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PubMed1986

Death imagery and death anxiety.

This study investigated the relationship between positive/negative death imagery and death anxiety. Subjects were 179 undergraduate students at a large, private, midwestern university. Results reveal that on five measures of death anxiety the subjects with low death anxiety scores had significantly more positive death images than did those with high death anxiety scores. The few subjects who imagined death to be young (N = 14) had a significantly more positive image of death than those who perceived it to be an old person. Death was seen as male by 92% of the male respondents and 74% of the female respondents. Significant differences in death imagery and death anxiety were found between subjects enrolled in an introductory psychology course and those enrolled in a thanatology course. No sex differences in death anxiety or positive/negative death imagery were found.

Adolescent↗
PubMed1991

Representativeness of deaths identified through the injury-at-work item on the death certificate: implications for surveillance.

BACKGROUND: This research investigated the accuracy of the injury-at-work item on the death certificate for surveillance of occupational injury deaths in Oklahoma during 1985 and 1986. METHODS: Representativeness of occupational injury deaths identified by death certificates was assessed by comparing these deaths with all occupational injury deaths identified through death certificates, workers' compensation reports, medical examiner reports, and OSHA records for categories of occupation, industry, and external causes of death. RESULTS: Certain external causes of death (e.g., motor vehicle traffic deaths) and certain occupations (e.g., farming) and industries (agriculture and services) are more often underidentified through death certificates. CONCLUSIONS: The findings of this study support Baker's observation that no single data source contains all deaths or all the data elements necessary to describe occupational injury deaths. Data sources may be combined to improve representativeness through more complete case ascertainment.

Accidents, Occupational↗
PubMed1995

The cause of death in inflammatory bowel disease: a comparison of death certificates and hospital charts in Rochester, New York.

OBJECTIVE: This study examines the causes of death from Crohn's disease and ulcerative colitis by comparing death certificates with hospital charts as part of an ongoing, community-based analysis in Rochester, NY. METHODS: A registry of 1358 inflammatory bowel disease patients followed from January 1973 to December 1989 was analyzed for the cause of death by a study of death certificates as well as by a study of hospital records, including surgical pathology and autopsy records. A panel of physicians defined specific criteria for diagnosis, cause of death, and relation of death to inflammatory bowel disease. RESULTS: One hundred and thirty patients (59 with ulcerative colitis and 71 with Crohn's disease) from the registry were found to have death certificates recorded by Monroe County during this period. There was an 80% concordance of the death certificate to the hospital record for the cause of death and its relationship to inflammatory bowel disease. Discordance was noted in cases of colon cancer and surgical complications. CONCLUSIONS: Sixty-eight percent of Crohn's disease and 78% of ulcerative colitis patients died from causes unrelated to their inflammatory bowel disease. Deaths caused by Crohn's disease decreased from 44% in the 1973-1980 period to 6% in the 1981-1989 period. Crohn's disease was a direct cause of death in 25% of the female patients, whereas only 6% of male patients died directly of Crohn's disease. Colorectal cancer caused 14% of the deaths in ulcerative colitis patients, three times more often than in Crohn's disease patients. Excluding cancer, there were only two deaths directly due to ulcerative colitis, both in the first 2 yr after diagnosis.

Adolescent↗
PubMed2005

Characteristics of anorexia nervosa-related deaths in Norway (1992-2000): data from the National Patient Register and the Causes of Death Register.

OBJECTIVE: This study investigated demographic and diagnostic characteristics of individuals whose medical record or death certificate indicated the presence of anorexia nervosa at the time of death. METHOD: Two national registers, the National Patient Register (NPR) and the Causes of Death Register (CODR), were examined in Norway for anorexia nervosa-related deaths occurring across a 9-year period (1992-2000). RESULTS: The medical record or death certificate listed anorexia nervosa as a diagnosis or cause of death for 66 individuals. Rates of death were 6.46 and 9.93 per 100,000 deaths for the NPR and the CODR, respectively. A substantial percentage of deaths (43.9%) in both registers occurred at or above the age of 65 years. For the NPR, the mean age at the time of death was 61 years and 31% of deaths occurred among men. For the CODR, the mean age at the time of death was 49 years and 18% of deaths occurred among men. DISCUSSION: Potential merits and shortcomings of assessing mortality rates using register-based data without linkage to a previously identified clinical sample are discussed.

