Do centenarians die healthy? An autopsy study.

BACKGROUND: Our goal was to assess the prevalence of common causes of death and the demographic variables in a selected population of centenarians. METHODS: The autopsy reports and medical histories of all individuals > or =100 years, dying unexpectedly out of hospital, were gathered from 42,398 consecutive autopsies, performed over a period of 18 years at the Institute of Forensic Medicine, Vienna. These records were evaluated with regard to age and sex, circumstances of death, season, time and the cause of death, as well as the presence of any other comorbidity. RESULTS: Forty centenarians (11 men, 29 women) were identified with a median age of 102 +/- 2.0 (range: 100-108) years. Sixty percent were described as having been healthy before death. However, an acute organic failure causing death was found in 100%, including cardiovascular diseases in 68%, respiratory illnesses in 25%, gastrointestinal disorders in 5%, and cerebrovascular disease in 2%. Additionally, centenarians suffered from several comorbidities (cardiac antecedents, neurologic disorders, liver diseases, cholecystolithiasis), which were not judged to be the cause of death. CONCLUSIONS: Centenarians, though perceived to have been healthy just prior to death, succumbed to diseases in 100% of the cases examined. They did not die merely "of old age." The 100% post mortem diagnosis of death as a result of acute organic failure justifies autopsy as a legal requirement for this clinically difficult age group.

Unexpected out-of-hospital deaths in persons aged 85 years or older: an autopsy study of 1886 patients.

PURPOSE: The aim of this study was to determine the causes of death in the very elderly. METHODS: We reviewed 24,081 consecutive autopsies performed over 10 years (1989 to 1998) at the Institute of Forensic Medicine, Vienna, Austria. We focused on autopsies of people aged 85 years or older who died unexpectedly out of hospital. RESULTS: The mean age of the 1886 patients (561 men and 1325 women) at the time of death was 88 +/- 3 years (range, 85 to 108 years). Thirty-one percent (n = 588) of those who died were described as having been previously healthy. Cardiovascular disease was the most common cause of death (n = 1465 [77%]). Thirteen percent (n = 246) died of respiratory illness, 5% (n = 94) of gastrointestinal disorders, and 3% (n = 53) of diseases of the central nervous system. Genitourinary and metabolic diseases were uncommon. CONCLUSION: Although this out-of-hospital sample is not representative of the entire elderly population, postmortem examinations emphasize the importance of cardiovascular diseases in causing unexpected deaths in older persons.

A useful modification of the Kerrison rongeur.

STUDY DESIGN: A useful modification of the Kerrison rongeur is reported. OBJECTIVES: To modify a rongeur of the Kerrison type to avert the problems associated with conventionally designed rongeurs. METHODS: A commercial rongeur of the Kerrison type was equipped with a special chip collector attached immediately behind the cutting edge. RESULTS: Conventionally designed rongeurs necessitate the continuous removal of resected bone chips. This time-consuming activity can be avoided easily by the use of the modified rongeur. CONCLUSIONS: The design of the chip collector fully met the expectations for the modification: no clogging of resected bone material, easy clinical use, and shorter operating times. The modified rongeur, available in two lengths (190 and 290 mm) and three sizes of the chip collector (diameter of 4, 6, and 8 mm) proved to be useful in clinical applications.