“Old age” no longer a diagnosis as a cause of death

Are we dying because of growing old, or is our lifespan limited by the damage accumulated in our body’s various systems as we age? That has been a topic of debate for some years at the World Health Organization, where the International Classification of Diseases (ICD) is reviewed periodically. At the start of the debate it was recognized that attributing someone’s demise solely to the number of years they have been on Earth is a form of ageism, which leads to artificial rules such as compulsory retirement from work and other forms of marginalization of the aging population. 

The ICD had its origin in the 1860s when, during an international statistical congress held in London, Florence Nightingale proposed the development of the first model of the systematic collection of hospital-related data. Apart from recording and tracking statistics about illness and causes of death on death certificates, the ICD has become an important tool of governments and professional organizations for, among other things, resource allocation, including financial reimbursement for health care services, measurement for patient-care quality, and evaluation of large-scale research programs. 

The first conference to revise the classification of causes of death took place in 1900 and revisions have occurred every 10 years since. The latest debate about replacing “old age” as a cause of death led to three different proposals. One suggestion was “senescence,” acknowledging cells undergoing lethal changes with aging. Another proposal was “decline in intrinsic capacity,” recognizing the biological, physiological, and psychological changes negatively affecting an aging person’s overall capacities. “Frailty” was yet another consideration (i.e., that reduced reserves across multiple physiological systems could be strong predictors of mortality, independent of age and gender). 

The debate is now over: As of January 2022, “old age” was removed from the ICD as a cause of death, and agreement was reached to replace it with “aging-associated biological decline in intrinsic capacity.” No more dying of old age. 
—George Szasz CM, MD

Suggested reading
Conway J. Debate rages on the inclusion of old age in the ICD-11. Lifespan Extension Advocacy Foundation. Accessed 11 August 2022. www.lifespan.io/news/debate-rages-on-the-inclusion-of-old-age-in-the-icd-11.

Rabheru K, Byles JE, Kalache A. How “old age” was withdrawn as a diagnosis from ICD-11. Lancet 2022;3(7):E457-E459.

Wikipedia. International classification of diseases. Accessed 11 August 2022. https://en.wikipedia.org/wiki/International_Classification_of_Diseases.

This post has not been peer reviewed by the BCMJ Editorial Board.

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