Undiagnosed Diseases in an Aging Population

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.

Section: Discussionsupporting

confidence: 55%

Autopsies and Death Certificates in the Chronic Care Setting

Gloth

Burton

1990

“…Similar findings were noted in 1946 in a study of 166 cases of pneumonia in a long‐term institution for the aged (2). In the same institution, a 1974 study of 250 consecutive necropsies (representing a 70 percent rate) showed that bronchopneumonia was the most common undiagnosed cause of death (3). In two studies of the mortality associated with chronic brain syndrome, bronchopneumonia was found to be the most frequent cause of death among the aged in institutions (4, 5).…”

Section: General Medicinementioning

confidence: 99%

Contributions of the Long‐Term Care Facility to the Medical Care of the Aged

Rodstein

1979

Care of the aged in the United States by advanced long-term care institutions has resulted in many important contributions to our knowledge of the aging process and disease over the past four decades. These institutions are characterized by well organized medical staffs, with full-time medical directors who also serve as chiefs of the Medical Department and as stimulators and coordinators of research and teaching. These institutions provide comprehensive management, with laboratory, x-ray and necropsy capabilities and multiple levels of care. Many serve as teaching centers and have affiliations with medical schools and university hospitals for house staff and postgraduate medical training. Several contributions to the medical literature on aging are described, among them being the earliest published in this country concerning pneumonia, cancer, arcus senilis, atypical and silent myocardial infarction, digitalis therapy, subacute bacterial endocarditis, calcific aortic stenosis and congenital heart disease. Fundamental papers have been published on a system of functional classification, attitudes toward death and dying, evaluation of mental status, the diagnosis and care of chronic brain syndrome, psychologic evaluation, the diagnosis and care of many ophthalmologic disorders, and the causes, incidence and prevention of accidents among the aged. The long-term care institution, under proper circumstances, is an excellent site for good medical care, and significant contributions to research and teaching.

“…In a series of 5,000 deaths reported in 1969, only 5 death certificates gave pulmonary embolism as the primary cause of death. The proper figure could have been in excess of 100 cases if supported by postmortem documentation (30).…”

Section: Datamentioning

confidence: 99%

The Autopsy in Geriatrics†

Freeman

1975

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.