What it means when doctor gives cause of death as ‘old age’

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People often say that friends and relatives have passed away due to “old age” but this is not always medically accurate. In fact, it can be rather complex, which is why ‘old age’ is so rarely given as an official cause of death.

The likelihood of suffering from health issues increases as we age. Our cells stop repairing themselves, the immune system gets weaker and the body becomes more damaged. Common problems include dementia, heart issues and high or low blood pressure.

Although many people die peacefully while asleep, this does not mean they have died simply of old age. Dr Tuly Rosenfeld, a geriatrician at the University of New South Wales, told WalesOnline: “The reason that many older people quietly die in their sleep is because their swallowing systems don’t work, they inhale food, fluid, saliva into their lungs, they catch pneumonia and they die.”

Our mobility worsens as we age, which means older people are more likely to fall and injure themselves. This can lead to a hospital stay where the patient is at risk of infection they cannot fight off. And recovering from trauma like a hip fracture can be extremely difficult when a patient is over 100 years old.

In such cases, it is not old age alone which causes death, but complications arising from conditions that come with ageing. Dr Rosenfeld said doctors do not always know the exact cause of death in an elderly person because they may have conditions that subtly overlap — which can make it hard to give an official cause.

When it comes to writing death certificates in the UK, there is strict government guidance that says doctors should avoid giving old age – or even “senility” or “frailty of old age” – as the sole cause of death. There are, however, “very limited circumstances” where this is acceptable. These are when a doctor has:

• personally cared for the deceased over a long period (years or many months);

• observed a gradual decline in the patient’s general health and functioning;

• not been aware of any identifiable disease or injury that contributed to the death;

• been certain that there is no reason that the death should be reported to the coroner.

The guidance continues: “You may mention old age or frailty as a contributory cause, especially if it explains the severe effect of a condition that is not usually fatal. If the immediate cause of death was Covid-19 or its consequences, and the patient had no specific pre-existing health conditions, but appears to have been especially vulnerable to Covid-19 or its effects because of old age or frailty, it is appropriate to state old age as contributing to the death.

“You should bear in mind that coroners, crematorium referees, registrars and organisations that regulate standards in health and social care, may ask you to support your statement with information from the patient’s medical records and any investigations that might have a bearing on the cause of death. You should also be aware that the patient’s family may not regard old age as an adequate explanation for their relative’s death and may request further investigation.”

It goes on: “While there is no statutory age limit or restriction on referring to ‘old age’, a death certified as due to old age or senility alone will usually be referred to the coroner, unless the deceased was 80 or older, all the conditions listed above are fulfilled and there is no other reason that the death should be referred. Similar terms, such as ‘frailty of old age’, will be treated in the same way.”

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