Department of Forensic Medicine, Health Law and Ageing Research Unit, Monash University, Melbourne, Victoria, Australia.
Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia.
Inj Prev. 2019 Oct;25(5):357-363. doi: 10.1136/injuryprev-2017-042689. Epub 2018 Jul 9.
To examine the impact of changes to the reporting requirements in coronial legislation on the nature and frequency of nursing home resident deaths reported to Coroners.
National retrospective study of a population cohort of nursing home resident deaths.
Accredited Australian nursing homes between July 2000 and June 2013.
Residents who died in nursing homes accredited by the Aged Care Standards and Accreditation Agency reported to Coroners.
We explored three death-reporting models in the nursing home setting: comprehensive model, selective 'mechanism of death' model and selective 'age of death' model. These models were examined by manner of death subgroups: natural, falls-related and other external causes using the outcome measure of deaths notified to the Coroner per 1000 residents. We used an interrupted time series analysis using generalised linear regression with a negative binomial probability distribution and a log link function.
The comprehensive model showed the proportion of reportable deaths due to natural causes far exceeded those from falls and other external cause. In contrast, the selective notification models reduced the total number of reportable deaths. Similarly, the selective 'age of death' model showed a decline in the reportable external cause deaths.
Variation in the causes, locations and ages of persons whose deaths are legally required to be notified to Coroners impacts the frequency and nature of deaths of nursing home residents investigated by Coroners. This demonstrates that legislation needs to be carefully framed and applied to ensure that the prevention mandate of Coroners in Australia is to be achieved.
研究法医立法中报告要求的变化对向法医报告的养老院居民死亡的性质和频率的影响。
对养老院居民死亡的人口队列进行全国回顾性研究。
2000 年 7 月至 2013 年 6 月期间澳大利亚认证的养老院。
向法医报告的在 Aged Care Standards and Accreditation Agency 认证的养老院中死亡的居民。
我们在养老院环境中探讨了三种死亡报告模型：全面模型、选择性“死因”模型和选择性“死亡年龄”模型。通过使用每 1000 名居民向法医报告的死亡人数作为结局指标，按死亡方式亚组（自然、与跌倒相关和其他外部原因）检验这些模型。我们使用广义线性回归进行中断时间序列分析，采用负二项概率分布和对数链接函数。
全面模型显示，由于自然原因导致的报告死亡比例远远超过因跌倒和其他外部原因导致的报告死亡比例。相比之下，选择性通知模型减少了报告死亡人数的总数。同样，选择性“死亡年龄”模型显示报告的外部原因死亡人数有所下降。
需要向法医报告死亡的人员的死因、地点和年龄的差异会影响法医调查的养老院居民的死亡频率和性质。这表明立法需要仔细制定和应用，以确保澳大利亚法医的预防任务得以实现。
