Wach A, Faßbender C, Ackermann H, Parzeller M
Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland.
Institut für Biostatistik und Mathematische Modellierung, Zentrum der Gesundheitswissenschaften, Klinikum und Fachbereich Medizin, Goethe-Universität Frankfurt a.M., Frankfurt am Main, Deutschland.
Rechtsmedizin (Berl). 2021;31(6):509-519. doi: 10.1007/s00194-021-00469-6. Epub 2021 Mar 8.
In Germany, a constant demographic change is taking place, which leads to an increasing aging of the society. The present study aimed to analyze natural deaths occurring at an age of ≥ 65 years, since health vulnerability in this age group is gaining importance.
Autopsy reports of the Institute of Forensic Medicine, University Hospital of the Goethe University Frankfurt/Main, Germany, were retrospectively evaluated regarding natural death cases of ≥ 65-year-olds in a time comparison (period I: 2000-2002; period II: 2013-2015).
During both periods, a total of 1206 autopsies concerning this age group were performed. Among these, 404 cases (33.5%) of unnatural death and 39 cases (3.2%) of a combination of natural and unnatural death were recorded; in 94 cases (7.8%), the manner of death could not be elucidated. The majority ( = 669; 55.5%) included cases of natural death. In the largest group of these ( = 350; 52.3%), cardiac causes of death were predominant, followed by 132 (19.7%) respiratory and 47 (7.0%) abdominal causes of death. In addition, 37 (5.5%) cases of malignant neoplasms, 33 (4.9%) of ruptures of large vessels, 33 (4.9%) of cerebral, and 37 (5.5%) other cases of natural death were noted. A significant decrease of cardiac causes of death was observed in the comparison of periods I and II. In particular, there was a significant decrease in high-grade occlusive coronary sclerosis. Moreover, there were significant differences between both sexes. Men had significantly more bypasses, stents and heart scars and suffered a myocardial infarction about 10 years earlier than women.
The results of the present study are largely consistent with the literature. The decrease in numbers of cardiac deaths may be attributed to increasingly better medical care and to a significantly higher rate of stent implantation. Especially in times of pandemics, the role of forensic gerontology will become more important.
在德国，人口结构正在持续变化，这导致社会老龄化加剧。本研究旨在分析65岁及以上人群的自然死亡情况，因为这一年龄段的健康脆弱性日益受到关注。
对德国法兰克福歌德大学大学医院法医学研究所的尸检报告进行回顾性评估，比较两个时间段（时间段I：2000 - 2002年；时间段II：2013 - 2015年）内65岁及以上人群的自然死亡病例。
在这两个时间段内，共对该年龄段进行了12次尸检。其中，记录了404例（33.5%）非自然死亡病例和39例（3.2%）自然与非自然死亡合并病例；94例（7.8%）死亡方式无法明确。大多数（=669例；55.5%）为自然死亡病例。其中最大的一组（=350例；52.3%）以心脏原因导致的死亡为主，其次是132例（19.7%）呼吸原因和47例（7.0%）腹部原因导致的死亡。此外，还记录了37例（5.5%）恶性肿瘤病例、33例（4.9%）大血管破裂病例、33例（4.9%）脑部病例以及37例（5.5%）其他自然死亡病例。在比较时间段I和II时，观察到心脏原因导致的死亡显著减少。特别是，高级别闭塞性冠状动脉硬化显著减少。此外，两性之间存在显著差异。男性接受搭桥手术、植入支架和心脏瘢痕的情况明显更多，且比女性早约10年发生心肌梗死。
本研究结果在很大程度上与文献一致。心脏死亡人数的减少可能归因于医疗护理的日益改善以及支架植入率的显著提高。特别是在大流行时期，法医老年医学的作用将变得更加重要。
