Objective: To determine how often 'old age' was given as a cause of death in patients presenting for cremation, with particular reference to their characteristics and the medical conditions known to the certifying doctor at the time of death.
Design: Prospective review of all cremation papers presented to one crematorium over a two-year period.
Setting: An English crematorium serving a population of about 250,000.
Main outcome measures: Deaths certified as being associated with 'old age' and those solely registered as due to this cause. Demographics of the patients and whether further enquiries by the medical referee revealed un-notified co-morbid conditions.
Results: Of 4300 cremation papers studied, 300 (7%) deaths were said to be associated with old age, of which 98 were to old age alone. Simple further enquiry discovered between one and six unrecorded co-morbid conditions in at least two-thirds of those certified as dying solely from old age.
Implications: If this experience were reflected throughout the country, it would suggest significant underestimation of the incidence of medical conditions, with resultant effects on national and international health policy and investment.