“Senile:” An Antiquated Descriptive Term
© 2024 HMP Global. All Rights Reserved.
Any views and opinixons expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates.
The US population is trending toward senescence, with 73.1 million people projected to be older than age 65 years by 2030— approximately 20% of all Americans. By 2034, it is expected that the number of older adults will outstrip children for the first time in US history.1 In turn, the prevalence of older adult-associated dermatologic disease will increase, reflecting the changing population demographics. Aging is a natural process, universally experienced by all. Language significantly impacts how we perceive and understand aging because words frame perception. The persistent use of “senile” perpetuates a biased view that fails to acknowledge the inherent dignity and value of older individuals. “Senile” is often used pejoratively and carries negative connotations, implying decline, weakness, and cognitive impairment. By using such terminology, dermatology inadvertently reinforces harmful stereotypes that disregard the diverse experiences and wisdom that come with aging. More respectful and inclusive language in dermatology can contribute to a shift in societal attitudes about aging.
Advocacy directed toward the elimination of senility and its derivatives in the field of medicine has previously been discussed. Schatz in 1978 captured the distress experienced by patients when confronted with “senile” diagnoses in medical reports and insurance forms, commenting that for patients “aging is a reality difficult to face.”2 Schatz suggested the use of alternative medical terminologies such as “maturity-onset keratosis” in substitution. These sentiments were echoed by correspondence from Wilson, citing that “senile” has become a derogatory term and should be eliminated.3 The World Health Organization attempted to replace senility in the International Classification of Diseases with “old age” in 2022 due to the former term’s negative connotations. However, many professional and nongovernmental organizations across the world opposed this change, arguing that old age is not pathologic, and the change could further amplify ageism.4 Therefore, it is important to distinguish that chronologic age does not equate to biologic age; physiologic aging is a heterogeneous process that differs between individuals depending on a multitude of genetic and social factors. Hence, diagnoses based on chronologic age may elicit myriad disease classification issues.
Within dermatology, “senile” as a term remains readily used in practice, subsequently reflected by the medical literature. Several diagnoses, including senile xerosis, senile pruritus, senile gluteal dermatosis, and senile lentigo, are frequently utilized within publications both pre- and post-2000 despite the outdated nature of this term (Figure). There are many successful examples of now obsolete diagnoses, from “female hysteria,” which was deeply rooted in a patriarchal history of medicine, to the shift from “mental retardation” to intellectual disability. As clinicians, we should be cognizant of patient sensitivities and preferences and consciously avoid feeding into potentially insulting stereotypes. Many traditional diagnoses have an alternative medical term that can be used; we recommend utilizing the terms “older adult” or “age associated” to be more inclusive and avoid negative connotations (Table). While other fields of medicine move away from the usage of the word “senile,” the slow pace within dermatology to adopt the same approach is apparent. Hence, we call for increased consideration of the holistic care of older adult patients and advocate for the elimination of the use of ageist terminology, including “senile.”5
Dr Onyeka is a dermatology resident at Stanford University in Stanford, CA. Xiaochen Zhong is a medical student at the University of California, San Francisco. Jaya Manjunath is a third-year medical student in the George Washington School of Medicine and Health Sciences at George Washington University in Washington, DC, and the founder of Seniors with Skills, an international 501(c)(3) nonprofit organization with a mission to end social isolation amongst senior citizens. Dr Butler is an associate professor and director of the inflammatory and aging skin research program in the division of dermatology and the assistant dean for student affairs in the college of medicine at the University of Arizona College of Medicine in Tucson, AZ.
Disclosure: The authors report no relevant financial relationships.
References
1. American community survey. US Census Bureau. August 13, 2023. Accessed October 22, 2024. https://data.census.gov/table?q=B21100:+SERVICECONNECTED+DISABILITY-RATING+STATUS+AND+RATINGS+FOR+CIVIL IAN+VETERANS+18+YEARS+AND+OVER&g=010XX00US&tid=ACSDT1Y2021. B21100
2. Schatz H. Concerning aging. JAMA. 1978;239(3):190.
3. Wilson FM 2nd. “Involutional” vs ‘senile.’ JAMA. 1978;239(17):1743. doi:10.1001/ jama.1978.03280440027007
4. Rabheru K, Byles JE, Kalache A. How “old age” was withdrawn as a diagnosis from ICD-11. Lancet Healthy Longev. 2022;3(7):e457-e459. doi:10.1016/S2666- 7568(22)00102-7
5. Manjunath J, Friedman A. Assessing dermatology provider perceptions and attitudes about the unique needs of older adult patients. J Drugs Dermatol. 2022;21(3):331-332. doi:10.36849/JDD.6541
