11.2: Most Common Causes of Death (Ob1)

The United States: In 1900, the most common causes of death were infectious diseases which brought death quickly. Today, the most common causes of death are chronic diseases in which a slow and steady decline in health ultimately results in death. How might this impact the way we think of death, how we grieve, and the amount of control a person has over his or her own dying process?

The leading causes of death and number of deaths per category in 2004 in the United States are listed below. (National Vital Statistics Reports, Center for Disease Control, 2006).

1. Heart Disease (654,092)
2. Malignant neoplasms (cancer) (550,270)
3. Cerebrovascular disease (stroke) (150,147)
4. Chronic lower respiratory disease (123,884)
5. Accidents (123,884)
6. Diabetes Mellitus (106.694)
7. Alzheimer's Disease (72,815)
8. Influenza and Pneumonia (65,829)
9. Nephritis (61,472)
10. Septicemia (42,762)
11. 11. Suicide (33,464)
12. Chronic Liver Disease (31,647)
13. Hypertension and hypertensive renal disease (26,549)
14. Parkinson's disease (22,953)
15. Pneumonitis (18,018)

These numbers reflect a change in Alzheimer's disease which moved up from the 8th leading cause of death to the 7th and influenza and pneumonia moved down in rank from 7th to 8th.

Deadliest Diseases Worldwide

The top 12 deadliest diseases in the world are listed below along with the estimated number of deaths per cause. These figures are for 2002 and do not reflect deaths due to violence or suicide (World Health Organization, World Health Report, 2004). Notice the higher rates of death due to HIV/AIDS, perinatal conditions and diarrheal conditions than is found in the United States. Deaths of infants, young children, young mothers, adolescents, young adults and midlife adults are more common. Many of these deaths are due to preventable causes. Ideas about the swiftness and unpredictable nature of death are certainly greater when living under such circumstances.

1. Heart disease (7.2 million)
2. Cerebrovascular disease (5.5 million)
3. Lower respiratory infections (3.9 million)
4. HIV/AIDS (2.8 million)
5. Chronic obstructive pulmonary (2.7 million)
6. Perinatal conditions (2.5 million)
7. Diarrheal diseases (1.8 million)
8. Tuberculosis (1.6 million)
9. Malaria (1.3 million)
10. Trachea, bronchus, lung cancers (1.2 million)
11. Road traffic accidents (1.2 million)
12. Diabetes mellitus (1 million)

A Comparison of Death by Age in the United States

A comparison of the causes of death in the United States in the year 2007 for people in late adulthood and among all ages is given below. Notice that 29 percent of all deaths were of people ages 85 and older and that rates of death due to heart disease had declined since 1997, although heart disease is still the leading cause of death.

Figure 11.2.1: Chart of Death rates among persons 65 years of age and over

Figure 11.2.2: Pie Charts of Deaths for all ages, 2007

The Process of Dying - Aspects of Death (Ob2)

One way to understand death and dying is to look more closely at physical death, psychological death, and social death. These deaths do not occur simultaneously. Rather, a person's physiological, social, and psychic death can occur at different times (Pattison, 1977).

Physiological death occurs when the vital organs no longer function. The digestive and respiratory systems begin to shut down during the gradual process of dying. A dying person no longer wants to eat as digestion slows and the digestive track loses moisture and chewing, swallowing, and elimination become painful processes. Circulation slows and mottling or the pooling of blood may be noticeable on the underside of the body appearing much like bruising. Breathing becomes more sporadic and shallow and may make a rattling sound as air travels through mucus filled passageways. The person often sleeps more and more and may talk less although continues to hear. The kinds of symptoms noted prior to death in patients under hospice care (care focused on helping patients die as comfortably as possible) is noted below.

Figure 11.2.3: Bar Chart of Hospice care of patients’ symptoms at the last hospice car visit before death 2007

When a person no longer has brain activity, they are clinically dead. Physiological death may take 72 or fewer hours.

Social death begins much earlier than physiological death. Social death occurs when others begin to withdraw from someone who is terminally ill or has been diagnosed with a terminal illness. Those diagnosed with conditions such as AIDS or cancer may find that friends, family members, and even health care professionals begin to say less and visit less frequently. Meaningful discussions may be replaced with comments about the weather or other topics of light conversation. Doctors may spend less time with patients after their prognosis becomes poor. Why do others begin to withdraw? Friends and family members may feel that they do not know what to say or that they can offer no solutions to relieve suffering. They withdraw to protect themselves against feeling inadequate or from having to face the reality of death. Health professionals, trained to heal, may also feel inadequate and uncomfortable facing decline and death. A patient who is dying may be referred to as "circling the drain" meaning that they are approaching death. People in nursing homes may live as socially dead for years with no one visiting or calling. Social support is important for quality of life and those who experience social death are left without the benefits that come from loving interaction with others.

Psychic death occurs when the dying person begins to accept death and to withdraw from others and regress into the self. This can take place long before physiological death (or even social death if others are still supporting and visiting the dying person) and can even bring physiological death closer. People have some control over the timing of their death and can hold on until after important occasions or die quickly after having lost someone important to them. They can give up their will to live.