Causes and place of death in Italian patients with amyotrophic lateral sclerosis

R. Spataro, M. Lo Re, T. Piccoli, F. Piccoli, V. La Bella

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Abstract

Objectives -

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.

Patients and 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.

Original languageEnglish
Pages (from-to)217-223
Number of pages7
JournalActa Neurologica Scandinavica
Volume122
Issue number3
DOIs
Publication statusPublished - Sep 2010

Keywords

  • ALS
  • CARE
  • DATABASE
  • END
  • EPIDEMIOLOGY
  • LIFE
  • NATURAL-HISTORY
  • POPULATION
  • SURVIVAL
  • UNITED-STATES
  • deaths
  • epidemiology

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