title: Physicians' attitudes toward the definition of "death from age-related physical debility" in deceased elderly with aspiration pneumonia.
abstract: OBJECTIVE
  Deaths from aspiration pneumonia in elderly patients are occasionally considered to be "death from age-related physical debility", because most aspiration pneumonias are a result of aging and lead to death without any definitive therapy. The aim of the present study was to assess physicians' attitudes toward the diagnosis of and actual description of "death from age-related physical debility" on death certificates for deceased patients with aspiration pneumonia.
  
  
  METHODS
  This study surveyed 62 Japanese physicians including 36 pulmonologists and 26 other physicians who treat patients with pneumonia. Their attitudes regarding consideration and actually recorded "death from age-related physical debility" for deceased patients with aspiration pneumonia were assessed by using anonymous questionnaires, which included the decision-making process and the necessity of detailed diagnostic criteria.
  
  
  RESULTS
  A total of 32 (52%) respondents had considered deceased patients with aspiration pneumonia to be "death from age-related physical debility", and 10 (16%) have actually stated this on the death certificate. Advanced age, bedridden status, inability of oral intake and disturbance of consciousness including dementia were major factors in their decision-making. A total of 34 (55%) of the respondent physicians wanted detailed criteria to be established.
  
  
  CONCLUSIONS
  Physicians' attitudes toward the definition of "death from age-related physical debility" vary a great deal depending on the respondent. The description in death certificates therefore might inaccurately reflect the results of current mortality statistics in Japan.
authors.affiliation: Internal Medicine 2, Oita University Faculty of Medicine, Yufu, Japan. komiyakh1@oita-u.ac.jp
authors.forename: Kosaku
authors.initials: K
authors.lastname: Komiya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishii
authors.forename: Hisako
authors.initials: H
authors.lastname: Kushima
authors.forename: Shintaro
authors.initials: S
authors.lastname: Sato
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kimura
authors.forename: Takaaki
authors.initials: T
authors.lastname: Yasuda
authors.forename: Eiji
authors.initials: E
authors.lastname: Okabe
authors.forename: Issei
authors.initials: I
authors.lastname: Tokimatsu
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kadota
mesh_terms: D001291:Attitude of Health Personnel; D002423:Cause of Death / Q000639:trends; D003644:Death Certificates; D003657:Decision Making; D003951:Diagnostic Errors / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D010820:Physicians / Q000523:psychology*; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000401:mortality*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends