Clinical causes of death of 2372 older persons in a nursing home during 15-year follow-up

Abstract

Objective: To investigate the causes of death in older persons in a nursing home.

Design: The major clinical cause of death of all persons aged 60 years older residing in a nursing home during a 15-year period was investigated in a prospective study. The author carefully reviewed the major cause of death with the physicians who took care of all persons who died either in the nursing home or after transfer to a general hospital.

Setting: A large nursing home in which 2372 of 3164 older persons (75%) died during a 15-year period.

Patients: The 2372 persons who died included 766 men and 1606 women, mean age 81 +/- 8 years.

Measurements and main results: A total of 2372 of 3164 persons (75%) died during the 15-year period,. Seven hundred sixty-six of 1023 men (75%) and 1606 of 2141 women (75%) died (P not significant). The major cause of death in these 2372 persons was sudden cardiac death in 25%, myocardial infarction in 18%, refractory congestive heart failure in 11%, thromboembolic stroke in 6%, cerebral hemorrhage in 1%, pulmonary embolism in 2%, mesenteric vascular infarction diagnosed at surgery in 1%, peripheral vascular disease, including dissecting aneurysm of aorta and ruptured abdominal aneurysm, in <1%, pneumonia in 15%, urosepsis in 4%, bacterial endocarditis in 1%, sepsis from abdominal abscess or gastrointestinal or biliary tract in 1%, sepsis from decubiti, gangrene of lower extremity, and osteomyelitis in <1%, cancer in 9%, renal failure in 3%, gastrointestinal or liver disease in 2%, hematologic disorders in 1%, and chronic obstructive pulmonary disease in 1% of persons.

Conclusions: The major cause of death of persons in the nursing home was cardiovascular disease, which accounted for 63% of deaths. The second major cause of death was infectious disease, accounting for 21% of deaths. Cancer accounted for 9% of deaths, renal failure for 3% of deaths, gastrointestinal or liver disease for 2% of deaths, hematologic disorders for 1% of deaths, and chronic obstructive pulmonary disease for 1% of deaths.