Is Aging a Disease? Why the Debate Won’t Die

The core problem: “Disease” typically implies a deviation from normal physiology with specific etiology, diagnostic criteria, and treatability. But everyone ages. Some scholars argue that classifying aging as a disease pathologizes a universal process and risks ageism , while others counter that a disease label would unlock regulatory pathways and resources to treat its root biology. The so-called aging disease dichotomy is increasingly seen as a false distinction, since aging involves accumulative pathologies similar to those found in recognized diseases. Many experts argue that aging appropriately fits within the disease classification framework because it shares features with established disease processes.

Regulatory reality check: The WHO explicitly clarifies that “old age” is  not  classified as a disease in ICD‑11 , and the U.S. FDA does not accept “aging” as an indication . This is a major reason trials like TAME (Targeting Aging with Metformin) are designed around multimorbidity and delay of age-related diseases, rather than “treating aging” per se. The debate over whether aging should be seen as a disease process continues to shape research and regulatory approaches.

In 2013, López‑Otín and colleagues crystallized aging biology into 9 “hallmarks of aging.” In 2023, this framework expanded to include 12 hallmarks, reflecting a decade of mechanistic discovery. 

These hallmarks represent key biological mechanisms and underlying processes that drive the aging process and are central to understanding the complex aging processes in humans. The hallmarks (e.g., genomic instability, epigenetic alterations, mitochondrial dysfunction, cellular senescence, altered intercellular communication, etc.) give us druggable targets and testable hypotheses. 

Disruptions in the cell cycle (relevant to genomic instability) and stem cell exhaustion are included among these hallmarks, highlighting the importance of stem cells in tissue regeneration and the decline in regenerative capacity with age. Oxidative stress and the accumulation of reactive oxygen species contribute to molecular damage, while damaged mitochondria are recognized as a hallmark of aging and a key factor in age-related diseases. Enhanced stress resistance is associated with boosted longevity in certain model organisms, such as nematodes and mice, providing insights into mechanisms of lifespan extension. As the hallmarks framework has expanded, metabolic disorders are increasingly recognized as integral to the aging processes, linking metabolic imbalances to age-related pathologies.

Meanwhile, epigenetic clocks and related EpiScores have matured from conceptual biomarkers to tools with growing predictive validity for morbidity, mortality, and functional decline. Still, their qualification as regulatory surrogate endpoints remains an open question, and different clocks capture different (sometimes complementary) biological signals.

1. Aging is the dominant, shared driver of most chronic diseases; targeting it is maximally efficient. Aging is not a benign progression, but a process that leads to functional decline and increased risk of aging related and age related diseases, which can be targeted by medical interventions.

2. A disease label could unlock regulatory pathways and reimbursement models, accelerating geroprotective trials and biomarker qualification. It would also accelerate research and developing treatment, including precision medicine interventions and regenerative medicine, to address the underlying mechanisms of aging and aging related diseases.

3. Classifying aging as a disease creates incentives for earlier, preventive interventions , potentially generating massive economic and public health returns. This could promote the development and funding of biomedical procedures and regenerative medicines, supporting medical research with a clearer focus on aging related and age related diseases. Such interventions could help treat aging and potentially even lead to curing aging.

1. Ageism & stigma: Pathologizing a universal process could worsen age-based discrimination and medical undertreatment (“that’s just old age”). Many experts argue that aging is a natural process, or a collection of natural processes, and is not a disease. For many, aging is seen as a benign progression rather than a pathological state.

2. Heterogeneity: Aging is highly individualized and multicausal , challenging the standard disease model that favors clear etiologies and diagnostic thresholds . A person's age does not necessarily determine health status; while chronic illnesses are common in older age, they are not universal, and many individuals remain healthy and active.

3. Healthy aging exists: Many older adults maintain high function and resilience; calling them “diseased” may conflict with public health frameworks that emphasize capability, well being, and functional capacity in older age.

An aging population is pushing already strained health systems to the brink. As the world's population grows older, countries face major challenges in adapting their health and social systems to support older adults. Healthy aging delivers large economic value via extended productivity, reduced dependency, and decreased healthcare utilization. But without equitable access to diagnostics, prevention, gerotherapeutics, and end of life care—especially in middle income countries— longevity gains could widen health disparities. Any policy path—disease label or not—must integrate equity, affordability, and public health perspectives, and prioritize person centred integrated care and robust primary health services.

1. Move—enough, and often. Adults should accumulate 150–300 minutes/week of moderate aerobic activity or 75–150 minutes of vigorous activity, plus muscle-strengthening ≥2 days/week. Cardiorespiratory fitness is a powerful, dose-responsive predictor of mortality.

2. Sleep at least 7 hours/night (most adults). Short sleep is linked to metabolic, cardiovascular, cognitive, and immune dysfunction.

3. Get enough protein—especially after age 65. Aim for ~1.0–1.2 g/kg/day, higher with illness or intensive training, to counter anabolic resistance and sarcopenia.

4. Eat a high-quality dietary pattern (e.g., Mediterranean-style, rich in plants, extra-virgin olive oil, nuts, and fish) to reduce cardiometabolic risk.

5. Train your VO₂ max and grip strength. Add 1–2 weekly sessions of higher-intensity intervals (scaled to your fitness and medical status) to raise aerobic capacity— one of the most potent predictors of survival.

6. Maintain (or build) social connection. Strong social relationships confer a ~50% higher likelihood of survival —an effect size comparable to major biomedical risk factors.

7. Target geroscience hallmarks. Interventions such as exercise that modulate chronic inflammation, mitochondrial function, nutrient sensing, or epigenetic state are promising.

Whether you call aging a disease, syndrome, or driver of disease, the mission is the same : Develop, validate, and deploy interventions that extend healthy, high-functioning years for everyone. Let’s build the regulatory science, biomarkers, and trial designs that make that possible—while framing aging in a way that avoids stigma and centers autonomy, equity, and dignity.

Organizations such as the American Medical Association play a significant role in shaping disease classification, as seen in their recognition of obesity as a disease, which influences research funding and healthcare policy. Global health bodies like the World Health Organization are also working to standardize disease diagnosis worldwide, ensuring consistent terminology and approaches in international health protocols.

Transparency about commercial or financial relationships is essential in aging research and policy to maintain objectivity and public trust.