Advanced pathological ageing should be represented in the ICD
Authors: Ilia Stambler, Aleksey Alekseev, Yuri Matveyev, Daria Khaltourina
Journal: The Lancet Healthy Longevity (2022)

In their Comment in The Lancet Healthy Longevity, Banerjee and colleagues1Banerjee D Mukhopadhyay S Rabheru K Ivbijaro G de Mendonca Lima CA Not a disease: a global call for action urging revision of the ICD-11 classification of old age.Lancet Healthy Longevity. 2021; 2: e610-e612Summary Full Text Full Text PDF Scopus (3) Google Scholar proposed to exclude the code ‘Old age’ MG2A from the latest version of the International Classification of Diseases, ICD-11, claiming 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.2Stambler I Recognizing degenerative aging as a treatable medical condition: methodology and policy.Aging Dis. 2017; 8: 583-589Crossref PubMed Scopus (33) Google Scholar 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.3Barzilai N Appleby JC Austad SN Cuervo AM Kaeberlein M Gonzalez-Billault C Lederman S Stambler I Sierra F Geroscience in the Age of COVID-19.Aging Dis. 2020; 11: 725-729Crossref PubMed Scopus (17) Google Scholar 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—ie, preventive, regenerative, and curative medicine.4Mkrtchyan GV Abdelmohsen K Andreux P et al.ARDD 2020: from aging mechanisms to interventions.Aging (Albany NY). 2020; 12: 24484-24503Crossref PubMed Scopus (10) Google Scholar This research and development necessitates appropriate ICD coding. In fact, WHO addressed this issue by including a new extension code XT9T ‘Ageing-related’ in the section aetiology. This code describes ageing-related conditions and can be helpful for research and clinical development.5Khaltourina D Matveyev Y Alekseev A Cortese F Iovită A Aging fits the disease criteria of the International Classification of Diseases.Mech Ageing Dev. 2020; 189111230Crossref PubMed Scopus (10) Google Scholar, 6The Lancet Diabetes & EndocrinologyOpening the door to treating ageing as a disease.Lancet Diabetes Endocrinol. 2018; 6: 587Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar However, there is still a need for coding both the pathological biological ageing process as a whole and its advanced stage as well. 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. We advocate for a full therapeutic utilization of the new ICD-11 criteria for ageing-related ill health, by enhancing research and development of corresponding diagnostics and therapeutics to directly address the main risk factors for older persons—the degenerative ageing processes. We declare no competing interests. Not a disease: a global call for action urging revision of the ICD-11 classification of old ageThe inclusion of old age in the 11th revision of the International Classification of Diseases (ICD-11) under general symptoms (code MG2A) and in the causality section of XT9T,1 has been justified by arguing that old age brings about several biological changes of vulnerability.2 We argue that simply equating old age as a disease in the ICD-11 is potentially detrimental and deleterious from clinical, research, and humanitarian points of view, and propose alternate productive solutions. Full-Text PDF Open AccessAdvanced pathological ageing should be represented in the ICDThe rapidly evolving field of longevity medicine focuses on identifying individual ageing trajectories by determining the biological age over time and targeting ageing mechanisms to extend healthspan, the time lived with an optimal performance and health.1 Currently, the ageing trajectory is determined by reaching an individual's optimal peak performance, followed by an individually variable, but overall physical and mental decline. This decline is often accepted as an inevitability, accompanied by age-related diseases, multimorbidity, frailty, and multisystemic failure. Full-Text PDF Open Access