AIBU to question why they put "Died of old age" on Prince Philip's death certificate?

[SolarLightxoxo]

I mean everyone dies of something surely? It's not like you come to a certain age and you just drop dead.

And your point is?
All the things you’ve listed are frequently as a result of the passing of time. Or are you trying to say that if they can all be stopped we’ll live forever?

Geez. My point is as previously stated, we - the humans - do not really know exactly the aging of the human body is caused by, or if it can be halted.

Once the mechanism and their interactions are better understood, some expect within the next ten years or so, we will know more about whether aging and death (the idea of an "organism-design-limited lifespan") are as inevitable by X age as they currently are, or whether we can extend our natural lifespans and healthspans, etc.

*exactly what

@MissLucyEyelesbarrow

But all things being equal, there's no benefit to not actually knowing what someone died of for what is a statistical record.

So what do you think should happen? No one is intentionally falsifying death certificates. But, as I have explained above, without an autopsy, the cause of death is always an educated guess. Guessing a more specific diagnosis like MI (heart attack), instead of old age doesn't make the stats any more accurate.

Better training of medical professionals in recording of cause of death? Not all countries are equal in their use of garbage codes and its one of the markers used to assess the quality of the death registration system (% of garbage codes which includes old age) Personally I'd prefer 'unknown' if its really unknown. We know the age so it's obvious that unknown for someone who is 110 os different to unknown for someone of 50.

Better training of medical professionals in recording of cause of death?

Unless the training is going to give us x-ray vision, I'm not sure how you think that will help.

There isn't any way that doctors can know for sure what has killed someone (who has died of natural causes) without an autopsy. Even for a patient with very advanced cancer, the cause of death might be stroke, pulmonary embolism, MI, renal failure, liver failure, heart failure, bowel ischaemia, hypercalcaemia, hyperkalaemia, hyponatraemia, GI bleed - all of which are more common if you have cancer. It isn't a training issue, it's simply unknowable without autopsy.

Some countries do better than others. And there have been improvements over time in recording of cause of death. So clearly there are things we can do to record it better.

@Oyvavoy

Some countries do better than others. And there have been improvements over time in recording of cause of death. So clearly there are things we can do to record it better.

What do you mean by better?

You seem to be assuming that more specific diagnoses on death certificates = greater insight into the true cause of death. But that's not true at all (excepting certificates issued after autopsy). Doctors in other countries are no more able magically to guess exactly what killed someone than doctors in the UK. If they use more specific diagnoses on certificates, that doesn't mean that they are guessing more accurately.

You are also missing the fundamental point that increasing specificity when you are having to make an educated guess makes the data less accurate because, the more specific the diagnosis, the more likely this is to be wrong. In my cancer example above, if I put 'Cancer' as the cause of death every time, I will always be broadly right but, if I choose one of the individual knock-on effects of cancer e.g. hypercalcaemia, I will often be wrong.

It's actually really detrimental to patient care and to public faith in medicine to pretend that we have certainties when we don't. Medicine is not an exact science, and that includes death certificates. We should be honest and transparent about that.

@Oyvavoy

Look up garbage codes for cases of death and you'll understand.

There's a reason recording old age as a cause of death js discouraged. I hadn't even realised it was still allowed in the UK.

And yet you work in a related field?

Not in the UK

@MissLucyEyelesbarrow

I don't think we're going to agree but thank you for the insights from the perspective of a medic.

Here's some material/literature which explains the issues with garbage codes including old age from a statistical perspective - it's pretty well established in the CRVS guidance and literature that it's not a good thing to have (hence the name - not my invention!).

getinthepicture.org/sites/default/files/resources/6.%20Death%20certification%20and%20ICD%20coding.pdf (specific slide which talks about old age)
www.ncbi.nlm.nih.gov/pmc/articles/PMC7446871/
crvsgateway.info/file/16948/276
www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32152-9.pdf (some explanatin of the way that garbage codes are redistributed - personally I think better a physician's educated guess than statistical modeling)
minerva-access.unimelb.edu.au/bitstream/handle/11343/245835/PMC7061466.pdf (quote below)
"Strategies to improve COD data quality in hospitals should address the most commonly used garbage codes from all categories. However, clearly, greater emphasis should be given to reducing the frequency of those codes, which have the greatest potential to seriously distort the evidence-base for public health policy designed to reduce premature mortality"
journals.plos.org/plosone/article?id=10.1371/journal.pone.0237539 (this article shows the UK is doing pretty well in terms of garbage codes - hence my surprise here that old age seems to be so common)

