Is Aging a Disease?

This is the question World Health Organization (WHO) leaders raised last year when they sought to officially define “old age” as a disease — rather than a fact of life — as part of the 11th revision of its International Classification of Diseases (ICD). The attempt was ultimately foiled by a major global campaign led by clinicians, including University of Ottawa geriatric psychiatrist Kiran Rabheru, MD, who argued that such a designation could result in real-world harm.

“ICD’s diagnostic categories substantially affect patient care, healthcare management, and resource allocation,” Rabheru writes in the Lancet Healthy Longevity. “In the context of highly prevalent and ubiquitous societal ageism, erroneous and arbitrary use of the ‘old age’ code, based on chronological age alone, would compromise safety and quality of healthcare for older people.”

WHO officials eventually agreed, shifting their terminology from “old age” to the more nuanced “ageing associated decline in intrinsic capacity.” This denotes a more specific state of health and encourages what Rabheru believes would be a more “dynamic assessment of a person’s health and capacity across a life trajectory.”

The controversy illustrates the ongoing ideological struggle between geriatric healthcare and longevity medicine. While geriatricians like Rabheru accept that viewing aging as a pathological problem encourages researchers to seek various genetic, cellular, and pharmacological gambits to slow the process, they’ve seen little hard evidence to persuade them such a pathway is possible.

“The more doctors confound aging with illness, the more it reinforces the view of aging as a pathology, which can lead to the undertreatment of elderly patients.”

Harvard scientist David Sinclair, PhD, author of Lifespan: Why We Age — and Why We Don’t Have To, disagrees. He says that when researchers focus on slowing the aging process, they may be able to eliminate many of the chronic illnesses that limit our “healthspan.”

“Medical research is moving toward not just putting Band-Aids on the symptom of disease but getting at the major root cause of all major diseases — which is aging itself,” he says.

Earlier this year, Sinclair and his team announced the results of a 13-year study in which a ­genetic treatment ­reversed the aging process in mice, arguing that it was a major breakthrough in antiaging.

“We think the various causes of aging may be addressable with a single treatment to reset the cell,” he says. “So, in the future, we could get one treatment — it could be a pill, it could be an injection — to go back 10 years [in cellular life].”

We’re not there yet, of course, and Yale University psychology professor Becca Levy, PhD, isn’t ready to overlook the dangers we may face if we move too hastily in that direction.

“When aging is seen as a strictly biomedical phenomenon and the social determinants, such as ageism, that play a crucial role are ignored, doctors are apt to dismiss treatable conditions as standard features of old age (for instance, back pain and depression),” she writes in her 2022 book, Breaking the Age Code.

“The more doctors confound aging with illness, the more it reinforces the view of aging as a pathology, which can lead to the undertreatment of elderly patients. For if doctors expect the health of their older patients to decline, the doctors are less likely to try to help them improve.”