Autopsies and Death Certificates in the Chronic Care Setting

Abstract

All autopsies (n = 34) performed over a period from July 1, 1981 to June 30, 1988 in a teaching nursing home were reviewed to determine the autopsy rate, to evaluate premortem versus postmortem diagnostic discrepancies, and to see if educational efforts could improve each. The autopsy rate was 3.5%. Major discrepancies appeared in 47.1% of cases. Pneumonia was the most frequent and most frequently missed diagnosis. Only 23 of 34 death certificates reflected the cause of death as documented in the chart, and only 12 had concordant diagnoses with those from autopsy. After a collective educational effort, the autopsy rate increased from a rate (average of initial six years) of 2.4% to 10.8% in the last year. The autopsy rate is low, but can be improved with educational efforts. Death certificates, in this population, may be misleading when used for general statistical purposes.

Indicators of Potentially Drug-Resistant Bacteria in Severe Nursing Home--Acquired Pneumonia

“…Nursing home-acquired pneumonia (NHAP) is a major cause of morbidity and mortality among institutionalized elderly individuals [1,2]. It accounts for 13%-48% of infections in nursing homes and is responsible for the majority of transfers to acute care facilities [3,4].…”

Determinants of the Autopsy Decision:A Statistical Analysis

“…12 The importance of nursing home residency at death has received particular attention because of the estimated increase in US nursing home residents from approximately 446,000 in 1963 to 1.77 million in 1990. 4,[12][13][14][15][16][17][18] This number is expected to increase to as high as 2 million in the year 2000 and 3.6 to 5.9 million by 2040. 19 The findings of this research are particularly important for the oldest old, because this is the age group for which the autopsy could markedly improve the current inadequate level of information on the natural processes of aging and morbidity and comorbidity.…”

Approach to the problem of pneumonia in long-term care facilities

“…[1][2][3] Although the incidence of pneumonia varies among reported series, the median reported incidence is approximately 1 per 1000 patient days of care. 4 This incidence of pneumonia among nursing home patients is approximately 10 times that experienced by the elderly living in the community, 5,6 and reflects the increased level of debility and burden of chronic illness borne by the long-term care population.…”