Adolescent↗
PubMed1984

Causes of death in Minamata disease: analysis of death certificates.

The causes of death in Minamata disease were analyzed and compared with those of control subjects. Of the 1422 Minamata disease patients in the Kumamoto Prefecture, 378 had died by the end of 1980. Of these 378, the first death occurred in 1954 with a peak incidence in 1956 when Minamata disease was officially reported for the first time. The number of deaths increased rapidly after 1972 with a second peak in 1976. The male:female ratio was 1.8:1 and the mean age-at-death was 67.2 years (SD = +/- 18.65). The mean age-at-death was younger in the cases of the initial outbreak than in those recently. There were, on the average, 2.8 causes of death per person. Of these cases, 157 (41.5%) had Minamata disease indicated on the death certificate, though 64 (16.9%) had Minamata disease coded as the underlying cause. Minamata disease and the noninflammatory diseases of the central nervous system (CNS) were the main underlying causes of death between 1954 and 1969, while, in the multiple cause data, pneumonia and non-ischemic heart disease were the most prevalent. Cerebrovascular diseases (18.0%) were the main underlying causes of death followed by malignant neoplasms (14.7%), cardiovascular diseases (14.1%) and Minamata disease (14.1%) in 1970 or later, while cardiovascular diseases (18.6%), Minamata disease (14.5%), cerebrovascular diseases (10.4%) and malignant neoplasms (7.1%) were the major multiple causes of death. As compared with the control, the proportions of deaths due to noninflammatory diseases of CNS and pneumonia were higher in the initial outbreak. Although the difference in the causes of death was less apparent recently, malignant neoplasms and hypertensive diseases tended to be lower. These results suggest that there is a need for a long-term follow-up of Minamata disease patients. The data also show the potential value of multiple causes of death coding in analyses of mortality.

Adolescent↗
PubMed2004

Dying peacefully: considering good death and bad death in Kwahu-Tafo, Ghana.

People in Kwahu-Tafo, a rural town in Southern Ghana, regard a peaceful death as a 'good death'. 'Peaceful' refers to the dying person having finished all business and made peace with others before his/her death and implies being at peace with his/her own death. It further refers to the manner of dying: not by violence, an accident or a fearsome disease, not by foul means and without much pain. A good and peaceful death comes 'naturally' after a long and well-spent life. Such a death preferably takes place at home, which is the epitome of peacefulness, surrounded by children and grandchildren. Finally, a good death is a death which is accepted by the relatives. This 'definition' of good death--'bad death' is its opposite--does not imply, however, that it is a fixed category. The quality of one's death is liable to social and political manoeuvre and, therefore, inherently ambiguous. The good death of a very old and successful person can be decried by the younger generation as the death of a witch who managed to live long at the expense of young people who died prematurely. The article is based on anthropological fieldwork carried out intermittently from 1971 to the present day.

Anthropology, Cultural↗
PubMed1999

[Deaths among inmates in the institutions of the Prison Service. Deaths in prisons, county jails etc].

The purpose of the study is to investigate the number and the character of deaths during stays in prisons, county goals etc. During the study period from 1992-1996 with approx. 38,000 imprisonments per year there were 74 deaths, 71 males and three females. The average age was 32.4 years. Approximately 16% had foreign citizenship. Twenty had leave, legal or illegal when death occurred. There were 34 suicides, 22 accidents, 3 homicides and 15 cases of natural death. Several deaths took place relatively shortly after the arrival at the institution, one third within a week. The most frequently used suicidal method was hanging. The accidents were dominated by poisoning deaths, often with morphines, possibly in combination with alcohol or other drugs. Two of the three homicides took place during leave. Among natural deaths, heart death was the most frequent cause of death with six of 10 unexpected deaths. Among expected deaths in prison there were three AIDS patients. Fourteen of the fifteen natural deaths had a substantial alcohol consumption and/or drug abuse. There ought to be a central registration of deaths in prisons and similar institutions. The autopsy frequency should be high, and forensic chemical investigation should be used more often. Drug dependent inmates should be informed about reduced tolerance to drugs in relation to release and leave.

