Cause of Death an DH's Death Certificate

LadyTexan

In a post on April 28, 2022, https://www.alzconnected.org/discussion.aspx?g=posts&t=2147560735 NW_Mike noted the following: 

One odd thing about my DW's passing I'd like to note. The coroner called today and said that since she fell and broke her arm almost 3 months ago, and the doctor and hospice both noted that the trauma from that no doubt accelerated her Alzheimer's, the death certificate will show her death as Accidental. I kid you not. My daughter just talked to someone else who lost a loved one to Alzheimer's and his death certificate showed Malnutrition as the cause of death. He had stopped eating (as did my DW) in the final stage. I only mention this because it leads me to wonder how many Alzheimer's deaths across this country are not being recorded as such. How much higher would the incidence of Alzheimer's be if medical examiners and coroners actually listed death as being from Alzheimer's? I wonder. 

I was certainly intrigued by that information. I just picked up DH Jesse's death certificates. His cause of death is listed as:

a) Adult Failure to Thrive (Immediate Cause)

b) Dementia with Behavioral Disturbances (Condition leading to the Cause)

DH's certificate seems appropriate to me. But it is interesting to me how death from a dementia related illness can be described differently by the physicians, e.g., malnutrition v. failure to thrive. I wonder if its a regional practice or based on training?

Jo C.

Cause of death for my LO - pneumonia - not a single word re dementia.   I actually called and asked for correction or addition - no can do.

So; if someone is gathering data/stats on causes of death from death certificates - this sure does skew things.

J.

Crushed

this is actually a well known issue

https://www.nia.nih.gov/news/death-certificates-may-not-adequately-report-dementia-cause-death
  
 

 

Research Highlights

Death certificates may not adequately report dementia as cause of death

October 15, 2020  

The actual number of deaths linked to dementia may be about three times greater than what is reported on U.S. death certificates, according to a recent NIA-supported study. The findings were published online August 24, 2020, in JAMA Neurology.......

The HRS analysis showed that about 13.6% of deaths during 2000 to 2009 had an underlying cause of dementia. However, on death certificates, only 5% had been assigned to dementia as an underlying cause of death. The researchers concluded that death certificates may under report dementia as the cause of death by a factor of 2.7. If cognitive impairment was added to dementia, the under reporting factor rose to 4.8.

Stokes AC, et al. Estimates of the association of dementia with US mortality levels using linked survey and mortality records. Journal of the American Medical Association Neurology. 2020. ePub Aug. 24;e202831. doi: 10.1001/jamaneurol.2020.2831.

  

Rescue mom

I was hoping crushed would speak to this on a broader level, although obviously dementia is the  focus here. Seems like many causes of death are open to various interpretations: as Lady T cited. And, was it a death caused by hurricane, or because a tree broken by storm fell on him?  Was it drowning, or an auto accident that put the car in the river? Was it mental illness, or a specific act preceded/caused by mental illness? Etc.

I usually saw this about natural disasters, as in 20 people died from the storm, when their deaths often occurred long after the storm was gone. Now, about Alzheimer’s, as above and IRL. But the question and concern over the “real numbers” applies to many things, and can affect what or how much is done to help.

EdiBug

My husband, Bill, passed away 10 months ago. His death cert issued in Los Angeles Co. lists cause of death as "Alzheimer's Disease." The autopsy done for research purposes at USC states findings as:

Primary - Alzheimer's Disease, high neuropathic change,

Secondary - Amyloid Angiopathy, moderate, diffuse,

Aadditional - Lewy Body disease involving primarily the substantia migration of the mid brain with focal Lewy Bodies present in the cortex.

At least his cert was clear and correct in terms of what his cause of death was. 

Crushed

The system is very clear to pathologist and some but not all doctors. 

If you have a heart attack and are in an ambulance and the ambulance crashes you are a vehicle death unless they determine you died before the crash
 
If you are working in a cancer hospice and deranged gunman comes in and shoots you because he hates cancer workers you are a gunshot death. 

If he shoots a terminal cancer patient that is also  a gunshot death

The cancer and gunshot are not medically connected.

If you have Alzheimers and fall down the stars due to a delusion someone is chasing you Alzheimer's is the underlying cause and the fall is the immediate cause  SINCE THEY ARE MEDICALLY CONNECTED. 

My father in law had cancer but died of MRSA infection.   My wife (who had the training) agreed with the hospital pathologist that Cancer was the underlying cause and MRSA  was the immediate cause  they were medically connected

 this has been a HUGE fight with people trying to downplay Covid deaths.  Co morbidities even cancer do not mean you did not die of Covid.  
Covid is not medically related to the cancer.  Cancer  is just an other significant  condition.

• The terminal event (e.g., cardiac arrest or respiratory arrest) should not be used. If a mechanism of death seems most appropriate to you for Line a, then you must always list its cause(s) on the line(s) below it (e.g., cardiac arrest due to coronary artery atherosclerosis or cardiac arrest due to blunt impact to chest).
• If an organ system failure such as congestive heart failure, hepatic failure, renal failure, or respiratory failure is listed as a cause of death, always report its etiology on the line(s) beneath it (e.g., renal failure due to Type I diabetes mellitus).

