When I see these patients that are essentially dying of old age, I have to look through the lense of the Centers for Medicare and Medicaid (CMS). You see, CMS doesn't recognize old age as a hospice diagnosis, and even worse, the CDC doesn't recognize old age as even a valid cause for death. Both agencies have decided that death must be more specific. For example, instead of "Old Age" or "Advanced Age" on a death certificate, it might read something like "Acute myocardial infarction related to underlying atherosclerotic coronary heart disease" even though the deceased was already bed bound, frail, and suffering from pneumonia.
To satisfy CMS, I have to look beyond the big picture and search for something more specific. I pull out my CMS guidelines for hospice admission and review the requirements for every illness the patient has. If I'm lucky, I might find that the patient squeaks by on a particular guideline. If I'm not so lucky then I have to qualify the patient under an obscure diagnosis called "Decline in Health Status", "Debility", or "Failure to Thrive". These are really just fancy words for "Dying of Old Age". But it's not enough for CMS to see documentation that a patient is ill and frail with multiple conditions. I have to document recent weight loss, mid-arm circumference, the patient's body mass index (BMI), their palliative performance score (PPS), the presence of infections and bed sores, and the list goes on.
I wonder what it would mean if I could admit patients to hospice with a diagnosis of "Advanced Age"? What if we began to recognize advanced age a universal and unpreventable cause of death? What would it mean to our health care system to have the financial, social, and personal aspects of long-term care front and center? What if addressed the problems of aging in the same way as we addressed the problems of heart disease and cancer?
The Leading Causes of Death (Minus "Old Age")
The Aging Heart by Mark Stibich, Ph.D, About.com's guide to Longevity