Causes of Death

In the United States, about 70% of all deaths occur after age 65. In 1999, the greatest percentages of deaths in this age group were due to heart disease, stroke, and cancer. However, because many older people have more than one chronic illness, the true cause of death is often uncertain, especially for people over 85.

Even as enormous strides are made in the treatment of disease, one thing remains true: eventually every person must die of something. So, as improvements in health care have helped decrease deaths due to heart disease and stroke, deaths due to cancer have increased. If, in turn, a way to decrease cancer deaths is found, some other cause of death will take its place. Humans have a maximum life span, and even the best health care cannot overcome this biological imperative.

Although life expectancy in the United States is not the highest in the world (this distinction is held by Japan), Americans reaching old age live longer than older people in many other countries. For women who reach age 80, life expectancy is 9.1 years, which is higher than life expectancy in Japan, Sweden, France, and England. Life expectancy is higher for older men in the United States as well.

When the current generation of older people was young, most people died in the privacy of their own home, usually cared for by family. If an illness developed slowly, a doctor probably came to visit often. If an illness developed suddenly, a doctor may not have seen the person until just before or just after death.

Today, most older Americans die in a hospital or nursing home. If an illness worsens at a slow pace, an older person living at home is likely to be admitted to a hospital several days or weeks before death. Those who get ill rapidly are typically sent to an emergency room, where treatment is given briefly before death. Even people residing in nursing homes are sometimes transferred to a hospital when they get sick enough that the medical staff fears they will die. Yet, despite the statistics on what does happen, surveys show that many older people would rather not die in a hospital, preferring, if possible, to die at home surrounded by loved ones. The thought of dying away from home is disturbing to many. It also adds greatly to the cost of medical care. Dying in a hospital is expensive.

Of total Medicare expenditures for a given year, more than 25% are for services provided during a person's last year of life, with much of this amount spent in the last 60 days. Medicare expenditures are 7 times higher for those who are in the last year of their life than for those who are not.

Older Americans now have several mechanisms to help ensure that they die where and in the manner they most prefer. Americans can choose to be hospitalized or not, to have aggressive treatment or not, to undergo resuscitation attempts or not, and to be fed artificially or not. An advance directive document called a living will allows people to make their wishes known regarding medical care and heroic resuscitation attempts. A different document called a durable power of attorney for health care allows people to choose someone to make decisions for them in such matters if they become unable to make those decisions themselves. Completing and updating such documents have become essential parts of aging.

See the table Leading Causes of Death Among People 65 and Over in 1999.