Opening the door to treating ageing as a disease

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Opening the door to treating ageing as a disease

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Opening the door to treating ageing as a disease
The Lancet Diabetes & Endocrinology | August 2018 | DOI: https://doi.org/10.1016/S2213-8587(18)30214-6

Death in old age was historically attributed to just that—ie, old age and natural causes. However, with increasing life expectancy and the desire to maintain good health in older age for as long as possible (so-called healthy ageing), calls to recognise ageing as a disease that can be treated are increasingly relevant and debated, despite the lack of a universally accepted set of ageing biomarkers and uncertainty about the time of transition to disease.

Progress in being able to classify, and thus treat, ageing as a disease was made recently when WHO implemented an extension code for ‘Ageing-related’ (XT9T) diseases—defined as those “caused by pathological processes which persistently lead to the loss of organism's adaptation and progress in older ages”—in the latest version of the International Classification of Diseases, ICD-11. The new code, implemented as a result of a joint proposal submitted to WHO's ICD-11 Task Force by researchers from the Biogerontology Research Foundation, the International Longevity Alliance, and the Council for Public Health and the Problems of Demography, can be immediately applied to relevant conditions listed in ICD-11 as well as to newly recognised conditions in the future. As ICD codes are prerequisite for the registration of all new drugs and therapies, the recognition of age as a pathological process, together with replacement of the ICD-10 ‘Senility’ (R54) code with ‘Old age’ (MG2A) in ICD-11, represents undeniable progress towards overcoming the regulatory obstacles that have thus far hampered the development of therapeutic interventions and preventative strategies targeting ageing and age-related diseases.

According to WHO, 22% of the world's population (roughly 2 billion people) will be over the age of 60 years by 2050, an increase from just 12% (about 900 million) in 2015; by 2020, people aged 60 years and older will outnumber children younger than 5 years. This population ageing (a shift in the median age of a country's population towards older ages) was first evident in high-income countries such as Japan, but low-income and middle-income countries (LMICs) are now experiencing the greatest rate of change: by 2050, 80% of people older than 60 years are predicted to be residing in LMICs. Increased life expectancy can be seen as a sign of progress and prosperity in a country, reflecting improvements in health care (access, availability, and affordability), diet, work safety, and socioeconomic status together with reductions in famine, conflicts, communicable diseases, and risky health behaviours such as smoking. But the benefits of living longer are counteracted by the global rise in ill health in old age due to the increasing burden of non-communicable diseases (predominantly obesity, diabetes, cardiovascular diseases, and cancer) and ageing-related conditions. Moreover, how to provide adequate health and social care to an ageing population is a major economic challenge for all countries, threatening to cripple already overstretched health and social care budgets in some.

Although implementation of the extension code XT9T in ICD-11 is not tantamount to formal recognition of ageing as a disease, it does signal acknowledgment by WHO of ageing as a major disease risk factor and of the considerable public health problem posed by ageing-related diseases. Whether this move will be enough to entice the pharmaceutical industry to initiate development programmes targeting the ageing process and, more broadly, human lifespan remains to be seen. However, given the impending economic threat posed by population ageing and the potential benefits of intervention, ranging from better health in old age for individuals to decreased health-care costs, increased workplace productivity, and increased economic growth for countries, progress on this front is vital.

The Lancet Diabetes & Endocrinology has just published a four-paper Series on Ageing and endocrinology, highlighting endocrine-related diseases and comorbidities as some of the most common age-related conditions and major impediments to maintaining good health in old age. The papers discuss the physiological basis of endocrine-system ageing, the clinical implications of using testosterone to treat older men with hypogonadism, thyroid dysfunction during ageing, and the role of the endocrine system in frailty. Understanding how the endocrine system ages is paramount to realising the goal of healthy ageing—the door to which has at least now been opened by implementation of the ‘Ageing-related’ ICD-11 extension code.

For more on classifying ageing as a disease see Front Genet 2015; 6: 326

For more on ICD-11 see https://icd.who.int/

For more on the Biogerontology Research Foundation see http://bg-rf.org.uk/

For more on the International Longevity Alliance see http://longevityalliance.org/

For more on the Council for Public Health and the Problems of Demography see http://sozd.org/en

For more on ageing and health see http://www.who.int/news-room/fact-sheet ... and-health

For more on risk factors for ill health among older people see http://www.euro.who.int/en/health-topic ... der-people

For the ageing and endocrinology Series see https://www.thelancet.com/series/ageing ... ology-2018
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