[Death after a fall in patients with advanced dementia: cause of death natural or unnatural?]

OBJECTIVE: This article describes and discusses the viewpoints of elderly care physicians and municipal coroners regarding the qualification of natural or unnatural deaths of nursing home residents with advanced dementia who fall.

DESIGN: A digital questionnaire was sent to all elderly care physicians-in-training and their trainers in the Netherlands, and to all 23 municipal coroners in the Mid-Holland region.

METHOD: As well as questions on knowledge of the Dutch law and prognostic figures concerning dementia-related death, the questionnaire described two cases with minimal differences. The respondents were asked if they would issue a certificate of natural death in each case, and if not, would they have preferred to do so. They were also asked to explain their answers.

RESULTS: Of the 405 elderly care physicians who responded, 68% and 49%, respectively, would have issued a certificate stating the cause to be natural death in each case, or if they did not they would have preferred to do so. All 15 coroners who filled in the questionnaire came to the conclusion of unnatural death.

CONCLUSION: The majority of the elderly care physicians feel that a certificate of natural death can be issued if a fall in a nursing home results in a fracture, as this can be considered as part of the disease process of dementia.