Causes of Death Determined in Medicolegal Investigations in Residents of Nursing Homes: A Systematic Review

OBJECTIVES: To systematically review published research characterizing the nature and circumstances surrounding the death of older people in nursing homes specifically using information generated for medicolegal death investigations. DESIGN: Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement using the key words death, nursing homes, and medicolegal death investigation. SETTING: Cross-sectional data from original, peer-reviewed articles published in English between 2000 and 2013 describing deaths of nursing home residents. MEASUREMENTS: Information was extracted for analysis about study and population characteristics, number and type of deaths, study design, findings, and limitations. RESULTS: Thirteen studies were identified. The studies examined external causes of deaths from suicide, choking, restraint or bed-related injuries, falls, and pressure injuries. Deaths were more frequent in women with existing comorbidities. Suicide was predominant in men. Identified risk factors and opportunities to reduce harm were identified at individual, organizational, and structural levels. Overall, the quality of the studies limited the aggregation and comparability of findings. CONCLUSION: This systematic review informs researchers, clinicians and policy-makers about how to reduce external causes of death in nursing homes.