Accidents↗
PubMed1990

[Is brain death actually death?].

The paper rejects "brain death" as a new criterion, or definition, of actual death. The main theses are two: 1. Brain death as such--in any of its meanings--is not man's death and this can be proven by means of many cogent and some plausible arguments. 2. Even if the theoretical arguments against the identification of man's actual death with brain death did not demonstrate their non-identity, the opposite position would still be uncertain, at least. In view of this undeniable fact, a minimal ethical responsibility demands that we must not act, by organ retrievals, on the assumption of the identity of "brain death"--in any of its meanings--with man's actual death. We must avoid those actions which, like killing, presuppose a high degree of moral certainty concerning death, given that we cannot attain such certainty, as in the case of brain death. Thus organ and heart-explantations are found to be unethical. A newly thought out notion of biological death of the human organism as a whole ("clinical death" as irreversible cessation of all vital bodily functions, in particular of cardiopulmonary and cerebral functions) is proposed as theoretically best founded and ethically safest medical criterion of death.

Brain Death↗
PubMed1989

[Experimental studies on stress hormones at the time of sudden death (II)--Differences in adrenocortical hormone levels of cardiac arrest-preceding type and apnea preceding type sudden death under cerebral ischemia or aortic stenosis].

Under cerebral ischemia or aortic stenosis, changes in plasma and adrenal corticosterone (CS) levels before and after cardiac arrest-preceding type (CPT) and apnea-preceding type (APT) sudden death were examined to determine the response of the hypophyseal adrenocortical system in Wistar rats. The plasma CS value at 1.5 hours after cerebral ischemia treatment was about 3 times that of pretreatment under non-anesthesia. With the occurrence of CPT and APT sudden death during cerebral ischemia, a difference between CS levels before and after death was more pronounced in the adrenals than in the plasma. The adrenal CS value after death was significantly lower than that before death in APT sudden death (P less than 0.05), though the CS value in adrenals after death was the same as that of living animals with cerebral ischemia in CPT sudden death. APT sudden death may thus be concluded to have a lower CS level in the adrenals than CPT sudden death (P less than 0.01). In the case of aortic stenosis, the effect of this treatment on plasma CS level was not as distinct as in the case of cerebral ischemia. Only a slight increase in plasma CS was noted on the 6th day from treatment. Under this condition, a difference between plasma or adrenal CS levels before and after CPT and APT sudden death was similar to the case of cerebral ischemia. The adrenal CS value after death in both sudden death types was also the same case of cerebral ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Glands↗
PubMed1991

Causes of death in a cohort of 50,465 young men--validity of recorded suicide as underlying cause of death.

We studied causes of death in a cohort of all young males (n = 50,465) conscripted for military service in 1969-70. Six hundred eighty three deaths occurred in the cohort during the follow-up through 1983. Injury-related deaths accounted for 75% of all deaths. Of these, 38% were definite suicides, 10% undetermined suicides and 30% motor vehicle accidents. The validity of officially recorded causes of death was studied by scrutinizing all death certificates (n = 683) and forensic reports, including police reports, toxicological and histological data, from a sample (n = 322) of deaths with unclear circumstances. Of 161 officially recorded suicides (E950-959), only one case was reevaluated into poisoning, "undetermined" (E980). Of 47 cases officially recorded "undetermined" (E980-989), 9 were reevaluated into definite suicide (E950-959) although we believe that this is still an underestimation of "true" suicide cases. An alcohol concentration of more than 0.1 g% was found in 45% of all violent deaths (E800-999), 34% of all suicides and 60% of all "undetermined" deaths. We conclude that the causes of death in most cases of injury related death in young age are recorded with high accuracy. Reevaluation of recorded deaths from "undetermined" causes revealed a number of definite suicides, although the "true" number of suicides is difficult to assess even after close scrutiny of the information available.

