Age at Death and Causes of Death of Patients Dying in Psychiatric Hospitals: Survey at 15 Hospitals in Tochigi Prefecture, Japan

Background: Japan entered an aging society in the late 1990s. The aging of inpatients in psychiatric hospitals has increased the need for medical care, but the actual situation has not been fully investigated. Objectives: We investigated the actual situation of in-hospital deaths through death certificates. Methods: The survey was conducted at 15 of 26 psychiatric hospitals in Tochigi Prefecture, Japan that consented to the survey. We examined the death certificates of patients who died between 1996 and 2015 at these 15 hospitals. The number of the certificates was 2441 (1443 males and 998 females). The number of deaths and the average age of death per year were calculated. Then, we surveyed the data regarding the diagnosis of death described in the death certificates based on the International Classification of Diseases-10. Results: The average age of death was in the 60s from 1996 to 2000 in the first 5 years, but since 2001, it has exceeded 70 years. Respiratory diseases accounted for 40% of the total, cardiovascular diseases for 26%, and malignant neoplasms for 11%. On the other hand, extrinsic death such as suffocation was 4%, and suicide was 1%. Conclusions: The reason of the elevation of death age might be related to the implementation of novel antipsychotics in Japan since 1996 and the establishment of the long-term care insurance system for the elderly in 2000. It is considered that the reasons why respiratory diseases, cardiovascular diseases, and malignant neoplasms occupy the top ranks of death are that these diseases have a high risk of death in the elderly.