[The issues behind solitary deaths of older people in central Tokyo].

Objectives　The purpose of this study was to clarify the issues behind the increasing number of solitary deaths of older people in central Tokyo.Methods　In this study a request was made to the national government for information on the 2016 vital statistics survey of ward A, one of the 23 wards of Tokyo. The entries in the death forms do not distinguish between death and post-mortem certificates. However, in the 23 wards where there is a medical examiner system, if the medical institution of the doctor who prepared the post-mortem certificate is the Tokyo-to Medical Examiner's Office, it is possible to identify that the postmortem examination was performed. If the hospital is listed, it is considered a death certificate. A descriptive analytical study was made on the relationship between the cause of death, sex, age and marital status with regard to postmortem examinations of deaths at home or in hospitals resulting from illnesses and home care deaths.Results　Of the 4,429 deaths in Ward A in 2016, 613 were found to be postmortem examinations, of which 436 (71.1%) were of individuals who were 65 years or older. Of the 757 deaths at home, 399 (52.7%) were postmortem examinations, of which 271 were deaths from illness. The number of home care deaths was 358 (47.3%). The mean age of death was 73.6 years for 145 males and 79.5 years for 123 females, out of 268 home deaths of 34 years or older identified as death from illness by postmortem examination. On the other hand, the mean age of death in 358 home care deaths was significantly older as compared to postmortem examination deaths. 65.3% of deaths at home and 54.1% of hospital deaths were due to sudden death-type diseases such as ischemic heart disease. Of the postmortem examination of home deaths from illness among the older people aged 65 years or older, 65.5% of the 110 males and 87.3% of the 110 females were single. Bereavement occurred in 27.3% of men and 52.7% of women, separation in 16.4% of men and 9.1% of women. 21.8% of men and 25.5% of women were never married.Conclusions　In the solitary deaths of older people in central Tokyo, sudden death disease is the direct cause of death and, in the background, there are bereavement from a spouse in women, separation or bereavement from a spouse in men, and being unmarried in both.