will have some or many patients using these treatments without supervision, so will need to have some knowledge about them.

This is the first review on this topic in Age and Ageing. It focuses on gerotherapeutics that have an established basic scientific foundation and/or where there is the possibility of widespread use in the community. It also provides a summary of how these drugs are being discovered, using traditional drug discovery approaches, repurposing, or by investigating populations with exceptional longevity.

Drug discovery and drug development in ageing
The overall process of drug discovery of gerotherapeutics has so far been similar to that used to discover drugs for the treatment of individual diseases. The foundation for discovering gerotherapeutic drugs is a detailed understanding of the biology of ageing. This knowledge is used to identify ageing pathways and proteins that can be manipulated by drugs [9]. The aim is to find novel compounds that can be protected by patents and then generate profits to offset the substantial costs involved in bringing any new drug to the market.

The biological processes of ageing that are potential targets for gerotherapeutics have been classified into nine groups called the Hallmarks of Ageing. These are currently considered to be the fundamental processes of ageing, or at least reflect the current major domains of research in ageing biology. The Hallmarks are interconnected and integrated. This means that a drug that acts on just one Hallmark can potentially influence the other Hallmarks, and hence the entire ageing process. The Hallmarks of Ageing are a useful platform for grouping gerotherapeutics on the basis of their major mechanisms [9].

Repurposing provides another pathway for drug development. Here, drugs that are already registered for unrelated diseases and have established safety, are tested for additional indications [9]. In the case of gerotherapeutics, an innovative process involving detailed analysis of clinical and preclinical effects on lifespan, healthspan and ageing biology found nine drugs that could potentially be repurposed for their ageing or ‘gerotherapeutic’ effects. These were: sodium-glucose cotransporter-2 (SGLT2) inhibitors, metformin, acarbose, rapamycin/rapalogs, methylene blue, ACEi/ARB, dasatinib (and quercetin), aspirin and N-acetyl cysteine [10]. Metformin, rapamycin and the combination of dasatinib and quercetin have already been extensively studied for their effects on ageing.

More recently, the value of increasing healthspan, which is the duration of healthy life before the onset of disease or disability, has been emphasised. Recent studies of gerotherapeutics in laboratory animals have been more like to report increases in healthspan measured by latelife health, than increases in lifespan.

Although ageing-related diseases are poorly defined, it is believed that therapies targeting ageing might delay or prevent multiple ageing-related diseases. This will be preferable to the current medical approach of treating each disease individually, with the associated risks of polypharmacy and over-medicalisation [5]. However, due to funding and duration constraints, human clinical trials of gerotherapeutics with the primary outcomes of lifespan and healthspan are unlikely to be feasible. Instead there has been an attempt to develop biomarkers of ageing that reflect ageing biology and can act as surrogate markers for these outcomes in clinical research.

Nutrient sensing pathways
Many strains and species of animals, when given significantly less food than they would eat if food was freely available, have longer lifespans, reduced cancers and delayed onset of ageing changes. This is called caloric restriction. Conversely, overeating and obesity can be potentially considered to be accelerated ageing and is associated with accumulation of all the Hallmarks of Ageing.



Metformin
It may be surprising to many clinicians that metformin, the common anti-diabetic drug that was first available in 1957, is also widely lauded as for its potential effects on ageing.

It was initially proposed that metformin might be a CR-mimetic, a drug that replicates the ageing benefits of caloric restriction without any need to alter diet. Rather than being simply a CR-mimetic, metformin has now been found to have effects on all the Hallmarks of Ageing. Amongst its actions, metformin interacts with mitochondrial complex 1 and activates the AMP-activated protein kinase (AMPK) pathway. This leads to increased insulin sensitivity and decreased mTOR signalling, oxidative stress, genetic instability and inflammation.

As reviewed elsewhere human clinical trials have shown the metformin has many effects apart from managing hyperglycaemia in type 2 diabetes. These include two pivotal clinical trials related to the use of metformin in diabetes: the Diabetes Prevention (DPP) study, which found that metformin prevented type 2 diabetes in non-diabetics; and the UK Prospective Diabetes Study (UKPDS), which found that it reduced cardiovascular outcomes and diabetes related deaths in people with type 2 diabetes. There are many (>250) other studies and systematic reviews concluding that metformin can also reduce mortality, cancers, cardiovascular events, dementia and cognitive impairment.

This combination of human clinical studies and preclinical data on the ageing effects of metformin, together with its established safety record led to metformin becoming one of the first drugs to be considered for human ageing trials. Led by Nir Barzilai, ‘Targeting Ageing with Metformin’ (TAME) is a 6-year, double blind, randomised, placebo-controlled diet evaluating metformin in 3,000 non-diabetic participants aged 65–80 years of age. Outcomes include age-related diseases and biomarkers of ageing. Although there are already convincing studies of metformin and cardiovascular disease, cancer and cognition [19], the purpose of TAME is to use metformin as a tool that will tie those outcomes in a cluster that will give a green light to study ageing outcomes for other gerotherapeutics in the pipeline.

Rapamycin
Rapamycin, in high doses is an immunosuppressant used in organ transplantation. However, its main physiological main action is to inhibit its eponymous receptor, Mechanistic Target of Rapamycin (MTOR). The MTOR pathway is a nutrient sensing pathway that responds to increased levels of amino acids by increasing protein synthesis via activation of transcription. Inhibition of MTOR by rapamycin leads to a reduction protein synthesis. Rapamycin, like metformin was initially thought to be a CR-mimetic [20] but since has been shown to have effects that are distinct from caloric restriction [21] and influences other Hallmarks of Ageing such as autophagy and stem cells.

