Deaths in nursing homes. Quality of the post-mortem external examination of the body in multimorbid patients

Due to an increased life expectancy in the population of Germany there is a concomitant increase of multimorbid residents of nursing homes. Post-mortem external examination and definition of the manner and cause of death can be a challenge, particularly concerning deceased multimorbid patients. In this article the quality of the medical post-mortem external examination of multimorbid residents of nursing homes is analyzed by comparing the manner and cause of death given on the death certificate to the final result of the autopsy. Final autopsy reports as well as any additional medical expert reports of residents of nursing homes over the age of 60 years were analyzed and compared to the information on the death certificates in retrospect. The analysis of the 356 included cases showed a high degree of multimorbidity. In approximately 10 % of the cases certified as natural death, the result of the autopsy showed an unnatural death. On the other hand, more than 40 % of the cases declared as an unnatural death were identified as a natural death by the autopsy. In 53.7 % of the studied cases the cause of death stated in the death certificate matched the result of the autopsy. Defining the manner and cause of death during the post-mortem external examination of the body often requires differential diagnostic considerations, especially where multimorbid residents of nursing homes are concerned. Patterns of medical reports indicating an unnatural death can be only slightly developed or be completely missing. An inconclusive manner and cause of death or subtle but suspicious injuries should lead to a forensic autopsy for further clarification.