I disagree Mom was at home in hospice, I saw what she went thru in the dying process. Death certificate says Alzheimer's & Dementia, I say she died from congestive heart failure and stroke; hospice nurse practioneer told me, prior to my mom's death, mom would die of a massive stroke after she suffered a stroke initially in April/2016. Alzheimer's & Dementia is contradictory to what this nurse practioneer said. My mom ate and drank up 'til the day she died contrary to what hospice says about my Alzheimer's & Dementia patients. I don't see where Alzheimer's & Dementia had anything to do with the immediate cause of mom's death. Mom's death certificate read like mom's admission into this hospice while mom's condition at the end I don't think had anything to do with Alzheimer's & Dementia. Congestive heart failure and osteoporosis were listed way down at the bottom of the certificate. Does the immediate cause of death matter, if so what should I do? Thank you for your advice.

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mothersdeath, I know exactly what you mean... when my Mom passed her death certificate stated "advanced dementia".... even though my Mom didn't have dementia three month prior to a major fall at home, the brain trauma apparently caused the advanced dementia. Thus, with that type of dementia it is hard for the body to maintain normal life.
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There are two main things cause of death are important for.

One is payout of insurance. For example, if the cause of death is accident, some insurance pays out double. If the cause of death is suicide, insurance won't payout.

The other is for future statistical analysis. And by this I am referring to those studies on cause of death that say...heart disease is the number one cause of death. Or, lung cancer deaths are increasing or whatever. These studies can be important for many reasons. One would be to see where the government should put money for research. Another would be where money goes for social change planning (like reducing smoking etc).

Now, having said that...cause of death can be a very emotional thing, and that's what I think you are referring to. When a doctor decides on cause of death, he uses many things to determine the cause...autopsy if there was one, previous medical records, observers (as in the case of accidents or suicides), hospice records and many many other things. In fact, many deaths are cause by more than one thing (such as a combination of heart disease and cancer. Or a combination of dementia and a head injury). In the US there is only room for one cause of death on the certificate. Therefore the doctor has to use his best abilities and experience to choose what will appear in that slot. The other causes are usually listed as contributing factors lower on the form. In your case, he felt that the main cause was Alzheimers was the main cause but noted that she also had other conditions in the contributing factors section.

In my mom's case, the cause of death was accident (which at first made me feel EXTREMELY guilty as I felt like they were implying that it was preventable, it happned a month prior to her death) and the contributing factor was a subarachnoid hemorrhage ... which I felt was the actual, immediate cause of death, but after some discussion with the doctor I realized why he did it this way. The accident a month prior triggered the hemorrhage. Without the accident there would have been no hemorrhage. So I get it, and the guilt faded.

I believe your doctor was trying to say that the Alzheimers was the cause of the death in the big picture. The other conditions did make it worse.

If they didn't do it this way, every single death certificate would say cardiac cessation or cardiac arrest...because ultimately, the immediate cause of death for everyone is when the heart stops right? But WHY did the heart stop...this is what is necessary information, not just for the family but for the future generations who will need this information for family medical history research, for informational purposes that can be used to reduce risk factors etc. Cause of death is not always the immediate cause.

My biggest hope for you is that you don't take this personally. That you just let it be as changing from alzheimers to stroke or anything else will not make any difference for you. It won't change anything for you. You are certainly allowed to disagree...but what are the chances that any other doctor would agree with you? They wouldn't, instead if you did challenge this...they would immediately seize her body and exhume it if it has been buried and do additional autopsy work. Do you really want this? I'd assume you don't.

I really hope you find peace.

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I went through something similar. My father was dying from CHF. We first had palliative care but dad was quickly switched to hospice two months before he passed. Up unti about two weeks prior to death my father was still mentally sharp. At that point hospice began recommending large quantities of liquid morphine and liquid Ativan. I wasn't crazy about all these pain/anxiety meds but I didn't want my beloved daddy to be in pain, struggle for breath or be agitated in any way. Once on these drugs dad started having delusions which I've read are typical prior to death. Daddy though he was in the old mountain cabin my family use to rent. He though the hospice people were his long deceased skiing/climbing buddies and they had come to take him skiing - he could hear the hospice folk but not see them most of the time. Anyhow - daddy was worried and being packed and finding his car keys. Again, I have read in hospice literature that this type of delusion is very common near death. Anyhow - when I got the death certificate I saw that dementia had be listed as one of the main contributors of his death. For some reason this really bothered me - I guess I was proud that daddy had remained mentally sound until the end - that, and I know he wouldn't have liked that diagnosis pinned on him either. I thought about trying to get it changed but ultimately I wondered how much it really mattered - and it wouldn't change anything, my dad was still gone. I guess you need to determine for yourself how much it really matters and how much fight you've got in you. I can't imagine getting this changed will be easy - not so much in a "fighting the system" kind of way - but in the way of dealing with a government agency. 1000 phone calls, being redirected to different offices and people - and endless time being put on hold, etc. At the time I just didn't have the mental or physical energy to take that all on.
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