The Controversy over “Old Age” in the WHO ICD-11 Classification
A recent dispute surrounding the classification of “old age” in the WHO International Classification of Diseases (ICD-11), highlighting concerns about potential real-world harm. The WHO’s subsequent retraction of the term and replacement with “ageing associated decline in intrinsic capacity” set the stage for a deeper exploration of the ideological conflict between longevity science and geriatric medicine in the field of longevity medicine.
Aging as a Potential Pathogenic Process
The central question emerges: whether ageing should be considered a disease. Advocates argue that viewing ageing as a pathological process allows researchers to explore mechanisms to slow it down, potentially targeting pathways associated with various age-related diseases. This perspective offers potential advantages, such as identifying targetable mechanisms for slowing ageing and addressing multiple diseases simultaneously, thereby improving healthspans and prolonging life spans.
Controversies Surrounding the Classification of Ageing as a Disease
However, clinicians express reservations about classifying ageing as a disease, citing its universal and normal nature, its potential modifiability through lifestyle interventions, and the risks of reinforcing ageism and discrimination. Additionally, the absence of clinically substantiated interventions that effectively slow ageing or disease progression in humans, despite positive preclinical outcomes and substantial investments in anti-ageing technologies.
The Need for Collaboration in Longevity Medicine
Emphasizing the necessity of collaboration between longevity science and geriatric medicine to deliver effective longevity medicine. Acknowledging each other’s perspectives and engaging in constructive discussion are deemed crucial for the field to reach its potential. The collaboration, rather than dispute, is key to addressing the needs of ageing populations effectively and advancing research and interventions in longevity medicine.
Aging is a normal human attribute globally accepted, and longevity is a sought-after privilege. While age is a recognized risk factor for diseases, chronological age in humans is highly variable, limiting its usefulness for individual diagnosis, prognostication, and treatment. It is also insufficient for planning population health, healthy aging, and social care. The narrative highlights that old age itself is not a disease but underscores the presence of ageism in society, with implicit biases causing economic and health costs during events like the COVID-19 pandemic. The article suggests replacing the term “old age” with more precise alternatives like “senescence,” “aging associated decline in intrinsic capacity,” or “frailty,” each offering a nuanced perspective on the biological, physiological, and psychological aspects of aging. Importantly, it stresses that frailty, often associated with age, is reversible and should not carry a negative or fatalistic connotation. The text concludes by drawing attention to the global issue of ageism, citing WHO’s report stating that one in two people worldwide holds ageist views.
Rabheru, Kiran et al. “How “old age” was withdrawn as a diagnosis from ICD-11.” The lancet. Healthy longevity vol. 3,7 (2022): e457-e459.