Causes of death in elderly nursing home residents

According to previous studies, 20% to 24% of deaths in the United States occur in nursing homes. This number is increasing. Overall vital statistics document that the leading causes of death in the United States remain cardiovascular/cerebrovascular and cancer, with Alzheimer's disease seventh as of 2004. However there are few statistics on causes of death specifically in the nursing home population. The objective of this study was to determine the most common causes of death in one nursing home in our practice, and specifically to see how common it was to die of dementia in the nursing home.

To improve on these inadequate data, we conducted a retrospective chart review study of all patients who died in a Philadelphia nursing home during a 6-month period from May to October 2006. The 2 authors manually extracted select data from individual charts including site, date and cause of death, patient age and comorbidities, and whether the patient was on hospice or had an advance directive. There was no intervention related to the study.

Thirty-nine patients expired in the nursing facility during the 6-month study time period. The primary cause of death was determined to be Alzheimer's/dementia in 14 cases (36%), cardiac/cerebrovascular (30%), 9 pulmonary (23%), 3 hematologic and other malignancies (7%), and 1 ESRD. There were 66% patients on hospice and 89% had advance directives usually including a DNR/DNH order. None received resuscitation in the nursing home, and none had autopsies.

The single most common cause of death occurring within the nursing home was Alzheimer's, with most dying appropriately on hospice care. This is markedly different from the general population, where the most common causes of death are cardiac, pulmonary, renal, malignancies, infections, and accidents. However the true cause of death in the nursing home resident is often difficult to specify when patients often have little workup before they die and seldom have autopsies.