Unraveling the Mystery of Rising At-Home Deaths: A Decades-Long Examination

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In July 2022, The Spectator brought attention to a concerning trend in Britain – a surge in deaths occurring at home, a phenomenon that pre-dated the COVID-19 pandemic.

The article shed light on a potentially alarming rise in cases of individuals found deceased in their homes, prompting questions about social isolation, lack of support, and potential systemic failures.

This investigation aims to delve into the historical context, exploring the data from 1979 to 2020 in England and Wales to discern whether the increase in at-home deaths and cases of postmortem decomposition is indicative of broader societal issues.

The Rise of At-Home Deaths:

According to the Office for National Statistics (ONS), deaths at home in Britain have been on an upward trajectory since 2007, experiencing a sharp spike in 2020 due to the COVID-19 pandemic. The trend persisted into 2022, raising concerns about the potential implications beyond the immediate health crisis. The Spectator’s article highlighted not only the statistical increase but also individual cases that underscored the gravity of the situation.

Individual Cases Illustrating the Issue:

The media reports cited instances that underscored the severity of the problem. Sheila Seleoane’s tragic death in a London social housing block in 2019, undiscovered for over two years, revealed critical failures in the follow-up procedures of her housing association.

Similarly, Laura Winham’s mummified body discovered in 2021, more than three years after her death, prompted her family to blame care and welfare services for neglect. These cases, while anecdotal, hinted at a potential link between the reduction in care and welfare services since 2010 and the observed rise in at-home deaths.

Exploring Social Isolation and Neglect:

Against the backdrop of escalating at-home deaths, concerns about social isolation and neglect have emerged. While existing literature primarily focuses on palliative care, two London-based studies linked a significant increase in severely decomposed bodies to social isolation during the first lockdown. However, the lack of long-term trend analysis necessitates a broader examination, considering the rise in deaths at home before the pandemic.

An Exploratory Analysis:

This article embarks on an exploratory analysis spanning four decades, from 1979 to 2020, to determine whether the number of people found in a state of decomposition at postmortem increased over time. The objective is to discern patterns that might indicate societal failures in safeguarding its members. If an upward trajectory is identified, it could serve as a proxy for the failure of social structures to address issues of social isolation and neglect both before and after death.

Discussion

Main Findings of This Study:

The primary focus of this study is to present preliminary findings regarding deaths of individuals likely to have been found decomposed, utilizing a proxy marker of ICD codes. The authors argue that any increase in this measure can be considered a proxy for prolonged neglect and social isolation before death, potentially indicating a breakdown in formal and informal social support networks.

The complex nature of the decomposition process is acknowledged, influenced by various individual and environmental factors. The study concentrates on cases where decomposition has progressed to a point where determining the cause of death becomes impossible. The authors contend that severe decomposition suggests a prolonged period of isolation in the perimortem period.

The analysis highlights the importance of postmortem interval as a crucial factor influencing decomposition, outweighing other variables like medical conditions and ambient temperature on a population scale. Despite considerations like increased body mass index affecting decomposition speed, the overall postmortem interval is deemed more significant.

The study confirms the observed increase in at-home deaths over an extended period, predating austerity measures. Notably, the rise is not confined to older age groups, challenging the perception that loneliness and isolation are primarily associated with aging. Both younger and older men exhibit a rapid increase in at-home deaths, particularly in the 1990s and 2000s.

What is Already Known on This Topic:

From 2012 onwards, mortality trends in the UK worsened, attributed to austerity measures initiated in 2010. While initially impacting older age groups, the study notes a subsequent widespread deterioration in mortality outcomes across various demographics. The rise in mid-age mortality, often linked to “deaths of despair,” is highlighted, with social changes contributing to increased social isolation.

Existing research emphasizes the detrimental health effects of social isolation and loneliness, correlating with an increased risk of all-cause mortality. Notably, the analysis of postmortem reports indicates that every markedly decomposed case that died at home lived alone.

Living arrangements in the UK have undergone significant changes from 1996 to 2021, with a notable increase in the number of men living alone in the working-age group. However, living alone is only one factor contributing to perimortem social isolation, with family, friend, and local community connections playing crucial roles.

What This Study Adds:

Utilizing a proxy for severe decomposition, the study reveals an increase over time in ‘undefined’ deaths among both sexes, suggesting a higher rate of being found decomposed, especially among men.

Limitations of This Study:

The study acknowledges limitations in using ICD-10 codes R98 and R99 as a proxy for severe decomposition, as these codes may not capture cases where the body is decomposed but postmortem findings can still establish a defined cause of death.

Severe decomposition is identified as the most likely reason for a cause of death to be labeled as ‘unascertained.’ However, exceptions exist, such as coronial or administrative issues, potentially leading to an ‘unascertained’ cause of death.

The limitations also extend to the difficulty in quantifying the effects of family, friend, and local community social connections on perimortem social isolation due to sparse and fragmentary data.

Unanswered Questions and Future Research:

The authors express the need for further research to explore more suitable proxies for a body found in a state of decomposition, emphasizing the potential validity of their chosen proxy.

The effects of living alone on mortality, specifically being found decomposed, warrant deeper investigation in future research.

Research utilizing coroners’ reports is deemed challenging due to variations in reporting across regions, urging for standardized data collection methods.

The authors advocate for recording bodies found decomposing in publicly available data, suggesting collaboration with coroners’ authorities to explore ways of reporting decomposition status. They propose the consideration of adding a code for advanced decomposition to the International Classification of Diseases (ICD) by the World Health Organization.

In conclusion, the study provides a comprehensive exploration of at-home deaths, decomposition, and potential social implications. The findings underscore the need for further research, standardized data collection, and a broader societal response to address the complex interplay of factors contributing to the observed trends.

Table 1. ICD-9 and ICD-10 codes used for proxy described in Box 1 for ‘undefined deaths’.

ICD versionYearsCodeDescriptionIncludes
9a1979–1984798.9Sudden death, cause unknownUnattended death
799.9Other ill-defined and unknown causes of morbidity and mortalityUnknown cause
9b1985–1993798.9Sudden death, cause unknownUnattended death
799.9Other ill-defined and unknown causes of morbidity and mortalityUnknown cause
9c1994–2000798.9Sudden death, cause unknownUnattended death
799.9Other ill-defined and unknown causes of morbidity and mortalityUnknown cause
102001–2021R98Unattended deathDeath in circumstances where the body of the deceased was found and no cause could be discovered; Found dead
R99Other ill-defined and unspecified causes of mortalityDeath NOS; Unknown cause of mortality

ICD: International Classification of Diseases; NOS: not otherwise specified.

At present, there is no ICD code for ‘decomposed body’. While R98 and R99 codes are non-specific, we pose that these codes are the most likely way a ‘1a Unascertained’ death would be coded. ONS have confirmed (personal communication 26 October 2023, included in Supplementary Appendix I) that the only code that can be applied when the cause of death is described as decomposed or unascertained is R99.1 We have included R98 as the definition of it in ICD is quite specific for ‘no cause could be discovered’ which is suggestive of decomposition.


reference link : https://journals.sagepub.com/doi/10.1177/01410768231209001

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