Most people have a grandparent or great-aunt who, whether suddenly or gradually, "died of old age." Technically speaking, however, old age isn't actually a cause of death in the same way that hypertension or diabetes or a car accident can be. Regardless, the saying persists, but what do we mean when we say that someone died of old age?
First, what constitutes old age, anyway? In the United States, anyone 65 or older is considered an "older adult." The group is then subdivided out, with people 65-74 considered "young-old," those 75-84 are "middle-old" and anyone 85 or up "old-old," according to Dr. Niharika Suchak, associate professor in the Department of Geriatrics at Florida State University College of Medicine and medical director of Big Bend Hospice, Tallahassee, Florida.
"A person does not die of old age but many people die at an old age," Suchak says in an email interview. "At an advanced age, a cascade of adverse health events may occur, to which the person's advanced age makes them more susceptible."
This is not to say that all people over 65 will rapidly decline at the same rate, however. "As one grows older, one may become more dissimilar with others in the same age cohort due to genetics, lifestyle behaviors, life experiences and physiologic reserve [the ability of an organ to carry out its activity under stress]," says Suchak. "For many, growing older is not always accompanied by life-limiting declines in health." So, there is a lot of merit to staying active, vital and eating healthy!
For a lot of people, though, age makes it harder for organs to recover from stressful activities or events. "But it's not like as you get older your vital organs have reduced functioning in an age-based universally predictable manner until one day when the heart beats one last time and then stops," Suchak notes. Instead, she says, "There is increased occurrence of a variety of chronic conditions with age and these multiple comorbidities increase your risk of mortality. It is not old age by itself that is the culprit."
Your Body and Homeostasis
So, what is the culprit, then? One of the big bummers is that the body is less able to maintain homeostasis over time. Even if you've never heard of it, homeostasis is something you've relied on for your entire life. It's literally the act of the body keeping things the same (homeo means "similar" and stasis means "stable"). People with great homeostasis tend to have well-regulated body temperature, blood pressure, blood sugar, water balance and blood flow. All of those things are very important to living a healthy life.
Unfortunately, it's not unusual for big problems to develop the older a person gets. "The changes that occur with aging contribute to dysregulation and loss of maintenance across physiologic systems," Suchak explains. Because of this, homeostasis declines and disease development skyrockets. The result is high blood pressure, diabetes and any other number of problematic diseases that can cause death from "old age," so to speak. A lifetime of eating the wrong things, smoking or getting little exercise can start to take a toll.
It also doesn't help that potentially fatal complications often show up differently in older people than they do in younger patients. "Younger people and older people can die and do die from some of the same types of illnesses for example, heart attack, blood clot in the lungs, severe infection, etc. but older adults might appear to react differently to these clinical insults," Suchak notes.
For example, symptoms of pneumonia in a younger person are fever, cough and chest pain. In an older person, pneumonia could present instead with high blood sugar and mental confusion. "Often a change in functional status, i.e., the inability to do some of the daily activities that an older adult may normally do, may be the only presentation or sign of a new condition. This type of an atypical presentation may lead to delay in seeking medical attention and/or delay in recognition of the new condition or illness," Suchak explains. The older you get, the worse it is to delay treatment of something so serious.
Failure to Thrive
Sometimes, an older adult experiences a decline in function without a clear cause. This is known as "failure to thrive," (FTT) and is associated with decreased appetite, weight loss, inactivity, dehydration, depression, low cholesterol and poor immune function. These maybe a result of becoming increasingly frail and may be accompanied by cognitive impairment and/or functional disability, Suchak notes. Such a range of circumstances can muddy the waters of what it means to "die of old age."
Clearly, the aging process is complex. So, under the unfortunate circumstances that a cause of death becomes necessary for a death certificate, how does a medical professional know what to put down?
"Old age is never written as a cause of death on a death certificate. Often, the immediate cause or physiologic process for death is cardiopulmonary arrest which occurs due to an underlying condition (often acute) such as severe heart attack, uncontrolled infection, progression of cancer, severe stroke, large pulmonary embolism, etc." says Suchak. In fact, regardless of the cause, everyone dies almost the same way, she says, with cessation of heart function being the last stage.
Determining what to put on the death certificate is something of a process, as a result. "When a doctor completes a death certificate, you have to enter underlying cause(s) of death," Suchak explains. "You work backwards from the cardiopulmonary arrest to the immediate underlying condition such as pneumonia and then to the condition that predisposed or contributed to the occurrence of the pneumonia such as dementia and then to the specific type of dementia such as Alzheimer's disease." In other words, just because someone checked into the hospital with pneumonia doesn't mean that's what goes on the certificate.
So while "dying of old age" is not a medical term, there is something to the fact that as people age, they do seem more accepting of the reality of death.
"Most people who die in their 90s and beyond have come to terms prior to the dying process with the finality and immediacy of death as an outcome of a lived life," says Suchak. "There may be less of a struggle 'to live' and fewer last-minute, rushed efforts in the form of aggressive treatments. They may have made their peace and are ready to move on to the next phase in the cycle of life and death. 'Dying of old age' can sometimes signify the readiness to say goodbye and depart."