@Oyvavoy I am enjoying our debate

I think we are, to an extent, talking at cross-purposes. There are two groups of patients, when it comes to death certificates:

1. Have had autopsy: cause of death usually established precisely
2. Everyone else - educated guess most of the time.

For group 1, using a precise code is helpful for understanding disease and planning health care because it helps epidemiologists know how many people are dying of any given condition.

But for group 2, using a precise code won't do that, because it's a best guess. In fact, by using a precise code when you are just guessing, you will dilute the accurate coding of group 1.

As a statistician, it may give comfort to feel that all deaths have been given a precise code. But, to plan health care, it is much more useful to know that, of each 100 people autopsied, 10 definitely died of heart disease, than to know that, of every 10,000 non-autopsied deaths, doctors guessed that 1,500 were due to heart disease.

My Great Gran died of old age, she was 104, still in her own home, doing her own cooking and cleaning. She sat in the chair one day and died. No heart condition, no illness just very very old

@Oyvavoy you’re not a medic in this country, yet you’re implying you know better than the doctors here.
Old Age is perfectly acceptable cause of death in many countries. People get old...they die! 🙄

Didn’t Harold Shipman used to write that in death certs for people he murdered? And nobody would ever question it.

I was delighted when the doctor put this on my father's death certificate. It seemed a very gentle and appropriate way of describing his passing.

Old age and heart failure were on my 94-year-old Dad's. He had chronic kidney disease, and his lungs were pretty shot, with the heart failure, but basically, everything was just stopping working

The queen didn't want syphilis on it

I remember saying to my siblings after our elderly dad died that I hoped they would just put old age as the cause of death. Yes, he had a number of small health issues but not one would have killed him as such . . . Dad was also in his 90s and lived until his last day, only being in hospital for the past 2 weeks. I think there's a stage when there is just a general failing of the body due to old age.

After a certain age, bodies just get old and begin failing. Unless there is one obvious cause, they will put old age. Often things like aplastic anaemia or heart failure are also old age as the body is just old and stops working properly.

@Thingaling

Didn’t Harold Shipman used to write that in death certs for people he murdered? And nobody would ever question it.

Ironically, I believe Shipman did contact the coroner and ask if it was OK to put 'old 'age'. But I doubt that the choice of cause of death on certificates made much difference to the cover up. The key lie he must have had to keep telling was that the deaths were expected. He falsified medical records to make it look as if the patients had diseases that they didn't; really have, which then made it easy to explain why they had died.

It would be much harder to do these days because GPs rarely work in isolation any more - a GP colleague or practice nurse would be very likely to notice that there were entries in the medical record that didn't fit what the patient was telling them. You might get away with it for one patient, but probably not for lots of them.

Yep "frailty in old age" is a cause of death.

I doubt the death certificate would have said ‘old age.’ Wouldn’t it say ‘natural causes’?

We had old age put on my Mil's death certificate last August the registrar checking the details with me said it had been many years since she had seen that listed as a cause and that during in the current times she found it quite a comforting term as did we.
For months we cared for her in her decline with very little help from medical professionals and as we weren't Drs we felt it was more fitting.

The most likely wording was "natural causes " At his age it would be a mixture of many things

My father recently died and the cause if death on his death certificate was old age. When I saw Prince Philip leaving the hospital I instantly recognised the look and knew he did not have long left.

@LaurieFairyCake

Seems fair to me (you're allowed if they're over 80 and there's no single cause)

It's better than putting heart failure when he had a procedure a month before death - and the resulting intrusion into the doctors/hospital etc

Absolutely agree. They could have said Gran died of heart failure-it stopped working or asphyxiation-she couldn’t breathe in enough oxygen. She was in her 90’s and had been getting increasingly frail. They said it was old age.