The Prevalence of Lonely Deaths and Suicides in the Home

An Analysis of Death Certificates and Emergency Physician Protocols

Representative surveys about the preferred place of death confirm that the majority of the German population wishes to die at home, since this location is associated with the possibility of dying with dignity and in the presence of family close friends (1). The present study investigated whether this wish might be strongly idealized because in real life, dying situations at home can also be stressful. In this context the study aimed to investigate in greater detail societal problem areas such as lonely deaths and suicides. In concrete terms, we studied prevalence rates of the following unusual dying scenarios: lonely deaths and suicides in the home.

Methods

Our data came from all death certificates and emergency physician protocols (NA RD Münster V2–0, DIVI) of the independent city of Münster in 2017 (population: 306 729, 12/2017). In the context of the “Westphalian place of death study” (2)—one of the most comprehensive studies of places of death in Germany—a follow-up data collection to the observation period 2017 was carried out in Münster and, additionally, an emergency physician follow-on project was initiated—focusing on persons dying during the emergency physician deployment and those found already dead. The sources were available as a complete dataset from Gesundheitsamt Münster (the public health authority for the city) and the professional fire brigade in Münster—the provider of emergency ambulance services for the city as mandated by the city as the rescue/ambulance services organization. The data were reconciled in a pseudonymized format. The study collective consisted of all deaths that had taken place in the home in the city of Münster in 2017. The indicator we used for a lonely death at home was a find of a dead body showing signs of physical decomposition. Suicides were identified by doctors’ comments on the manner and cause of death. Any and all information from the coroner (relating to place of death, manner and cause of death, among others) and emergency physician (relating to initial diagnoses, diseases, scene of incident, pronouncement of death, among others) were analyzed. We used descriptive statistics for our analysis. We determined the 1-year prevalence (1 January 2017 to 31 December 2017) of lonely deaths and suicides in the home.

Results

We analyzed 3844 death certificates and 6641 emergency physician protocols. We identified 576 deaths in the home. The analysis of other places of death yielded the following numbers: hospital (2255 deaths), hospice (251 deaths), nursing home (726 deaths), other location (36 deaths). In 196 of all persons who had died in the home (34.0%) an emergency physician had attended at the end of life. In 69.9% of cases the emergency physician had found a person already deceased. We identified 29 lonely deaths, where the dead body had been found in the home, showing signs of decomposition. For 11 persons, a final contact when still alive was established. This contact took place a mean of 10.2 days before death (minimum 2 days, maximum 28 days, median 7 days). 18 bodies underwent a postmortem examination. No indications of suicide were found. The remaining 11 bodies were not among the identified suicides. A total of 20 suicides had taken place in the home. The following methods were used: (men (m), women (w)): hanging, strangulation, suffocation (m=7, w=1), sharp object (m=3, w=1), firearm (m=3, w=0), poisoning with medical drugs (m=0, f=2), carbon monoxide poisoning (m=1, w=1), self-immolation (m=0, w=1). Table 1 provides an overview of the characteristics of people who died at home. We determined a prevalence of 5.0% (95% confidence interval: [3.2; 6.8]) for lonely deaths in the home, and of 3.5% [2.0; 5.0] for suicides in the home (Table 2). Comparisons by age and sex showed that men and younger persons (<60 years of age) were more commonly affected.

Table 1

Characteristics of persons who died in the home (N = 576)

Table 2

Prevalence of lonely deaths and suicides in the home

Discussion

We determined in our study a prevalence of 5.0% for lonely deaths in the home and of 3.5% for suicides in the home, relative to all deaths in the home in the city of Münster in 2017. This means that such death scenarios are rare events. The percentages contradict the unreflected assumption that dying in the home always happens in a dignified manner. The study dealt with the phenomenon that is social isolation. This topic does not represent a marginal phenomenon in society, as was confirmed by results from a socioeconomic panel, which showed that 14.2% of the population of Germany were stressed by experienced loneliness in 2017 (3). Furthermore, the fact that dead bodies were found that had already started to decompose indicates that loneliness may also entail the loss of close social contacts. All and any attempts and projects aiming to contain social isolation in society—for example, the Loneliness Competence Network—deserve recognition and support. The analysis of death certificates for the city of Münster showed that in 2017, a total of 18 persons had died by suicide, 20 of these in the home environment. Relative to the total of 3844 deaths, this makes for 0.99%. This is largely consistent with the national rate of 0.94% (10,119 suicides in 1 million deaths [2022]). The publication by Rhee et al showed that suicides most commonly occur in the home (4). In Münster, the proportion was 52.6% (20/38). Suicidality is a problem for society as a whole. As described in the National Suicide Prevention Program in Germany (5), it requires cooperation/collaboration of many parties so as to shape prevention activities successfully and in a sustained manner. A limitation of our study lies in the fact that the investigation was focused exclusively on the city of Münster and can therefore not be considered as representative for the whole of Germany.

Burkhard Dasch, Florian Bernhardt, Hans Martin Sudhaus, Philipp Lenz

Department of Palliative Care, Münster University Hospital (Dasch, Bernhardt, Lenz), [e-mail]

Department of Hematology, Klinik für Hämatologie, Hemostaseology, Oncology and Pneumology, Münster University Hospital (Sudhaus)

Ethics approval

The study was approved by the ethics committee Westphalia-Lippe (reference: 2022–169-b-S)

Conflict of interest statement
PL is a spokesman in the departmental section for palliative services in the working group “inpatient care in the German Association for Palliative Medicine” and sits on the board of DELTA—Leben und Sterben in Begleitung e. V. [DELTA—living and dying and company, reg. assoc].

BD is a spokesman in the departmental section for palliative services in the working group “inpatient care in the German Association for Palliative Medicine.”

The remaining authors declare that no conflict of interest exists.

Manuscript received on 28 May 2024, revised version accepted on 19 July 2024.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Dasch B, Bernhardt F, Sudhaus HM, Lenz P: The prevalence of lonely deaths and suicides in the home—an analysis of death certificates and emergency physician protocols. Dtsch Arztebl Int 2025; 122: 19–20. DOI: 10.3238/arztebl.m2024.0157

References

1. Deutscher Hospiz- und PalliativVerband e. V. (DHPV): Sterben in Deutschland—Wissen und Einstellungen zum Sterben 2022. www.dhpv.de/forschung/bevoelkerungsbefragung-sterben-in-deutschland-wissen-und-einstellungen-zum-sterben-2022.html (last accessed on 11 July 2024).

2. Dasch B, Zahn PK: Place of death trends and utilization of outpatient palliative care at the end of life—analysis of death certificates (2001, 2011, 2017) and pseudonymized data from selected palliative medicine consultation services (2017) in Westphalia, Germany. Dtsch Arztebl Int 2021; 118: 331–8

3. Deutsches Institut für Wirtschaftsforschung (DIW) Berlin, Kompetenznetz Einsamkeit; Entringer T: Epidemiologie von Einsamkeit in Deutschland. https://kompetenznetz-einsamkeit.de/wp-content/uploads/2022/07/KNE_Expertise04_220629.pdf (last accessed on 27 May 2024).

4. Rhee Y, Houttekier D, MacLeod R, et al.: International comparison of death place for suicide; a population-level eight country death certificate study. Soc Psychiatry Psychiatr Epidemiol 2016; 51: 101–6

5. Institut für Sozialwesen, Fachgebiet „Soziale Therapie“, Universität Kassel (2024): Nationales Suizidpräventionsprogramm. www.suizidpraevention.de/ueber-uns (last accessed on 11 July 2024).