title: Causes and place of death in Italian patients with amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  To determine the causes and place of death in a cohort of Italian patients with amyotrophic lateral sclerosis (ALS). A better understanding of the likely causes of death in ALS might improve the palliative care at the end-of-life, whereas knowing the place of death will help to verify the need for highly specialized care services, e.g. hospice and nursing home.
  
  
  METHODS
  Between 2000 and 2008, 182 ALS patients (onset: spinal, 127; bulbar, 55; M/F: 1.6) were followed in a single ALS Tertiary Centre in Palermo, Sicily, Italy until death. Medical data for each individual patient were recorded in a large database throughout the disease course. Information concerning causes and place of death were obtained by consultation with relatives or the family physician.
  
  
  RESULTS
  Respiratory failure (terminal respiratory insufficiency, pneumonia) was the most frequent cause of death (81.3%), which included six cases (3.3%) who requested a terminal sedation. Sudden death and death during sleep accounted for by 6.0% and 6.6% of all deaths, respectively. Heart-related causes of death were relatively infrequent in our cohort, accounting for by 7.1% of all deaths (i.e. sudden death: 6.0% and myocardial infarct: 1.1%). Patients (85.2%) died at home.
  
  
  CONCLUSIONS
  The leading cause of death in ALS remains the respiratory failure, followed by the sudden death and death during sleep. Most patients in our cohort died at home, a choice that might be only partially driven by cultural factors. These findings might have a great impact on the development of the advanced and end-of-life palliative care and in the planning of specialized care services, as hospice and nursing home.
authors.affiliation: ALS Clinical Research Centre, Department of Clinical Neurosciences, University of Palermo, Palermo, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Spataro
authors.forename: M
authors.initials: M
authors.lastname: Lo Re
authors.forename: T
authors.initials: T
authors.lastname: Piccoli
authors.forename: F
authors.initials: F
authors.lastname: Piccoli
authors.forename: V
authors.initials: V
authors.lastname: La Bella
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies