OBJECTIVES: Ageing of the population brings the possibility of increased burdens for acute hospital services because of the marked increase in many common diseases with age. We aimed to examine the relation between age and use of acute services in hospitals in the period before death in a national sample of deaths in hospital. DESIGN: Retrospective cohort analysis of English hospital episode statistics database. SETTING: All NHS hospitals in England. DATA SET: All post-neonatal deaths occurring in English NHS hospitals during financial year 1999-2000, with episodes of care in the previous three years determined through matching on sex, date of birth, and postcode. MAIN OUTCOME MEASURES: Total bed days, mean and median length of stay. RESULTS: 253 799 in-hospital deaths were identified, representing about 45% of all deaths occurring in 1999-2000. Patients who died in hospital spent a median of 23 days in hospital in the three years before death; the median rose with age up to 45 years, but was fairly stable for ages 45 and above. The number of admissions to NHS hospitals in the three years before death averaged 3.6; this peaked at 10.4 in patients aged 5-9 years and decreased with age to 2.2 in those aged 85 and over. CONCLUSIONS: The average number of bed days spent in hospital in the period before death does not increase with increasing age.