Unexpected out-of-hospital deaths in persons aged 85 years or older: an autopsy study of 1886 patients

doi:10.1016/S0002-9343(03)00049-4

The American Journal of Medicine

Volume 114, Issue 5, 1 April 2003, Pages 365-369

https://doi.org/10.1016/S0002-9343(03)00049-4 Get rights and content

Abstract

Purpose

The aim of this study was to determine the causes of death in the very elderly.

Methods

We reviewed 24,081 consecutive autopsies performed over 10 years (1989 to 1998) at the Institute of Forensic Medicine, Vienna, Austria. We focused on autopsies of people aged 85 years or older who died unexpectedly out of hospital.

Results

The mean age of the 1886 patients (561 men and 1325 women) at the time of death was 88 ± 3 years (range, 85 to 108 years). Thirty-one percent (n = 588) of those who died were described as having been previously healthy. Cardiovascular disease was the most common cause of death (n = 1465 [77%]). Thirteen percent (n = 246) died of respiratory illness, 5% (n = 94) of gastrointestinal disorders, and 3% (n = 53) of diseases of the central nervous system. Genitourinary and metabolic diseases were uncommon.

Conclusion

Although this out-of-hospital sample is not representative of the entire elderly population, postmortem examinations emphasize the importance of cardiovascular diseases in causing unexpected deaths in older persons.

Section snippets

Methods

The Vienna Institute of Forensic Medicine is responsible for determining the cause and manner of death in all cases of unexpected deaths. Its geographic jurisdiction encompasses the greater Vienna area. The Austrian Law on Corpses and Funerals requires the use of an autopsy to detail and ascertain the cause of death in any case where there is uncertainty about the cause of death. This includes a requirement that all persons who had not consulted a physician in the 10 days preceding their death

Results

From 1989 to 1998, 24,081 autopsies were performed at our institute, 8% (n = 1886) of which were on persons aged 85 years or older; all were white. During that period, there were a total of 59,071 deaths involving persons aged 85 years or older in hospitals in Vienna. There was a predominance of women (1325 women vs. 561 men). The mean age was 88 ± 3 years (range, 85 to 108 years). Fifteen persons were older than 100 years, and 486 (127 men and 359 women) were aged 90 years or older.

Discussion

We found that the causes of death in very old persons who died unexpectedly out of hospital differed from those in persons in the same age group who die in hospitals or nursing homes. Almost 80% of the people we studied died from illnesses of the heart and great vessels. These figures are in accordance with other reports of sudden unexpected deaths in the elderly (4), but contrast with the autopsy reports from elderly patients who have died in a hospital, in whom cardiovascular disorders

Acknowledgements

The authors would like to thank Michael K. Bremer for critical review of this paper and Jeannie Wurz for editing the manuscript.

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Clinical studyUnexpected out-of-hospital deaths in persons aged 85 years or older: an autopsy study of 1886 patients

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Acknowledgements

Am J Cardiol

Mayo Clin Proc

Am J Med

Hum Pathol

Hum Pathol

The value of the autopsy in three medical eras

N Engl J Med

Cause of death in very old people

JAMA

Autopsy and multiple pathology in the elderly

Gerontology

Sudden unexpected death in the elderly

J Am Geriatr Soc

A clinicopathological study heart disease in the aged: the morphological classification of the 1,000 consecutive autopsy cases

Jpn Heart J

Cardiac pathology in the elderly

Cardiovasc Clin

The very elderly heart

Cardiovasc Clin

Clinical study
Unexpected out-of-hospital deaths in persons aged 85 years or older: an autopsy study of 1886 patients