Abstract
BackgroundSudden bath-related deaths occur frequently in Japan, particularly among elderly people. However, the precise mechanism of bath-related death remains uncertain, and effective prevention strategies have not been established.MethodsCases of bath-related deaths (n = 3289) were selected from all cases handled by the Tokyo Medical Examiner’s Office from 2009 to 2011 (N = 41 336). The ages and occurrence dates were examined, and major autopsy findings, including toxicological analysis, were evaluated for the autopsied cases (n = 550).ResultsMost cases occurred in individuals older than 60 years of age during winter. Analysis of autopsy findings revealed water inhalation signs in many cases (n = 435, 79.1%). Circulatory system diseases constituted more than half of the pathological findings regarding factors that may have contributed significantly to death (n = 300, 54.5%), and cardiac lesions were the most common pathological finding (n = 250, 45.5%). However, approximately one-third of the cases exhibited no remarkable pathological findings (n = 198, 36.0%). A quarter of all cases involved blood ethanol levels that exceeded 0.5 mg/mL (n = 140).ConclusionsThe results suggested that drowning plays an important role in the final process of bath-related death. Circulatory system diseases may be the primary underlying pathology; however, there were variations in the medical histories and pathologies of cases of bath-related death. From a preventive perspective, family members should pay attention to elderly people with circulatory system diseases during bathing, particularly in winter. Additionally, the notion that ill or inebriated individuals should not take baths should be reinforced.
Highlights
Many Japanese people relax by taking a bath
We examined aspects of cardiac pathology, including the extent of coronary artery stenosis and cardiomegaly, because our preliminary investigation showed that these features were present in a large majority of the cardiac pathology cases in bath-related deaths
Demographic findings of bath-related deaths Bath-related death was most frequently reported in individuals aged 80 to 89 years in both sexes (Table 1)
Summary
Many Japanese people relax by taking a bath. Unlike their European and American counterparts, the majority of Japanese people soak in standing water almost daily. A previous study showed that bath-related deaths typically occur during the winter months.[1,2,3,4] It is believed that a rapid change in body temperature, attributable to large differences between the bath water temperature and the ambient temperature in the dressing room, is a critical factor that is capable of inducing sudden death, in elderly people.[4] the precise mechanism of bath-related deaths is unknown, and preventive strategies have not been established because the majority of bath-related deaths do not lead to autopsy in the current Japanese death investigation system.[1] The need to gather objective evidence on autopsied cases has been emphasized[1]; there is a paucity of literature regarding autopsied cases of bath-related deaths.[4]. Sudden bath-related deaths occur frequently in Japan, among elderly people. Circulatory system diseases may be the primary underlying pathology; there were variations in the medical histories and pathologies of cases of bath-related death. The notion that ill or inebriated individuals should not take baths should be reinforced
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