Aim: To examine the causes of death in elderly patients with advanced dementia, we retrospectively investigated the medical records for death discharge cases hospitalized in the Department of Geriatric Medicine at Saiseikai-Nakatsu Hospital and examined death certificates issued throughout the hospital.
Methods: (1) From 2010 to 2013, 31 patients with advanced dementia died in the hospital or were discharged to receive terminal care at home. We evaluated their medical records to examine the pathological background and disease with which they were diagnosed when admitted to and discharged from the hospital. (2) In order to assess the relationship between disease and dementia, we examined death certificates with "senility" or " (aspiration) pneumonia" recorded as the direct death cause issued throughout the hospital in the one-year period of 2013.
Results: (1) There were many cases in which eating problems and dysphagia influenced the clinical course. A total of 21 patients died from eating problems and/or dysphagia. (2) All 13 cases with "senility" recorded as the direct death cause on the death certificate involved severe dysphagia. Investigating the medical records, 11 patients had advanced dementia and two patients had end-stage Parkinson's disease. In total, 46 cases were diagnosed as involving " (aspiration) pneumonia", whereas there were no cases in which the records mentioned dementia or dysphagia in another column on the death certification.
Conclusions: Advanced dementia is a mortal illness, and most patients with advanced dementia have dysphagia. Clinicians should be aware of the fact that dysphagia may lead to aspiration pneumonia and is a significant cause of death. Understanding the clinical course of dementia is important for determining the cause of death.