LIFE

Determinants of the beginning and end of life

Determinants of the beginning and end of life

Introduction

The aim of this study is to analyze key themes concerning the end of life in old age and to consider how these can contribute to gerontological knowledge. Drawing on international data, trends in mortality are identified, including age at death, causes of death, and place of death. These trends are analyzed for their significance for understanding the social conditions of ageing and dying. Secondly, themes from the study of death and dying are considered in relation to ageing, with a particular focus on what is understood by a 'good death' and how age influences this understanding. Thirdly, a discussion of issues in end-of-life care and support for older people considers the interrelationship between the social status of older people and the circumstances in which they die.

The study focuses on the complex and interconnected factors that shape the end-of-life course in old age. Socioeconomic and geopolitical structures, health and social care systems, family forms and functions, cultural and religious norms and practices, as well as individual lifestyles, resources, and relationships all have a bearing on the circumstances in which older people die. Around the world there are trends in common as well as significant differences.

Until recently gerontologists have not shown a great deal of interest in issues of death and dying. This is partly explained by the dominance in gerontology of the need to combat negative assumptions about ageing and to emphasize that old age is not all about decline and death. At the same time, until relatively recently, research into death and dying has focused on cancer deaths rather than the complex chronic illnesses that often lead to death in old age, and this has reinforced a separation in the two fields of study. A further point to consider is that information about the lives and deaths of older people is not always easy to obtain, particularly in less socioeconomically developed countries, and does not lend itself to international comparisons because of different conventions concerning death registration and certification.

Causes of death

Because of the ageing of populations it is expected that there will be a substantial worldwide shift in the distribution of deaths from communicable to non-communicable diseases. By 2030 it has been projected that almost 70 per cent of all deaths world-wide will be from non-communicable diseases, including ischaemic heart disease, cerebro-vascular disease (stroke) and chronic obstructive pulmonary disease (Mathers and Loncar (2006)). Obtaining information about causes of death is not straightforward because of inaccuracies and variations in recording individual deaths. For example, in some countries Alzheimer's disease has recently been recognized as the primary cause of death, whereas in others it is still seen as an underlying or contributory cause. These differences may appear insignificant but they matter because they have an impact on whether a person is seen as living with or dying from a disease and on the kind of care that is seen as ...