Further Wrangling Over the Definition of Aging as a Disease

The World Health Organization (WHO) manages the International Classification of Diseases (ICD), which goes through revised editions every so often. Since regulatory agencies and healthcare payers use the ICD in determining just about everything regarding whether or not specific treatments are permitted, many groups involved in the development of therapies to treat aging are interested in seeing aging unambiguously added to the ICD. At the end of the day this has little to do with semantics and a great deal to do with finances: the availability of funding for research and development, the direct and indirect costs of gaining regulatory approval, and so forth. Needless to say, this is all proceeding much as things usually do in large bureaucracies - slowly and to no-one's satisfaction, with the likely end result being greater ambiguity and cost rather than less ambiguity and cost.

It was proposed to exclude the code 'Old age' MG2A from the latest version of the International Classification of Diseases, ICD-11, with the claim that equating old age to a disease could have the negative consequences of treating calendar age as a disease, raising concerns of ageism. Yet, in fact, the 'Old age' code is not a new ICD addition, or one that should raise special concerns of ageism. The synonymic designation of 'Senility' or 'Old age' was carried over from ICD-10 as it has been a rather technical designation that allowed to establish the cause of death, when it was difficult or impossible to establish other causes. In contrast to the earlier versions, the ICD-11 allows for diverse synonymic interpretations, including those that can be highly useful for a clinician treating older persons, such as 'Ageing', 'Senescence', 'Senile state', 'Frailty', and 'Senile dysfunction', which refer to a state of health but not the number in the passport.

It is becoming increasingly clear that pathological processes of ageing are the major risk factors, and even major underlying causes of mortality and morbidity from non-communicable diseases, and, as we learn from the recent pandemics, also from infectious diseases. To address these ageing-related risk factors, there is a new wave of research and development that seeks to develop new therapies or repurpose older therapies, with the aim to slow and reverse the damage of ageing - i.e. preventive, regenerative, and curative medicine. This research and development necessitates appropriate ICD coding.

The new ICD-11 makes important steps toward that goal, as it provides a double focus for improving the health of older persons. First, by including the old age, senescence, and senile debility in the general symptoms category to target the state of ageing-related ill health, and second by including 'Ageing-related' code in the aetiology or causality category to target the pathogenic ageing processes. Thus, far from discriminating against the rights of older persons and fostering neglect for their curative or preventive health care, the ICD-11 codes for old age and ageing-related causality do exactly the opposite: they draw the public and professional attention to the specific health problems of older persons and call to action to improve the prevention and cures specifically for older persons. Thus, these designations are the very opposite of ageism.

Link: https://doi.org/10.1016/S2666-7568(21)00305-6


The concept of aging as a cause of morbidity is intuitive and does not require elaborate justifications. Old church records always recognized aging as a legitimate cause of death without any bureaucratic trepidations. For the purpose of classification, I would not equate aging to a disease because it is so much more than mere clinical manifestations of a system-specific malfunction. Rather I would create a code for "aging-associated" which should precede the specific pathology, for example "aging-associated" "cognitive impairment". Then again, cancer at 50 could not be conveniently called "aging-associated" even though it is caused by major drivers of aging - accumulation of mutations and epigenetic alterations. Maybe it is just a semantic tempest in a teapot for intellectual entertainment.

Posted by: Magomed Khaidakov at January 17th, 2022 11:08 PM

@Magomed Khaidakov
It sounds like a minor technicality but it affects the funding and therapy approval

Posted by: Cuberat at January 18th, 2022 9:29 AM
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