. . . and a time to die: the medicine of old age

Most deaths in Britain occur in old age, and old people dying have as many symptoms as do the young. Management is complicated by diagnostic difficulty, by the frequency of mental disorder (sometimes treatable) and of severe disability, and by the difficulty in ascertaining patients' feelings. Decisions about the management of dying are inevitable, and multifactorial, and views of others may be helpful. Cardiopulmonary resuscitation is not indicated if futile, and may or may not be wanted by the patient. Withholding or withdrawing life-prolonging treatment may be justified if the totality of life gained (length and quality) is not justified by the burden of treatment. Decisions are most difficult when the prognosis is poor but not definitely fatal. Palliative care is important, not only in cancer. Euthanasia is seldom requested at present, and in The Netherlands is carried out less in old people than young. It would do little for the most serious problems of old age.