Do People Really Die of ‘Old Age’?

If anyone could credibly stand as an example of dying from old age, it would be Jeanne Calment. In 1997, Calment passed at the age of 122 years, making her the oldest human with a documented paper trail of her lifespan.

Though the cause of her death wasn’t specified, it almost certainly wasn’t from simply being elderly. While many deaths are said to be “of old age,” the term largely amounts to a hand wave over the real cause of death. It’s not old age that kills: It’s the ailments that come with it.

“There are always other pre-existing diseases, or new diseases, that cause the deaths in question,” Dr. Elizabeth Dzeng, an assistant professor of medicine at University of California, San Francisco, told Gizmodo in 2020. “’Old age’ isn’t something you’d put on a death certificate—most likely, it would be something like cardiac arrest, which occurs due to some underlying issue such as an infection, heart attack, or cancer.”

Diseases that might appear more obviously in younger people might show up more insidiously in older populations, Dzeng added. “With pneumonia, for instance, they may not show the normal signs of infection—they may instead present with high blood sugar, if they’re diabetic, or if they have dementia, they may just present with changes in their mental status: heightened confusion, an inability to do the things they would normally do. When we’re older, and that sort of thing happens, we may not pin it on the underlying disease process.”

“Old age” was more useful some decades back, when medical professions had less knowledge and fewer diagnostic tools at their disposal to arrive at a conclusive diagnosis. Yet dying “from old age” has remained a persistent summary. For years, the World Health Organization (WHO) included “old age” as a cause of death in their International Classification of Diseases (ICD) data manual. The term wasn’t retired in the ICD until 2022, when WHO substituted it with “aging-associated biological decline in intrinsic capacity.”

But the fact remains that such a label is used not in the absence of a real cause, just in the absence of determining one. This is often due to a lack of information rather than a lack of curiosity: In a patient with several co-morbidities, for example, the ultimate contributor to their death may not be clear.

Not all cultures shy from relying on old age as a catch-all term. In Japan, rōsui, or decline associated with old age, was the third leading cause of death in 2021. “We would say these days, ‘She had all sorts of conditions but since she was old, let’s say she died of old age,’” gerontologist Akihisa Iguchi told The Wall Street Journal in 2022. One Japanese physician told the outlet he lists rōsui on half the death certificates he signs each year.

It's more accurate to state someone died at an advanced age rather than of an advanced age, though perhaps some families may prefer the vague term when there’s little sense in pinpointing the exact cause. It’s also a way to avoid the often-grim realty of what actually defeats us, from heart disease to pneumonia. When Queen Elizabeth II passed in 2022, the cause given was “old age.” Her actual cause of death has never been publicly revealed.

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