Reasons for outpatient care for those who died of “old age”

Abstract

Purpose of the study: to study the reasons for seeking outpatient medical care for patients in whom, after death, the code R-54 (old age) is indicated in the medical death certificate (MCD) as the initial cause of death (PPD).Materials and methods of research. Data from the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (USR registry office system of the Moscow Region) and electronic medical records (EMC) from outpatient clinics of the Moscow Region for 2020–2021. In total, 1,269 cases were registered in the MSS with the code R-54 (old age) indicated in the MCD as a PPD, of which 987 (77.7 %) sought outpatient medical care. Data included gender, age, 4-digit ICD codes for all reasons for referrals.Results. The mean age of the deceased was 87.7 ± 4.7 years (minimum 76 years, maximum 103 years; 1.4 % under the age of 80; females 88.08 ± 4.7; males 86.59 ± 4.6 p < 0.001). In 4 of the deceased, IHD was indicated as other causes contributing to death (part II of the MCD). On average, there were 3.77 ± 3.98 (men 4.2 ± 3.6 and women 3.6 ± 3.3; p = 0.04) reasons for visiting, indicated by 4-digit ICD codes. IHD group codes were registered in 21 %; AG 38.5 %; codes of the group “cerebrovascular diseases” – 25.3 %; cancer – 6.8 %; 5.1 % diabetes mellitus; 9.8 % – COVID-19. Among those who registered one reason for contacting (25 % – 1 4-digit ICD-10 code), 70 % applied for diseases, the rest of the reasons for contacting belonged to the codes of groups R, S and Z.Conclusion. In the overwhelming majority of cases, the R-54 code in the MCD is used unreasonably. However, taking into account the position of the WHO set out in the ICD and data from other countries, it is necessary to clarify the criteria for the use of both this code and other vaguely defined terms and codes that are used in the MCD as PPD.