Ageism and it’s effect on Health.

Dear Editors

ICD-11 is the acronym for the International Classification of Diseases in its 11th edition. It corresponds to the classification used by the World Health Organization (WHO) to define symptoms and pathologies in all areas of health, including definitions and criteria for multiple pathologies and pathological conditions.

To the surprise of many, in January 2020, the “Old Age” was included under the code MG2A. This inclusion was widely rejected internationally. Numerous scientific and civil society organizations from multiple Latin American countries expressed their concern about this situation, including the World Psychiatric Society through its Branch of Advanced Age, in conjunction with the International Association of Psychogeriatrics, the Latin American and Caribbean Committee, the International Association of Gerontology and Geriatrics, the Working Group on Psychogeriatrics of SONEPSYN and even the Government of Chile through SENAMA.

Thanks to this wake-up call, this update has had a new change. “Aging with deterioration of intrinsic capacities” is the concept that was included, implicitly implying that older people maintain the same intrinsic capacities compared to other populations and that only the loss of these will be pathological. Therefore, an older person will not become part of a diagnostic category by default and/or by age.

Although this term has also received various criticisms, and we believe that it can be improved, it is undoubtedly a notorious advance in diminishing the promotion of discriminatory visions in medical classifications, focusing diagnoses on those who have a genuinely pathological condition.

Robert Butler coined the term ageism to refer to the process of systematic discrimination based on age. For our region, Leopoldo Salvarezza proposes the concept of «viejismo», which would be the correct translation for discrimination based on age towards older people and refers to the complex behavior that consciously or unconsciously devalues older people(1). One of the components of ageism is stereotypes about ageing that are defined as beliefs, usually negative, that include assumptions and generalizations about how people of a certain age should behave, without considering the individual differences that favor the heterogeneity of this natural stage of life. These are mainly associated with poor health, loneliness, dependence, and physical and mental malfunction.(1)

Like any other type of discrimination, ageism undermines the quality of life of this age group(1). It has a comprehensive and crucial multilevel effect on the health of the older people, both physically, mentally, and cognitively(2), which affects interpersonal relationships, social relationships, and health. Ageism has been associated with increased physical health pathologies, such as metabolic diseases. It also increases the risk of multiple mental health conditions, including cognitive impairment, loneliness, depressive and anxious symptoms, substance use, and even being able to increase the risk of suicide in the affected population and higher health expenditures(3). This impact is given not only by the change in the subject’s self-perception but also limits their adequate access to clinical care in quantity and quality(4), hindering clinical improvement, the identification of effective and safe treatments, considering their particular needs, what could be called “ageism in healthcare”, understanding as those policies, practices or procedures - explicit or implicit - of health institutions, which discriminate against older people and include stereotypes, prejudices and actions based on the age of people who are part of these establishments.(1)

Finally, previous reports have shown that ageism is modifiable, with interventions, including education and intergenerational contact, that can reduce it(6). Considering the known adverse effects on health and the presence of strategies that can reduce it, we call on all institutions and professionals who work with older people to fight against this and all forms of discrimination. Old age is a life cycle stage, such as childhood or adulthood. Including it within “general symptoms” would have corresponded to a severe setback in terms of discrimination since it considers as pathological a natural and expected stage of life.

The 69th World Health Assembly of 2016 established that “most health problems of older people are related to chronic disorders, especially non-communicable diseases. Therefore, they would not be inherent in old age but increase their prevalence at this stage of life, in the same way, other diseases have greater prevalence during other stages of the life cycle”. The same Assembly points out as one of its objectives is “combating ageism and transforming the understanding of ageing and health”. Cataloguing old age as a disease was a clear example of ageism, in which pathological conditions are assumed only by the individual’s age, without a scientific basis or an evaluation of his state of health.

For all the above, we celebrate the awareness on the part of the WHO after the allegations made by different actresses and actors concerned about ageing and dignified old age worldwide. This change will generate that the population of older people will not automatically belong to a diagnostic category at the time of its publication. However, the case must be evaluated to avoid age discrimination in medical teams and other governmental and social institutions.

We invite health professionals, especially those of us who are dedicated to mental health, to reflect on ageing and the direct consequences it has on the health of millions of older women and men. We need to generate changes both in our daily actions, in our areas of clinical work, and in the execution of the various public health policies that concern ageing and older people in Chile.