Death in young or middle aged people usually has a single, well defined cause, whereas cause of death in older people is often poorly defined. The multifaceted nature of the association between death and disability is gradually being realised.1 An older person may have a sudden cardiac death or succumb to rapidly advancing cancer, but a more common scenario is a fluctuating worsening of health towards death—for example, because of heart failure. Another pattern—gradual loss of life force—is seen especially in frail, institutionalised patients.

In the linked study, Driver and colleagues (doi:10.1136/bmj.a2467) analysed the effect of increasing age on the most important causes of death in developed societies: cardiovascular diseases and cancer.2 The study assesses the interaction between age and the main causes of death in 22 048 male doctors aged 40-84 in the United States. The most intriguing results are those in men aged 80-90, in whom the residual lifetime risk of cancer and cardiovascular diseases seems to plateau, even decrease. The lifetime risk of cancer was …