The Great Epidemiological Shift
A major change in how death has evolved over the last century is the shift in the primary causes of mortality. Around the early 1900s, infectious diseases such as influenza, pneumonia, tuberculosis, and gastrointestinal infections were the leading causes of death across all age groups, including a high rate of infant and child mortality [1, 2]. Advances in medicine, particularly the development and widespread use of antibiotics and vaccines, along with improvements in sanitation and living conditions, have significantly reduced deaths from infectious diseases [2]. This progress has led to increased life expectancy, allowing more people to live into old age where they are more likely to die from chronic, non-communicable diseases [2, 6].
Today, chronic conditions like heart disease, cancer, stroke, and diabetes are the leading causes of death in developed countries [1, 2]. This demographic transition means that the majority of deaths now occur in older populations [2]. Instead of a rapid death from infection, dying is often a more gradual process linked to managing long-term illnesses [2, 5].
The Institutionalization of Death
Historically, death was commonly a home-based event with family providing care [3]. Over the past century, death has become largely institutionalized [3, 7]. The majority of deaths now take place in hospitals, nursing homes, or other long-term care facilities [3]. This change is a result of medical advancements and the need for professional care and equipment to manage complex chronic illnesses [3, 5]. This shift has moved the experience of death out of the home and into medical settings [5, 7].
The Rise of Modern End-of-Life Care
The medicalization of death also spurred the development of specialized care for the end of life. Concepts like palliative care and hospice, which were not widespread a century ago, now provide holistic support focusing on comfort and quality of life for those with terminal illnesses [4, 5]. These programs offer pain management and support for both patients and families, sometimes enabling individuals to die at home with medical assistance, though institutional deaths remain prevalent [3, 4, 5].
The Prolonged Dying Process
Chronic diseases, often managed for years, mean that the dying process itself has changed [2, 5]. Many people now experience a prolonged period of declining health, often involving long-term care and complex medical interventions, a contrast to the rapid deaths from acute infections a century ago [5]. Medical technologies can extend life, leading to new ethical considerations for patients and their families [5].
Death 100 Years Ago vs. Death Today
| Feature | 100 Years Ago (approx. 1925) | Today (approx. 2025) |
|---|---|---|
| Leading Causes | Infectious diseases (e.g., pneumonia, influenza, tuberculosis) [1] | Chronic diseases (e.g., heart disease, cancer, stroke) [1] |
| Average Life Expectancy | Significantly lower, often below 50 years [2] | Significantly higher, often above 75 years [2] |
| Location of Death | Predominantly at home [3, 7] | Majority in hospitals or long-term care facilities [3] |
| Duration of Illness | Often rapid and acute [5] | Commonly prolonged and chronic [5] |
| Primary Caregiver | Family and community [3, 7] | Professional healthcare providers (doctors, nurses) [3] |
| End-of-Life Care | Limited to basic comfort measures at home [4, 5] | Specialized hospice and palliative care [4, 5] |
Social and Cultural Implications
The changes in how and when people die have significantly impacted societal views on mortality. With death less common among the young and often occurring in institutions, it can feel more distant and less understood [5, 7]. This has led to greater emphasis on end-of-life planning, like advance directives, allowing individuals more control over their final care [5]. The availability of grief support services also reflects a more formalized approach to mourning [7].
Conclusion
In summary, the most accurate statement regarding how death has changed in the past 100 years is that it is now more likely to occur later in life, in an institutional setting, and due to chronic disease rather than infectious illness [1, 2, 3]. This transformation reflects major medical and public health advances, shifting the experience of dying from a rapid, home-based event to a more prolonged, medically managed process in a healthcare facility [3, 5, 7]. While signifying progress in extending life, these changes also prompt a reevaluation of how we approach end-of-life care and the experience of death itself [5].
For additional context on historical mortality trends and data, you can consult resources from the Centers for Disease Control and Prevention. [1, 2]
