Volume 1, Issue 1
Article Type: Editorial

Death certificates for people dying with alzheimer’s

Allan S Vann^*

28 Abbey Drive, Commack, New York 11725, USA.

Received: Mar 17, 2025
Accepted: Apr 14, 2025
Published Online: Apr 21, 2025
Journal: Annals of Pediatrics and Neonatal Care
Copyright: Vann AS et al. © All rights are reserved

Citation: Vann AS. Death certificates for people dying with alzheimer’s. Ann Gerontol Geriatr Res. 2025; 1(1): 1004.

Editorial

When actor Gene Hackman died on or around February 18, 2025, he was 95 years old. The medical examiner, Dr. Heather Jarrell, stated that hypertensive and atherosclerotic cardiovascular disease was the cause of his death, but also that “Alzheimer’s disease was a significant contributing factor [1].”

That notation of Alzheimer’s Disease (AD) as a significant contributing factor (emphasis mine) with respect to Hackman’s death is critically important to acknowledge because many people with AD die with no mention of AD on their death certificates, and this omission, in my opinion, is both unfair and medically unsound.

According to the latest statistics from the Centers for Disease Control, statistics based upon what is written on death certificates, AD is the 6th leading cause of death in this country. “When a person dies, the cause or causes of death are listed on death certificates, typically by a physician, and filed with the state’s Bureau of Vital Statistics. This information is then forwarded to the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC), which compiles and reports the totals each year as the official U.S. mortality figures and leading causes of death [2].”

Death certificates provide space for listing primary and contributing causes of death. However, these data are not reliable when indicating deaths due, at least in part, to AD. Unfortunately, contributing causes of death are too often omitted on death certificates when it comes to people dying with AD. My wife’s death is a perfect example.

After struggling with early onset AD for nearly 10 years, my wife died in a nursing home. The death certificate listed “cardiac arrest” as the cause of her death. The section provided for noting “other significant conditions leading to death” was left blank. Nowhere on that death certificate was there any mention of AD. When I contacted the doctor who completed the death certificate to ask why, he said that he could not prove that AD was a factor in her death.

What? How could that be true? My wife was only in a nursing home because of her AD, not because of heart issues. Had she not been dealing with worsening end stages of AD, she would have been exercising properly, eating properly, sleeping properly, etc. as she had been doing before her AD significantly worsened. Sadly, confined to a wheelchair and unable to exercise regularly, having difficulty swallowing and unable to eat properly, my wife’s health deteriorated rapidly in those final weeks. In my opinion, her declining health was due primarily to AD, not cardiac issues.

My wife was also taking medication to help with increasing anxiety… medication that came with warnings about higher incidence of death if taken by someone with dementia. But these were the only medications that were at least mildly effective in helping her, so doctors prescribed them when safer medications failed to calm her down.

In 2014, the National Institute of Aging (NIA) concluded that, “Underreporting of Alzheimer’s as a cause of death-ondeath certificates is a well-known phenomenon. Some people with the disease never receive a diagnosis. Many others have dementia-related conditions, such as aspiration pneumonia, listed as the primary cause of death while the underlying cause, Alzheimer’s, is never reported [3].”

According to a 2020 study supported by the National Institutes of Health (NIH), “the actual number of deaths linked to dementia may be about three times greater than what is reported on U.S. death certificates [4].” If so, then AD would be the 3rd leading cause of death in this country, right behind heart disease and cancer.

Why is it so important for doctors to accurately list AD in the space provided for “other significant conditions leading to death” on death certificates? Not just for accurate statistics, but because CDC mortality data often provides the basis for federal funding for medical research. Perhaps, if AD deaths were recorded with greater accuracy, more federal funding would be funneled towards finding an effective means of prevention, treatment or cure for AD.

In my opinion, my wife died because of AD. But her death was counted as attributable solely to heart disease in that year’s CDC mortality statistics. It’s time for all death certificates and mortality data to accurately reflect the reality that AD is almost always a significant condition leading to death of those with Alzheimer’s.

References

1. What We Know About Gene Hackman’s Death. Available at https://www.nytimes.com/article/gene-hackman-death- updates.html#:~:text=On%20March%207%2C%20Dr.%20 Heather,was%20a%20significant%20contributing%20factor. 2025.
2. Morbidity and Mortality Weekly Report (MMWR), Mortality in the United States — Provisional Data, 2023. Centers for Disease Control. 2024; 73: 677–681. Available at https://www.cdc.gov/ mmwr/volumes/73/wr/mm7331a1.htm. Accessed online on March 15, 2025.
3. Number of Alzheimer’s Deaths Found to Be Underreported. National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services. 2014. Available at https://www.nia.nih.gov/ research/announcements/2014/05/ number-alzheimers-deaths-found-be-underreported. Accessed online on March 15, 2025. (Author’s note: going to this page reveals it is no longer available, but placing the IP address in the question box brings up the article!)
4. Death certificates may not adequately report dementia as cause of death. NIH, Research Highlights, October 15, 2020. Available at https://www.nia.nih.gov/news/death-certificates-may-not- adequately-report-dementia-cause-death#:~:text=Death%20 certificates%20may%20not%. Accessed online on March 15, 2025.