Understanding Death

Death Process

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, 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. Agonal breathing refers to gasping, labored breaths caused by an abnormal pattern of brainstem reflex. The person often sleeps more and more and may talk less, although they may continue to hear.

When a person is brain dead, or no longer has brain activity, they are clinically dead. Physiological death may take 72 or fewer hours. This is different than a vegetative state, which occurs when the cerebral cortex no longer registers electrical activity but the brain stem continues to be active. Individuals who are kept alive through life support may be classified this way.

For those individuals who are terminal, and death is expected, a series of physical changes occur. Bell (2010) identifies some of the major changes that occur in the weeks, days, and hours leading up to death:

• Weeks Before Passing
  • Minimal appetite; prefer easily digested foods
  • Increase in the need for sleep
  • Increased weakness
  • Incontinence of bladder and/or bowel
  • Restlessness or disorientation
  • Increased need for assistance with care
• Days Before Passing
  • Decreased level of consciousness
  • Pauses in breathing
  • Decreased blood pressure
  • Decreased urine volume and urine color darkens
  • Murmuring to people others cannot see
  • Reaching in air or picking at covers
  • Need for assistance with all care
• Days to Hours Before Passing
  • Decreased level of consciousness or comatose-like state
  • Inability to swallow
  • Pauses in breathing become longer
  • Shallow breaths
  • Weak or absent pulse
  • Knees, feet, and/or hands becoming cool or cold
  • Knees, feet, and/or hand discoloring to purplish hue
  • Noisy breathing due to relaxed throat muscles, often called a “death rattle”
  • Skin coloring becoming pale, waxen (pp. 5, 176-177)

Most Common Causes of Death

While death has always been a universal component in the human experience, its prevalence and circumstances have changed over the years. Today, we associate death with the elderly, but looking back even one hundred years ago, death was more common among children and in various age ranges. At that time, it was not uncommon for American families to lose a child during childbirth or infancy. Today less than 10% of all deaths worldwide occur to children under the age of 5, but as recently as 1990, that number was nearly 25%.^[1]

The graph above shows data from 2016, which reveal that nearly half of the 55 million global deaths occurred to those aged 70 years or older. There is still a great amount of disparity in death statistics based on location and access to medical care. In the United States, for example, deaths in that same age group of 70 years old or older accounted for 65% of total deaths. In this section, we’ll look more closely at the leading causes of deaths in the United States and throughout the globe.

The United States

In 1900, the most common causes of death were infectious diseases, which brought death quickly. Due to advances in healthcare and medicine over the years, this has changed, alongside an increase in average life expectancy. According to national data, chronic diseases, or those in which a slow and steady decline causes health deterioration, were the most common causes of death in the United States in 2016^[2] In addition, accidents were more common than in previous years, often resulting in quick or unexpected death. How might this impact the way we think of death, the way we grieve, and the amount of control a person has over his or her own dying process, in comparison to the infectious diseases that were prevalent in 1900?

The 10 leading causes of death and percentage of deaths per category in 2022 in the United States are listed below.^[3]

Leading Causes of Death in the United States, 2022 (Statistica, 2024)

Nearly all of these top causes of death, with the exception of two—accidents and suicides (#11)—continue to be related to physical illnesses. Many are linked at least in part to lifestyle choices, including diet, exercise, and substance abuse. Similarly, many are preventable, to some extent, and some are avoidable if the proper actions are taken.

Deaths Worldwide

The leading causes of death in the world from 2021 are listed below, along with the percentage of deaths for which they were accountable. Retrieved from https://www.oecd-ilibrary.org/sites/216c1c0e-en/index.html?itemId=/content/component/216c1c0e-en.[/footnote] Notice there are several similarities between these and the top causes of death in the United States described above.

1. Cardiovascular disease – 28%
2. Cancers – 21%
3. Diseases of the respiratory system – 9%
4. COVID-19 – 7%
5. Alzheimer’s and other dementias – 6%
6. Accidents – 4%
7. Diabetes – 3%
8. Suicide – 1%

Differences in various factors including but not limited to economic status, access to medical care, belief systems, and natural resources play a major role in many of these causes of death, and tend to vary substantially between countries. This presents challenges for the interpretation of this list, making it difficult to determine the true prevalence of each in specific locations.

A Comparison of Death by Age in the United States

The major causes of death vary significantly among age groups. As you can see in Figure 1, congenital diseases and accidents are major causes of death among children, then accidents and suicides are the leading causes of death between ages 10 and 24. This changes again into middle and late-adulthood, as heart disease and cancer combined cause over 50% of deaths for those aged between 45 and 65.

Notice that unintentional injuries are the leading cause of death for the widest variety of ages.^[4][/footnote] These were the top causes of death for various age groups in the United States in the year 2016:

• < 1 year – Congenital anomalies
• 1 – 4 years – Unintentional Injury
• 5 – 9 years – Unintentional Injury
• 10 – 14 years – Unintentional Injury
• 15 – 24 years – Unintentional Injury
• 25 – 34 years – Unintentional Injury
• 35 – 44 years – Unintentional Injury
• 45 – 54 years – Malignant Neoplasms (cancer)
• 55 – 64 years – Malignant Neoplasms (cancer)
• 65 + – Heart Disease

The causes of death on this list resemble the causes presented in the previous sections, but the breakdown of these causes by age group highlights the true prevalence of each. Unintentional injury (accidents), for example, was found to be the third most common cause of death within the United States population, but it becomes apparent from this list that it is the most common for the widest range of age groups or developmental stages.^[5] Heart disease was found to be the most common cause of death overall, but this list shows that it is more restricted to one age group (65+) than other causes. Similarly, cancer was found to be the second most common cause of death within the United States population, but this list reveals that it is most prevalent for individuals in middle to late adulthood.

Death and The Media

^[6]

Interestingly, the things that actually result in death are not often the things we hear about on the news. Because of the availability heuristic—a cognitive shortcut in which people rely heavily on information that is most readily available in their mind, people may erroneously be more afraid of sensational deaths than death by more normal causes, such as heart disease.