Rapamycin increases the lifespan of mice, even when commenced in mid-life and late life. Studies undertaken at the National Institute of Ageing Interventions Testing Program showed that lifespan of mice commenced on rapamycin at the old age of 20 months increased by 9% in females and 14% in males [22], and by 18% in females and 10% in males when started at 9 months [23]. This was associated with lower rates of diseases and age-related pathology.

NAD precursors
NAD is a ubiquitous metabolite involved in many fundamental cellular pathways including those maintaining redox status, DNA repair and bioenergetics. Ageing is associated with reduced levels of NAD in many tissues, and depletion of NAD influence many ageing hallmarks.

Because NAD is a naturally occurring metabolite, there has been considerable interest in establishing the effects of NAD supplementation on ageing. Most studies have used NAD precursors (nicotinamide mononucleotide, NMN; nicotinamide riboside NR and nicotinamide NAM) because of their greater intracellular bioavailability. In vitro and animal experiments have shown that NAD supplementation can prevent or reverse a wide range of age-related pathologies and Hallmarks.

Lifespan studies have been undertaken in mice. One study reported an increase in lifespan of 5% when old mice were administered NR in food for 6 weeks [30], whereas another reported that 62 weeks of supplementation with NAM commenced in midlife did not increase lifespan . Recently the Interventions Testing Program confirmed that NR commenced in midlife or old age had no effect on lifespan.

There are >30 human clinical trials of NR and NMN registered in clinicaltrials.org [28]. To date, published studies of NR have mostly evaluated its bioavailability [33], whereas there have been some recent studies of NMN that have evaluated clinical outcomes in older adults. A 12-week period of treatment with NMN reduced drowsiness and improved leg function in older people [34]. A randomised clinical trial in 25 obese postmenopausal women found that 10 weeks of NMN compared to placebo was associated with improved insulin sensitivity in muscle but not liver or adipose tissue [35]. It should be noted that these are all very small studies where multiple outcomes were evaluated.

Other gerotherapeutics in the pipeline
There are many biotech companies that are developing drugs that have been designed to act on ageing pathways [36]. However the majority of these have nominated a specific age-related disease, rather than ageing, as the therapeutic target. This likely reflects the current regulatory environment where ageing has not yet been established to be a licensable indication, and the higher costs and lower feasibility of undertaking clinical trials where ageing is the outcome, compared with those where an age-related disease or syndrome is the outcome [9].

One group of drugs receiving considerable attention currently, are the senolytics. Senescence cells are cells that have stopped dividing. These cells often produce an inflammatory cocktail called the ‘senescence associated secretory phenotype’ (SASP) that contributes to age-related inflammation . Senolytic drugs target and destroy senescent cells. Front runners amongst the senolytics are the combination of dasatinib, which is a tyrosine kinase inhibitor used in leukaemia, with quercetin which is a naturally occurring flavonoid antioxidant [38]. Two early phase clinical small trials have reported that treatment with dasatinib and quercetin is associated with clinical improvement in pulmonary fibrosis and decreased numbers of senescent cells and SASP levels.

In the recent past, resveratrol and the Sirtuin Activating Compounds (STACs) had a very high profile in the media. Studies in laboratory animal models had identified the sirtuins, in particular SIRT1, as important regulators of ageing. Initial studies were undertaken with resveratrol, a naturally occurring SIRT1 agonist, and later a range of other compounds (STACs) that increase SIRT1 activity. Resveratrol and STACs delayed ageing and increased lifespan in some animal models. After many trials in humans did not find major effectiveness of these drugs for a range of indications, further clinical development was shelved.

A natural product similar to resveratrol, called pterostilbene has been combined with NR in a fixed dose combination oral capsule. It is claimed that this combination of drugs will both replenish NAD and increase the activity of sirtuins, providing a multipronged approach to delay ageing. Human trial data proving efficacy in any aspect of ageing has not yet been published. However a small placebo controlled trial in 32 participants with amyotrophic lateral sclerosis reported clinical improvement after 4 months of treatment with pterostilbene and NR [43]. Social media marketing of this drug combination emphasises the basic ageing science supporting these claims, and endorsement by high profile scientists. The product has been available online and likely has substantial international market penetration.

There are many other gerotherapeutics in the drug development pipeline and many more available direct-to-consumer [8, 36]. Only a small fraction of these are discussed in this review. The basic science and animal lifespan data underlying gerotherapeutics often can be exciting and compelling. However, as in all other areas of medicine, the use of drug therapies in people must be supported by clinical trial evidence proving that there is both efficacy and acceptable safety. This is even more important for treatments that are claimed to delay ageing, where healthy people without disease may want to take these drugs, potentially for many decades.



Conclusions
The discovery of gerotherapeutics has been facilitated by the increased understanding of the biological mechanisms for ageing. This has shown that there are a wide range of cellular pathways that can manipulated by drugs to delay ageing and ageing-related diseases. Such drugs have often led to remarkable outcomes in laboratory animal models. However, there has not been any convincing evidence from high quality clinical trials in humans that any gerotherapeutic drug should be made available to delay ageing, but for the example of metformin. However, in order to define the therapy as gerotherapeutics it has to be tested for effects of a cluster of seemingly unrelated diseases whose major risk is ageing. Even so, ongoing research is motivated by the enormous potential benefits of gerotherapeutics, especially the possibility of delaying multiple ageing-related diseases with a single therapy.

Contributor Information
David G Le Couteur, Department of Geriatric Medicine, Concord Hospital, Sydney, Australia.

Nir Barzilai, Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA.

Per informazioni più complete potete visitare il sito:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356533/