Accidents↗
PubMed1997

Principles for including or excluding 'mechanisms' of death when writing cause-of-death statements.

OBJECTIVE: To develop principles and refined definitions designed to improve the content of cause-of-death statements regarding inclusion or exclusion of so-called mechanisms of death. DATA SOURCES: Survey of readily available instruction manuals and other literature regarding mechanisms of death and instructions for death certificate completion. DATA SYNTHESIS: Definitions and principles contained in the information sources were reviewed, and a set of specific principles, criteria, and definitions were written. These principles are consistent with, but are more extensive and practically applicable than, those found in each of the information sources surveyed and may be used to decide which conditions to report in cause-of-death statements. CONCLUSIONS: Mechanisms of death include a defined list of terminal events (such as asystole) and a larger group of nonspecific physiologic derangements (such as portal hypertension) and are differentiated by definition from nonspecific anatomic processes (such as cirrhosis). Three principles may be applied in individual cases. Principle 1 states that terminal events are not reported in cause-of-death statements. Principle 2 states that a nonspecific physiologic derangement or a nonspecific anatomic process should be reported if (1) it is a recognized, potentially fatal complication of the underlying cause of death; (2) it constitutes part of the sequence of conditions that led to the death of the patient in question; (3) it is not a symptom or sign; (4) its existence in the patient would not be apparent unless included and explicitly stated in the cause-of-death statement; (5) its inclusion does not constitute an oversimplification of the facts; and (6) an etiologically specific underlying cause of death is also reported. Principle 3 states that if the existence of the complication is obvious based on the underlying cause of death or another reported complication, it need not be reported.

Autopsy↗
PubMed1997

Identifying deaths before 1979 using the Social Security Administration Death Master File.

For cohort studies, the Social Security Administration (SSA) traditionally has been the principal source of deaths that occurred before 1979. In 1988, the SSA abolished a system that provided a relatively complete accounting of deaths and replaced it with the Death Master File. We examined the completeness of the SSA Death Master File by comparing it with the U.S. Vital Statistics records and by searching the SSA Death Master File for known decedents from seven cohorts. Overall, only 53% of reported U.S. deaths and 75% of known deaths in our seven cohorts were included in the SSA Death Master File. Ascertainment was better after 1975 (89-95%). A re-analysis of two cohorts that excluded deaths before 1979 not found in the SSA Death Master File resulted in 20-35% decreases in both standardized mortality ratios and dose-response trends. Although the SSA system before 1988 provided relatively complete vital status information, the SSA Death Master File is inadequate for vital status determination. New cohorts with a substantial number of deaths before the inception of the National Death Index in 1979 will be most seriously affected.

Cohort Studies↗
PubMedDate not supplied

Seasonal variation of deaths from fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, and refractory congestive heart failure in older persons living in New York City.

OBJECTIVE: To investigate if there is seasonal variation in cardiac deaths in older persons living in a nursing home in New York City. DESIGN: In a prospective study, the major clinical cause of death of all persons aged 60 years and older residing in a nursing home in New York City during a 15-year period was investigated. The author carefully reviewed the major cause of death with the physicians taking care of all persons who died in the nursing home or after transfer to a general hospital. We investigated whether there was seasonal variation in deaths from either fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, or refractory congestive heart failure. SETTING: A large nursing home in which 1265 older persons died of fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, or refractory congestive heart failure during a 15-year period. PATIENTS: The 1265 persons who died from cardiac causes included 410 men and 855 women, mean age 83 +/- 8 years at the time of death. MEASUREMENTS AND MAIN RESULTS: During a 15-year period, 1265 older persons died of fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, or refractory congestive heart failure. Cardiac deaths occurred from December through March in 497 of 1265 persons (39%), from April through July in 378 of 1265 persons (30%), and from August through November in 390 of 1265 persons (31%). The frequency of cardiac deaths was significantly greater between December and March (P < 0.001). The incidence of cardiac deaths between December and March was 1.29 times greater than the average of the incidence of cardiac deaths during the two other 4-month periods. CONCLUSION: The frequency of cardiac deaths in older persons living in a nursing home in New York City significantly increased 1.29 times during the period December through March compared with the average of the two other 4-month periods (P < 0.001).

