The autopsy and the elderly patient in the hospital and the nursing home: enhancing the quality of life.

The autopsy is the ultimate "peer review." Yet the autopsy has nearly disappeared from hospitals in the United States and around the world. It is rarely performed in the nursing home or other long-term care (LTC) setting. As a result, all of society has lost much, in terms of quality of health care, the skills of physicians, and insights gained through autopsy-based research. The elderly have the lowest rate of autopsies of any age group. This is a paradox, since the greatest quality and quantity of knowledge would accrue from the often surprising findings revealed at autopsy that reflect the acknowledged "multiple simultaneous illnesses" occurring in older persons. This review and analysis describe why autopsy rates have fallen in hospitals and offer rationales and solutions for reversing this trend in the nursing home and other LTC settings.