Queen Elizabeth II officially died of “old age,” according to her death certificate that was released by the National Records of Scotland on Thursday. The 96-year-old monarch died at 3:10 p.m. on Sept. 8 in Scotland’s Balmoral Castle, with “old age” listed as the cause of death and “Her Majesty the Queen” listed as her occupation, according to the death certificate.

According to TODAY, the queen, whose 70-year-reign was the longest of any monarch in British history, died hours after Buckingham Palace officials announced that she was under medical supervision.  Her two oldest children — Charles and Anne — made it to her bedside before the palace announced that the queen “died peacefully at Balmoral this afternoon,” says The Washington Post.

Dying of old age is not quite an accurate description, but more likely a reflection of a medical condition that a younger person would have survived. For example, according to Business Insider, when most of us say a person died of old age, what we really mean is that someone died as a result of an illness like pneumonia or an event such as a heart attack that likely would not be the cause of death in a younger person.

The Centers for Disease Control and Prevention says that the number one cause of death for people over the age of 65 in 2020 was heart disease, followed by cancer, COVID-19, cerebrovascular disease, which leads to stroke, and Alzheimer’s.

The “old age” fatalities are usually quiet deaths, say experts. A person’s heart stops beating in their sleep, likely the result of a heart attack. While details of the queen’s underlying health conditions are not publicly known, she did suffer several issues that had her physicians concerned. She wasn’t able to travel to London to appoint the new British Prime Minister, Liz Truss, on Sept. 6, and the ensuing photos of the actual ceremony revealed the monarch used a cane indoors and her hands were quite purple, say sources.

According to Cake, a popular end-of-life planning service, when a death certificate says one “died of old age” it generally refers to “dying of natural causes related to aging.” Normally, there isn’t just one factor contributing to death. In the queen’s case, she suffered a bout of COVID-19 earlier this year which left her with mobility issues. Late in October 2021, the queen canceled a trip to Northern Ireland and was briefly hospitalized. Medical experts advised the monarch to take some time off. Shortly after that cancellation, she suffered a back sprain.

Later, Queen Elizabeth did not attend a climate summit in Scotland, again, due to medical concerns. Doctors recommended that she rest for two more weeks and tackle only minor duties. After her bout with COVID-19 last February, the queen was rarely seen in public during the spring, missing several key events. She did manage to attend the Royal Windsor Horse Show on May 13 and of course famously appeared on the balcony of Buckingham Palace following the Platinum Jubilee in June.

Doctors and coroners are typically pressed to specify a cause of death here in the United States, and the terms “old age” and “natural causes” are rarely used, according to A Place for Mom. They are expected to list both the immediate and underlying cause of death.

However, professionals can’t always pinpoint an underlying cause when the deceased may have had multiple health issues. And sometimes, it isn’t necessary for the public to be aware of these underlying ailments, so “natural causes” or “old age” are accurate enough terms.