Journal Article↗
PubMed2005

Unnatural causes of sudden unexpected deaths initially thought to be sudden infant death syndrome.

The aim of this clinicopathological study was to determine the frequency of infant deaths due to unnatural causes among cases of sudden and unexpected infant death. Nine institutes of legal medicine in Germany that took part in the German study on Sudden Infant Death Syndrome (GeSID), representing 35% of the German territory, investigated in a 3-year period (from 1998 to 2001) 339 cases of infant death that were not expected to be due to unnatural causes from the first external examination. All cases were investigated by complete, standardised, post-mortem examination including death scene investigation, autopsy, histology, toxicology and neuropathology. The frequency of unnatural deaths was 5.0% (n=17). The causes of death were head injury (n=7), suffocation (n=5), poisoning (n=2), neglect (n=2) and septicaemia due to aspiration of a foreign body (n=1). Two deaths were unsuspected accidents and 12 were due to infanticide. In 3 cases, it was not possible to differentiate between accidental death and infanticide. A complete postmortem examination including an analysis of the clinical history, death scene investigation, autopsy, histology, toxicology, and neuropathology is mandatory to differentiate sudden and unexpected deaths due to natural causes (e.g. SIDS) and cases of unnatural death.

Autopsy↗
PubMed2004

Diminishing proportional risk of sudden death with advancing age: implications for prevention of sudden death.

BACKGROUND: Advances in primary and secondary prevention of sudden death have led to a wide array of potentially beneficial therapies. Identification of patients most likely to benefit would be of use when considering costly interventions such as an implantable defibrillator. We sought to determine the effect of advancing age on the mode of death in the Amiodarone Trialists Metanalysis. METHODS AND RESULTS: Patients (n = 6252; age, 61.2+/-10.5 years; 83% men) were included in an analysis of predictors of sudden death (SD) and all-cause death (ACD), based on baseline variables at enrollment. Patients were divided into 5 age groups: < or =50 years, 51 to 60 years, 61 to 70 years, 71 to 80 years, and >80 years. During a mean of 16.8+/-10.3 months of follow-up, there were 1023 deaths, with an annual overall mortality rate of 11.7%. Both sudden death and nonsudden death rates increased with age, although the increase of nonsudden death with age was more dramatic. The overall proportion of death that was sudden (SD/ACD ratio) was 0.41, falling from 0.51 before age 50 years to 0.26 after age 80 years (P =.002 for trend). The SD/ACD ratio was not affected by sex, New York Heart Association Class, or left ventricular ejection fraction. CONCLUSIONS: Although the incidence of sudden death increases with age, the proportion of death that is sudden diminishes markedly. This finding may influence the yield of interventions targeted at prevention of sudden death.

Age Factors↗
PubMed2002

A measure of the quality of dying and death. Initial validation using after-death interviews with family members.

A reliable and valid measure of the quality of the dying experience would help clinicians and researchers improve care for dying patients. To describe the validity of an instrument assessing the quality of dying and death using the perspective of family members after death and to identify clinical correlates of a high quality death, a retrospective cohort study evaluated the 31-item Quality of Dying and Death (QODD) questionnaire. The questionnaire was administered to family members of patients who died in Missoula county Montana in 1996 and 1997. The interview included questions assessing symptoms, patient preferences, and satisfaction with care. Measurement validity was examined for item and total scores and reliability analyses for the QODD total score were assessed. Construct validity was assessed using measures of concepts hypothesized to be associated with the quality of dying and death. There were 935 deaths, of which 252 (27.0%) family interviews were represented. Non-enrolled decedents were not significantly different from enrolled decedents on age, sex, cause of death, or location of death. We excluded sudden deaths (n = 45) and decedents under age 18 (n = 2), leaving 205 after-death interviews. A total QODD score, on a scale from 0 to 100 with higher scores indicating better quality, ranged from 26.0 to 99.6, with a mean of 67.4 and Cronbach's alpha of 0.89. The total QODD score was not associated with patient age, sex, education, marital status, or income. As hypothesized, higher QODD scores were significantly associated with death at home (P < 0.01), death in the location the patient desired (P < 0.01), lower symptom burden (P < 0.001), and better ratings of symptom treatment (P< 0.01). Although the total score was not associated with the presence of an advance directive, higher scores were associated with communication about treatment preferences (P < 0.01), compliance with treatment preferences (P < 0.001), and family satisfaction regarding communication with the health care team (P < 0.01). Availability of a health care team member at night or on weekends was also associated with a higher QODD score (P < 0.001). The QODD total score demonstrated good cross-sectional validity. Clinicians caring for dying patients should focus on improving communication with the patient and family and improving symptom assessment and treatment. Health care teams should focus on continuity of care, including having a team member familiar with the patient available for calls at nights and on weekends. Future work will assess the potential role of the QODD in improving the quality of the dying experience.

