- Queen Elizabeth II died in September at the age of 96.
- Her cause of death was listed to be “old age.”
- Medical experts dispute that is an accurate cause of death.
After Queen Elizabeth II died in early September, the National Records of Scotland released an extract from her death certificate listing her cause of death.
The 96-year-old monarch died of old age.
Although this is the Queen’s official cause of death, from a medical perspective it offers few details of what led to her death.
So what does it mean to “die of old age?”
Changes that occur as we age
Even for older adults who are generally healthy, aging still impacts their bodies in certain ways that increase their risk of dying.
“We all have a lifespan, and our cells have a lifespan,” said Dr. R. Sean Morrison, a professor of geriatrics and palliative medicine and chair for the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai, in New York City.
“So even for people who never develop a disease, there comes a point when the body no longer can function,” he said.
One change that happens as we age is we are less able to fight off infection, he said, which increases the risk of dying from an infection.
During the pandemic, older adults were at greater risk for severe COVID-19 than younger adults. But they are also at greater risk of severe illness from seasonal flu and pneumonia.
Older adults also tend to lose muscle mass and strength, what’s called sarcopenia. “The result of that is people may develop gait disorders, an inability to move, or at some point just an inability to get up and walk,” said Morrison.
Loss of muscle strength can also make it difficult for a person to swallow and eat.
In addition, “as we age, we often develop multiple coexisting medical conditions that, in and of themselves, aren’t fatal, but in combination put a tremendous strain on the body,” said Morrison.
For example, an 80-year-old will generally not die from arthritis directly, but this condition can limit their ability to be physically active, which can contribute to the loss of muscle.
Similarly, diabetes can increase the risk of complications such as cardiovascular disease and kidney damage, especially if a person’s blood sugar levels are too high.
Even vision and hearing problems can increase the risk of older adults dying.
“Many of my patients who are in their 80s are walking around with five to seven diseases,” said Morrison, “none of which are themselves a terminal illness, but when combined increase the risk of death.”
Leading causes of death among older adults
We have a good idea of which diseases contribute to older adults dying because the Centers for Disease Control and Prevention (CDC) uses death certificates to track these conditions.
In 2019 the five leading causes of death for people ages 65 to 74 were cancer, heart disease, chronic lung diseases, diseases that affect blood flow to the brain (cerebrovascular diseases), and diabetes.
Among 75- to 84-year-olds, the causes are the same except for diabetes, which was bumped to number six by Alzheimer’s disease.
After age 85, heart disease moves into the number one spot, followed by cancer, Alzheimer’s disease, cerebrovascular diseases, and lung diseases.
But in 2020, the pandemic brought with it a new disease, one that impacted all age groups, but especially older adults.
That year, COVID-19 was along the top three causes of death for people 65 years and older, behind heart disease and cancer, CDC data show.
Few people, though, would say that someone whose death was caused by complications of COVID-19 “died of old age.”
“Old age” provides little information
Medical experts are divided on whether “old age” is a useful term to describe the cause of death for an older person.
Dr. David Cutler, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, California, thinks this term is “inappropriate” on a death certificate.
First of all, the death certificate includes a person’s birth and death dates, he said, so we already know that someone who died at age 96 was older.
In addition, to be useful for public health agencies, he said a death certificate should provide detailed information about deaths that have occurred in the country, states and communities.
“If death certificates are not filled out accurately, then we really won’t know what people are dying of,” said Cutler.
In particular, he thinks listing the underlying cause of death can support public health efforts to reduce deaths from certain causes.
He gave the example of a person who is in a car accident and hits their head. The immediate cause of death may be an inability to breathe due to the traumatic brain injury, but the underlying cause of death is a motor vehicle accident.
“That [underlying cause] is really important to include on a death certificate, because that informs public health authorities: what do we need to do to prevent deaths like this in the future?”
Health officials also track deaths from other diseases such as cancer, diabetes, and heart disease — this helps them know if efforts to reduce those deaths are working.
Morrison said he generally lists the immediate cause of death and all the underlying causes on a death certificate. But “I did use ‘old age’ the other day for somebody who was 103 years old, and truly died of old age,” he said.
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