Terminal Care in the Old

Abstract

Only 24% of the population die before the age of 65 and Table I shows the distribution of death in 10 year groups therafter. My starting point is therefore that most dying is done by the old and therefore it is appropriate to study their deaths perhaps more than has been done in the past. Isaacs and his colleagues (1972) looked back retrospectively from the deaths of old people in the West of Scotland and examined the pre-death phase. He elaborated the idea of “pre-death” as being a period during which physiological functions were maintained by an inherent medullary programme long after any recognisable person had disappeared. Fries and Crapo (1981) extrapolated from past successes in pushing morbidity and mortality into later life and proposed that there would eventually be a time when the expectation of life would approximate to the span of life and that we would all depart after a relatively short, sharp illness. There has been quite widespread criticism of this optimistic concept. In fact however very little has been written about the length of the period of decline and dependency terminating in death in the old. My comments are directed towards consideration of death in people on the far side of 75 years and mainly on the far side of 80 years of age. Perhaps I should give you some rather black good news. Amongst the old 10% fall down dead; less than 2% experience what has been described as the horrors of the geriatric long stay ward and the rest of us die reasonably quickly and tidily after quite a short final illness.