Cause of death in demented and non-demented elderly inpatients; an autopsy study of 308 cases

Abstract

Few studies evaluated cause of death (COD) in elderly demented and non-demented people, the majority based on death certificates alone. The present study is based on autopsy reports with neuropathological examination of 308 inpatients (58.1% female) over age 60 years (mean: 83.5, SD: +/−8.6). CODs were classified into seven groups. The most common were bronchopneumonia (n = 117; 38%) and cardiovascular disease (n = 116, 37.7%). In 176 patients (57.1%) neuropathology was indicative for dementia: 76.7% Alzheimer disease (AD), 4.5% vascular dementia, 4.0% mixed type dementia (AD + vascular dementia), and 14.8% other dementias. Main COD significantly differed in demented and non-demented patients: bronchopneumonia (45.5% in demented versus 28.0% in non-demented), cardiovascular disease (46.2% in non-demented versus 31.3% in demented). Whereas there were significant differences in COD between AD patients and non-demented ones (bronchopneumonia versus cardiovascular disease), no differences were seen between the latter and patients with other types of dementia than AD. Our data emphasize the high incidence of bronchopneumonia as a COD in patients suffering from AD.

Evaluation of Underlying Causes of Death in Patients with Dementia to Support Targeted Advance Care Planning

“…However, this will not influence our results since causes of death between both groups did not differ significantly. The study might be limited in that the accuracy of death certificates in the geriatric population is low which has been shown in literature [6,11,27]. However, these studies focused on immediate causes of death showing that pneumonia and dementia are underestimated.…”

“…The control group in this particular study was recruited from an ortho-geriatric rehabilitation unit and geriatric day care hospital, which is probably not a representative group of the general population. Studies focusing on immediate causes of death (defined as the disease that leads directly to death) have found higher frequencies of pneumonia as the cause of death ranging from 26.6% to 47.3% [6,7,9,11,12].…”

“…The majority of these studies investigated the causes of death in the entire group of demented patients without making a distinction between sex, age, and type of dementia [6,[9][10][11][12] or they were of a small sample size [6,7,9,10]. As a result, little is known about the potential differences in causes of death by age, sex, and dementia subtype.…”

“…Cardiovascular disease (CVD) and pneumonia are the main attributable causes of death in patients with dementia, as demonstrated in several registry-and autopsy-based studies [6][7][8][9][10][11]. The majority of these studies investigated the causes of death in the entire group of demented patients without making a distinction between sex, age, and type of dementia [6,[9][10][11][12] or they were of a small sample size [6,7,9,10].…”

Reframing Person-Centered Nursing Care for Persons With Dementia

“…The biomedical perspective also may enable ethical decision-making regarding preventive screening and use of certain medications, assessment and early detection of medication side effects, as well as common acute problems in persons with dementia, such as dehydration, pneumonia, constipation, delirium, and urinary tract infection. Attending to these concerns is paramount, as dementia is associated with an increased risk of death from pneumonia (Attems, Konig, Huber, Lintner, & Jellinger, 2005;Chamandy & Wolfson, 2005;Keene, Hope, Fairburn, & Jacoby, 2001), as well as urinary tract infection and dehydration (Fick, Kolanowski, Waller, & Inouye, 2005).…”