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Advanced pathological ageing should be represented in the ICD, Lancet Healthy Longevity, January 2022

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ICD for PostHappy and proud to see our correspondence article published in “Lancet Healthy Longevity”, entitled “Advanced pathological ageing should be represented in the ICD

By Ilia Stambler, Aleksey Alekseev, Yuri Matveyev, and Daria Khaltourina

(free and open access)

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

And happy to join forces with another correspondence article, in the same issue of “Lancet Healthy Longevity”, with the same title, by Evelyne Bischof, Andrea B Maier, Kai-Fu Lee, Alex Zhavoronkov, and David Sinclair.

https://doi.org/10.1016/S2666-7568(21)00303-2

These articles appeared in response to a campaign raised by some gerontologists to remove the designation “Old age” from the new version of the International Classification of Diseases – ICD-11 (the code “Old Age” MG2A), as they claimed this designation would sound discriminatory against older people simply because of their age (“ageist”).

This campaign is exemplified by the article of Debanjan Banerjee et al. “Not a disease: a global call for action urging revision of the ICD-11 classification of old age” in “Lancet Healthy Longevity” to which we respond

https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(21)00201-4/fulltext

As well as others

https://www.paho.org/journal/en/articles/old-age-and-new-icd-11-position-latin-american-academy-medicine-older-persons

https://www.ageing.ox.ac.uk/blog/ICD-11-and-an-argument-about-old%20age%20

https://www1.folha.uol.com.br/folha-100-anos/2020/08/queremos-morrer-velhos-mas-nao-de-velhice.shtml

https://www.portaldoenvelhecimento.com.br/a-velhice-e-uma-doenca/

There was perceived the danger that, because of this campaign, this entire category code would be removed, and thus aging would no longer be recognized as a contributor to disease or a part of age-related pathogenesis, which would have detrimental outcomes for the research, development and therapy specifically designed to address and prevent aging-related ill health. Thus the removal of this code could in practice damage the health of older people that the campaign wished to protect from ageist labels.

So our articles were intended to defend the remaining of this code, in order to draw attention and resources for research, development and treatment specifically to address and improve aging-related ill health.

And indeed, due to the campaign, an ICD revision was introduced concerning this code (made public after our articles were accepted).

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/835503193

Yet the result turned out to be even better for the purposes of supporting healthy longevity R&D and treatment, than the earlier version. It would not remove the code entirely, but just rename the main term from “Old age” to “Ageing associated decline in intrinsic capacity”. Indeed, the term “old age” was rather scientifically ambiguous, while the new main term encourages practical projects to define, measure and improve the “intrinsic capacity” of older persons (which is currently not well defined or widely adopted). At the same time, all the code synonyms that would help address aging as a medical condition remained, including over 40 “index terms” altogether, such as ‘Ageing’, ‘Senescence’, ‘Senile state’, ‘Frailty’, and ‘Senile dysfunction’, that we also mention in our article and whose practical utilization we support.

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/835503193

At the same time it should be noted that the new revision (“Ageing associated decline in intrinsic capacity”) is set in motion, but the official released version of ICD-11(that came into effect on January 1, 2022) still mentions “Old age”.

https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f835503193

https://icd.who.int/ct11/icd11_mms/en/release (search “ageing”)

But those semantic distinctions may not be crucial, as in either case, with the main stated significance of this code being the “general symptoms” of ageing, the attention would be drawn to addressing aging pathology and improving aging-related ill health, the need for which we also argue in our article. Notice additionally that neither version directly refers to aging as a “disease”, but refers to “general symptoms” (similar to the “general symptoms” of “cachexia”, fatigue”, “shock”, “sleep disturbance” etc. that are also in the ICD). This designation as “general symptoms” may help address aging as a medical condition generally. This is in addition to the “XT9T Ageing-related” ICD-11 code in the “Etiology” or “Causality” category.

Thus the main message and fact remain:

AGING IS NOW IN THE ICD AND CAN BE OFFICIALLY ADDRESSED AS A MEDICAL CONDITION!!! And this can help address and improve aging health!

It should also be noted that mere semantics will not be effectual for the good or bad of aging health. In order to practically implement the ICD aging categories, it will be necessary to develop and implement evidence-based metrics and clinical evaluation criteria for aging, not just to predict the trajectory of aging health but also necessary to test the effects of geroprotective or healthspan improving interventions, as we also argue elsewhere.

https://www.frontiersin.org/articles/10.3389/fgene.2021.764874/full

http://www.aginganddisease.org/EN/10.14336/AD.2017.0130

Hopefully our joint work, with the other co-authors and partners, will further stimulate this discussion and research. It was a great honor to be a part of this stellar team!

(Just to note, the views expressed in this post are my personal views, following our article publication and the public introduction of the new main term “intrinsic capacity” after our article was accepted). These are not necessarily the views of the other co-authors and partners. For our joint views, please see the articles themselves. Thanks for your consideration! Ilia Stambler)

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

https://doi.org/10.1016/S2666-7568(21)00303-2

#aging #longevity #oldage #geroscience #ICD11 #medicalcondition

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