Old age is given as the only cause of death in an increasing number of elderly patients who die each year, yet many have known pathologies and co-morbidities that go unrecorded.
There can be little doubt that advanced age is a significant contributory factor in the deaths of the elderly but who and what is old?
The World Health Organization defines those aged 60-74 years as elderly, and those older as aged.
An Oxfordshire study found the average age of patients certified as having died of "old age" was 89 years (range 69-106 years).
As mortality statistics are used to determine public health policy and allocate NHS resources, the term old age requires some definition and guidance in its use.
The diagnosis "senility without mention of psychosis" (which includes the terms "old age" , "senility" , "senescence" , "senile debility" and "frailty of old age") was recorded in 2.3% of deaths in England and Wales in 2000, a figure that has more than doubled in the last 5 years.
There is debate as to the acceptability of "old age" when given as the only cause of death.
It may be appropriate when a very elderly patient "declines over time" in the absence of any firm clinical diagnosis or has refused – or been too frail to undergo – investigation or intervention.
Others may have had multiple medical problems making it impossible to say with any certainty which one was immediately responsible for their death.
In such cases, a diagnosis of "old age" is used and covers a multitude of conditions.
Others suggest that the term "old age" is meaningless and most elderly people have definable pathology causing their death.
In January 2000, Manchester general practitioner (GP) Harold Shipman was convicted of the murder of 15 of his patients.
An audit of his clinical practice found that he was three times more likely to use the term "old age" as a single cause of death than his local colleagues.
In the aftermath of the Shipman trial, it has been proposed that the time had come to restrict or even abolish the use of this term on death certificates.
The life expectancy from birth for adults in the UK is 75 years for men and 80 years for women.
Doctors are advised to avoid giving old age or senility as a cause of death and to do so only if a more specific cause of death cannot be given and the deceased was aged 70 or over.
- Old age is recorded as the only cause of death in up to 3% of cases in England and Wales
- In most cases, simple enquiry revealed co-morbid conditions known at the time of death
- Failure to record these conditions may affect national and international health policies, investment and statistics