The Autopsy in Geriatrics†

Abstract

The marked decline in the autopsy rate is a serious matter that is not receiving enough attention in the present medical system. Before 1940, a high rate of postmortem examinations was a mark of distinction for a hospital and the findings contributed greatly to our knowledge of disease. This should continue. In geriatrics, a valuable goal is the differentiation of pathologic processes from the process of aging. One outstanding factor in the neglect of the autopsy is the cost to the hospital or other institution; moreover, the cost is not reimbursable by third-party insurance payers. The Pathology Resource Center is proposed as a solution for the problem. Regional autopsy centers could serve the surrounding institutions with greater competence and economy. Medicine should no longer be restricted regarding the valuable contributions to knowledge provided by autopsy findings.

‘How to do it’—obtaining consent for autopsy in Alzheimer's disease

“…There is evidence that the autopsy rate is declining (Freeman, 1975;Roberts, 1978). In the USA, a rate of 8%) in the over-65s has been described and only 2.4% of subjects over 90 underwent such an examination (Ahronheim et al, 1983).…”

“…The reasons for this decline have been suggested (Roberts, 1978), and include diminished interest by physicians, surgeons and pathologists, reluctance on the part of relatives and financial disincentives on the part of hospital administrators. It is unanimously agreed that the postmortem examination is both desirable and necessary in medicine (Freeman, 1975;Roberts, 1978;Ahronheim et al, 1983).…”

A Long‐term Geriatric Teaching Ward in an Acute‐care Hospital: A Three‐year Experience

“…Although families were never pushed, and their religious and ethical sensibilities were fully respected, the permission rate for autopsy was higher for our patients than for patients in the rest of the hospital. We attribute this to our careful communication with the families about the importance of the autopsy in the practice of geriatrics, 10 and to the fact that the chief of service would usually come into the hospital to comfort the families on the death of the patient. Neither this task nor the request for autopsy was left solely in the hands of the house staff.…”

Do old age psychiatrists miss physical illnesses?

“…They provide invaluable material for research (Burns et a/., 1990;Procter et al, 1990) and are also a potent teaching technique, not only for medical students but also for qualified clinicians. All this they do without disturbing the patient in the way officious overinvestigation would do in life (Freeman, 1975;Ahronheim et al, 1983).…”