Unexpected death in ill old age: An analysis of disadvantaged dying in the English old population

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The literature on death expectation in ill old age is mostly medical. A social science standpoint (especially quantitative) is practically absent. However, whether families, social and healthcare services can anticipate, support and prepare for the deaths of ill old adults is not reducible to the biomedical paradigm. Yet it is critical for end of life care (EOLC) policy. This study's aim is to investigate relatives' perception of death as unexpected in relation to both disease-related and care-related factors. Using the English Longitudinal Study of Ageing End-of-life Interviews Wave 6 this paper draws on probit regression analysis of unexpected (vs. expected) death in ill adults aged 50+. Findings are interpreted considering the containment of sudden death and the trajectories of dying in ill old age. The latter display overall visible decline preceding death. On this basis, EOLC literature and policy evidence death's uncertain timing as much as death's certain emergence in the horizon of expectation. Therefore, unexpected death in ill old age was interpreted as a failure to acknowledge dying, rather than the impossibility of discerning its approach. Very old age, dementia diagnoses and supported care environments were found to shape unexpected death.
Original languageEnglish
Pages (from-to)112-120
Number of pages9
JournalSocial Science and Medicine
Early online date25 Sept 2018
Publication statusPublished - 30 Nov 2018

Bibliographical note


•Relatives' expectations of death in ill old age are crucial to end of life care.

•Amongst old ill adults the very old are less expected to die than the younger old.

•Deaths from cancer and Alzheimer's disease are expected by relatives.

•On the contrary, deaths from other types of dementia are unexpected.

•Institutional care is associated with a higher likelihood of unexpected death.


  • Care homes
  • Death expectation
  • Dementia
  • End-of-life care
  • England (UK)
  • Old age dying
  • Older Adults
  • Palliative care
  • Relatives

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


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