 • When indicating neoplasms as a cause of death, include the following: 1) primary site
or that the primary site is unknown, 2) benign or malignant, 3) cell type
or that the cell type is unknown, 4) grade of neoplasm, and 5) part or lobe of organ affected. Example: a primary well-differentiated squamous cell carcinoma, lung, left upper lobe.
Part II    

 (Other significant conditions)
• Enter all diseases or conditions contributing to death that were not reported in the chain of events in Part I and that did not result in the underlying cause of
death. See examples.
• If two or more possible sequences resulted in death, or if two conditions seem to have added together, report in Part I the one that, in your opinion, most directly
caused death. Report in Part II the other conditions or diseases

 

 

 

ButterflyWings

Crushed wrote:

https://www.nia.nih.gov/news/death-certificates-may-not-adequately-report-dementia-cause-death

October 15, 2020  

The actual number of deaths linked to dementia may be about three times greater than what is reported on U.S. death certificates, according to a recent NIA-supported study. The findings were published online August 24, 2020, in JAMA Neurology...The researchers concluded that death certificates may under report dementia as the cause of death by a factor of 2.7. If cognitive impairment was added to dementia, the under reporting factor rose to 4.8

**************************************************************************** I have not read the article yet. It makes me wonder if the under-reporting is even more significant than stated above, due to the seemingly vast number of undiagnosed dementia cases which seem to be quite numerous. (My unscientific and unquantified opinion). 

Example: if DH's sibling died with suspicious behaviors but no diagnosis, there is no way Alz or another dementia would be included on the death cert, even if the underlying cause of his demise was the dementia is that right?

------------ ---**********

ButterflyWings

Crushed wrote:

https://www.nia.nih.gov/news/death-certificates-may-not-adequately-report-dementia-cause-deathThe actual number of deaths linked to dementia may be about three times greater than what is reported on U.S. death certificates, according to a recent NIA-supported study. The findings were published online August 24, 2020, in JAMA Neurology.......

The HRS analysis showed that about 13.6% of deaths during 2000 to 2009 had an underlying cause of dementia. However, on death certificates, only 5% had been assigned to dementia as an underlying cause of death. The researchers concluded that death certificates may under report dementia as the cause of death by a factor of 2.7. If cognitive impairment was added to dementia, the under reporting factor rose to 4.8.

I have not read the article yet. It makes me wonder if the under-reporting is even more significant than stated above, due to the seemingly vast number of undiagnosed dementia cases which seem to be quite numerous. (My unscientific and unquantified opinion).  Example: if DH's sibling died with suspicious behaviors but no diagnosis, there is no way Alz or another dementia would be included on the death cert, even if the underlying cause of his demise was the dementia is that right?

loveskitties

My father died 4/14/22 at a Memory Care Facility under Hospice care.

His death certificate listed Alzheimer's as primary cause of death, with AFIB as an underlying cause.

He had been diagnosed with both while living.

dayn2nite2

My mother's said 1.  COPD and 2.  Cardiac arrest.

Not one word about dementia and the red tape to try to get the certificate changed was too much for me to deal with in the immediate aftermath.

She actually had a heart attack which caused her final decline, did not have COPD at all.  People dying from and with dementia are undercounted in this country.

amicrazytoo

My DH cause of death was “Vascular Dementia”. It was signed by his primary care doctor. Maybe it depends on who makes the declaration. He died at home.

Doityourselfer

My husband's death certificate is listed as Immediate Cause: (A) Failure to Thrive Due to or as a Consequence of (B) Alzheimer's Disease.

elainechem

My husband died in February of 2020, just weeks before COVID-19 became a thing. He died of Alzheimer's. That's the only cause of death that his death certificate shows. He had a seizure, fell, and severely injured both shoulders 8 days before his death. The medical examiner had to review his case before signing off on it, but they determined that the fall was not a proximate cause of his death. The seizure was simply a sign that his brain had neared its end.

Quilting brings calm

I think it probably does depend on who is filling out the death certificate. Not all coroners are doctors.  Many are elected officials.  Many do not do autopsies depending on the situation.  My MIL died in an assisted living facility at 87.  She didn’t have dementia, she did have a heart condition.  She appeared to have died either while asleep or watching tv in bed. No autopsy was done. The coroner did come to her room and said she died of natural causes then and there.  The body went to the funeral home.  I have no idea what the death certificate said.

MN Chickadee

My mother's death certificate listed failure to thrive as the cause of death with Alzheimers and Covid-19 as contributing. I don't know how that gets factored into national statistics regarding Alzheimers deaths. I do know her death appeared as a Covid related death on public health records and was counted in our state's covid death toll. Hopefully it reflects similarly in Alz numbers because it was definitely both that killed her.

tcrosse

My DW's cause of death is given as End Stage Alzheimers. That determination was made by the hospice nurse who visited our home.

Nanateach

My late husband died in 2016.  His death certificate states,  "natural causes."