WHO backs down and gives up on classifying old age as a disease

After strong international pressure from scientific organizations and civil society, the WHO (World Health Organization) withdrew from the decision to classify old age as a disease in the new ICD 11 (International Classification of Diseases) version, which takes effect in January 2022.

The change was confirmed this Tuesday (14) by a director of the entity to the Brazilian physician and gerontologist Alexandre Kalache, president of the International Center for Longevity and who has already directed the WHO aging program.

The previous proposal was to replace the term senility (code R-54), which already exists in the ICD, with “old age without mention of psychosis; senescence without mention of psychosis; senile debility” (MG2A).

But there was a strong negative reaction because the understanding was that, by signing a certificate or a diagnosis, the doctor could start to consider old age as a disease.

The suggestion now is that the code text be “intrinsic capacity decline associated with aging”. However, there may still be changes until the end of the year.

The ICD is a set of 55,000 codes used by health professionals, researchers and public policy makers. It’s on its 11th update.

At first glance, the change may seem subtle, but aging experts say it is already calming the spirits of the international community. In recent months, there have been mobilizations by governments, medical societies and entities linked to aging in several countries, including Brazil, asking the WHO to change the code.

The assessment was that, by relating old age to the disease, the new classification could be used to neglect disease diagnoses in the elderly, prevent the correct recording of the causes of death and even increase discrimination against the elderly population.

“This decision now puts a brake on ageism that would reach unprecedented levels. Suddenly, we would all be labeled as old people. If it’s old, let it die. It won’t treat, it won’t make a diagnosis,” says Alexandre Kalache.

For nurse Yeda Duarte, a professor at USP and coordinator of the Sabe study, which monitors aging in the city of São Paulo, the WHO retreat was very important, but the scientific community is eagerly awaiting the final publication of the text.

“For now, there has been a promise of change. It’s still not the best ranking, but the CID is always something you can make suggestions, present evidence and it gets tweaked along the way.”

In a hearing in the Chamber of Deputies on the matter, Maria Cristina Hoffmann, representative of the Health Ministry for Elderly Health, said that the change could lead to records in death certificates without the guarantee of investigating the real cause of death, the which undermines the development of public policies.

“Death declaration is an important source of health knowledge. It would be a risk if they started to put there that the person died of old age. We would lose control of how many had Parkinson’s and how many died Alzheimer’s, very important information for policy planning public”, says geriatrician Marco Túlio Cintra, vice president of the SBGG (Brazilian Society of Geriatrics and Gerontology).

At the public hearing of the Chamber, Juan Escalante, representative of PAHO (Pan American Health Organization), the WHO arm for the Americas, justified that the intention of the ICD was not to classify old age as a disease, but to allow the inclusion of the word group factors that influence health.

In the opinion of Marco Cintra, from SBGG, the controversy may also have been caused by cultural factors. “For us, in Portuguese and Spanish, the term old age has become pejorative. We have been fighting a lot to fight stigmas and prejudices against aging. Aging is not a disease, it is not a burden for society. It depends on the aging of each person.”

Another issue much discussed in recent months was that, once associated with the disease, old age would become an even bigger target of the ‘anti-ageing’ industry and of treatments without evidence with promises to delay it. “There is no shortage of people wanting to enter this market. The anti-ageing industry commands $37 billion in the US a year. There is a powerful lobby,” says Kalache.

For him, the new term that should be adopted by the WHO (decline in intrinsic capacity) is also not ideal because it refers to the biological capacity of each one and takes away the importance of the social determinants of health.

“Inherited, intrinsic, biological factors account for only 25% of the chances of achieving good longevity; 75% depend on how you live, the access you have to healthy food, health, education, the practice of activities physical.”

In his opinion, it is possible that the discussion about the new code will drag on into the next year. “My bet is on the development of a code related to frailty. Frailty is something we can define, measure, intervene, anyone can become a fragile person at any stage of life.”

For Ieda Duarte, the previous classification would be a huge contradiction in the fight for active and healthy aging and also in relation to a publication by the WHO itself, in early 2021, of a report denouncing ageism against the elderly.

The classification of biological aging as a disease was made in articles published in international journals from 2015, by groups of researchers from Belgium, Sweden, the United Kingdom, among others.

In May 2019, the incorporation of the ICD-11 classification was approved at the 72nd World Health Assembly, but it went virtually unnoticed until the death of Prince Philip rekindled the debate.