Aged↗
PubMed2002

Comparison of causes of death using HEMO Study and HCFA end-stage renal disease death notification classification systems. The National Institutes of Health-funded Hemodialysis. Health Care Financing Administration.

Few data are available on the accuracy of death classification in patients with end-stage renal disease (ESRD). The National Institutes of Health-funded Hemodialysis (HEMO) Study allows the opportunity to compare cause of death recorded on the Health Care Financing Administration (HCFA) Death Notification Form 2746 with death classified by the HEMO Study. The HEMO Study cause of death is determined by trained HEMO Study Outcome Review Committee physicians. In this interim analysis, there were 220 deaths coded by both classification systems. Using the HEMO Study classification system, the most common cause of death was ischemic heart disease (20.4%), followed by arrhythmia and conduction problems (10.4%), cerebrovascular disease (8.6%), and non-access-related infections (7.7%). Using the HEMO Study final death classification as the reference standard, most differences in the two classification systems were related to coding of heart disease. Sensitivity for the HCFA classification ranged from 9.1% for congestive heart failure to 91.7% for malignancy, whereas specificity values were all greater than 78%. Positive predictive values ranged from 11.8% for other heart disease and conditions to 100% for malignancy and hepatobiliary disease, whereas negative predictive values were all greater than 85%. The kappa statistic between the two death classification systems ranged from 0.12 for congestive heart failure to 0.95 for malignancy. Studies using death classification from the HCFA ESRD death notification form for deaths secondary to either cardiovascular diseases or unknown causes should be interpreted cautiously.

Aged↗
PubMed1994

Causes of death associated with Alzheimer disease: variation by level of cognitive impairment before death.

OBJECTIVE: To describe causes of death for patients with Alzheimer disease (AD) and other dementing illnesses enrolled in a population-based Alzheimer disease patient registry (ADPR) and to describe the variation in causes by the level of cognitive impairment before death in probable AD cases. SETTING: The ADPR enrolls and diagnoses newly recognized potential dementia cases occurring in a large, stable health maintenance organization. To date, 654 cases have been enrolled and followed annually to monitor cognitive decline and verify initial diagnosis. DESIGN: Longitudinal descriptive study. PATIENTS: ADPR enrollees who have died. MEASUREMENTS: Death certificates were obtained for all who died (total n = 104, probable AD = 55); reported causes of death were reviewed by a physician to determine the underlying cause. AD patients were categorized according to their Mini-Mental State Exam score (cognitive impairment) within 12 months of death as (a) mildly (21+), (b) moderately (15-20), or (c) severely (0-14) impaired, and underlying cause and all reported causes of death for each group were tabulated. MAIN RESULTS: Among probable AD patients, pneumonia and AD were most often recorded on death certificates when cognitive impairment within the year prior to death had reached the severe level; heart disease, stroke, and other common causes of death predominated in AD patients who were less cognitively impaired. CONCLUSIONS: When AD cases were followed from first diagnosis to death, the causes of death varied by level of cognitive impairment. Illnesses potentially amenable to treatment caused death at all levels of disease, but more so early in the course of AD. Cognitive impairment may make patients less able to recognize and report symptoms of medical problems, thereby complicating efforts to intervene.

Aged↗