From the Guidelines
When listing causes of death in a death certificate for an elderly person who died of natural causes, it is essential to follow a sequential format that shows the chain of events leading to death, starting with the immediate cause, then intermediate causes, and finally the underlying cause, as outlined in the 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials 1.
Causes of Death
The immediate cause of death should be listed first, followed by any intermediate causes, and then the underlying cause. For instance, if the immediate cause is respiratory failure, due to pneumonia, due to influenza, with the underlying cause being chronic obstructive pulmonary disease, this sequence should be clearly documented. Other significant conditions contributing to death but not part of the causal chain, such as diabetes mellitus, hypertension, or dementia, should be listed separately.
Importance of Specificity
It is crucial to be specific about the conditions, avoiding vague terms like "old age" or "natural causes," as these are not acceptable medical causes of death, according to the principles outlined in the report by the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards 1. The timeframe between the onset of each condition and death should be included when possible to provide a clear understanding of the sequence of events leading to death.
Sequential Approach
This sequential approach is vital because it helps create accurate mortality statistics and provides valuable information for public health surveillance and research. Medical certifiers should use their best clinical judgment based on the patient's medical history, circumstances of death, and any available diagnostic information, as suggested by the guidelines for death attribution in clinical trials 1.
Classification of Cause of Death
The classification of the cause of death by physiological system, as detailed in the study, includes cardiovascular, pulmonary, renal, gastrointestinal, hepatobiliary, pancreatic, infection, inflammatory/immune, hemorrhage, non-CV procedure or surgery, trauma, suicide, nonprescription drug reaction or overdose, prescription drug reaction or overdose, neurological, malignancy, and other non-CV causes 1. This comprehensive classification system ensures that all potential causes of death are considered and accurately documented.
From the Research
Causes of Death in Elderly Individuals
When listing causes of death in a death certificate for an elderly individual who died of natural causes, several factors should be considered:
- The underlying cause of death should be listed first, followed by any intermediate causes that led to the underlying cause 2.
- If the death was precipitated by a seemingly simple and common event, such as a fall, it should be reported to the coroner and certified by the coroner 2.
- Nonspecific processes, such as congestive heart failure, can be listed as a cause of death, but the underlying cause of these processes should also be listed 2.
Common Causes of Death in Elderly Individuals with Type 2 Diabetes
Elderly individuals with type 2 diabetes are at a higher risk of death from:
- Myocardial infarction (MI), which is the primary cause of death in patients with type 2 diabetes 3.
- Coronary artery disease (CAD), which is a major risk factor for MI [(3,4)].
- Long-term mortality after an acute myocardial infarction (AMI), with a 30% higher risk of death compared to non-diabetic individuals 5.
Certification of Death
Physicians should certify deaths for patients they are providing care for, and in whom death is the result of known medical conditions, regardless of whether they or other medical personnel were actually present to witness the death 2.