Advanced pathological ageing should be represented in the ICD
Authors: Evelyne Bischof, Andrea B Maier, Kai-Fu Lee, Alex Zhavoronkov, David Sinclair
Journal: The Lancet Healthy Longevity (2022)

The 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.1Bischof E Scheibye-Knudsen M Siow R Moskalev A Longevity medicine: upskilling the physicians of tomorrow.Lancet Healthy Longev. 2021; 2: e187-e188Summary Full Text Full Text PDF Scopus (1) Google Scholar 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. At different states of the personal life cycle, predominantly reactive medical systems accommodate individuals and capture scarce physical and mental health data, rarely collected during younger adulthood. Longevity medicine provides an ecosystem for collecting, analysing, and translating longitudinal data, drawing conclusions from the momentary state of health towards predictive and prognostic trajectories, aiming at mitigating and eliminating specific risks of morbidity. The ultimate goal is to bring the individual closer to the state of optimal peak performance during the entire lifespan.2Zhavoronkov A Bischof E Lee K-F Artificial intelligence in longevity medicine.Nat Aging. 2021; 1: 5-7Crossref Google Scholar The latest version of the International Classification of Diseases, ICD11, supports installed new dynamics in the nascent field of longevity medicine by classifying ageing as a disease. It allows physicians to target ageing in a comprehensive rather than a less efficacious disease and syndromes-oriented manner.2Zhavoronkov A Bischof E Lee K-F Artificial intelligence in longevity medicine.Nat Aging. 2021; 1: 5-7Crossref Google Scholar, 3Khaltourina 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, 4Zhavoronkov A Bhullar B Classifying aging as a disease in the context of ICD-11.Front Genet. 2015; 6: 326Crossref PubMed Scopus (37) Google Scholar Banerjee and colleagues called for excluding old age from ICD-11, suggesting replacement by frailty.5Banerjee 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 Longev. 2021; 2: e610-e612Summary Full Text Full Text PDF Scopus (3) Google Scholar Whether the term old age is the best choice of terminology for a state of multi-malfunction is a semantic, redundant debate. First, ICD codes are carefully considered and revised before being implemented. Secondly, frailty refers to, mostly but not exclusively, age-related disabilities, although old age is not always associated with frailty. Thus, these terms are not mutually exclusive and can co-exist in the ICD, as a part of a hierarchy of causation. The extension code XT9T guarantees coding for measurable age-related processes—eg, inflammageing, mitochondrial dysfunctions, etc.1Bischof E Scheibye-Knudsen M Siow R Moskalev A Longevity medicine: upskilling the physicians of tomorrow.Lancet Healthy Longev. 2021; 2: e187-e188Summary Full Text Full Text PDF Scopus (1) Google Scholar The MG2A code, on the other hand, is representative of the paradigm shift in the definition of an individual's age, from chronological to biological, and will promote the development of therapies to optimise biological age. This paradigm shift in the definition of age, along with technological advances in the ability to control biological age, has led to considerable investment in the field of longevity to develop interventions targeting ageing mechanisms and systemic rejuvenation rather than a single organ or system at a time. Thus, the current ICD classification should remain to recognise and foster the rapid development of longevity medicines and to allow physicians treat biological age rather than specific diseases, thereby extending the healthspan and lifespan beyond current approaches. We declare no competing interests. Longevity medicine: upskilling the physicians of tomorrowLongevity medicine is advanced personalised preventive medicine powered by deep biomarkers of aging and longevity, and is a fast-emerging field. The field encompasses the likewise rapidly evolving areas of biogerontology, geroscience, and precision, preventive, and functional medicine. Full-Text PDF Open AccessAdvanced pathological ageing should be represented in the ICDIn their Comment in The Lancet Healthy Longevity, Banerjee and colleagues1 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. Full-Text PDF Open Access