Alzheimer’s disease and dementia are dramatically underreported as a cause of death for seniors in nursing homes, according to a recently published research paper.

Researchers at Harvard Medical School found that, among seniors in nursing homes with confirmed cases of dementia, only 16% of death certificates listed the ailment as the cause of death and 37% of death certificates did not even mention the condition as a contributing factor. Roughly 33% of death certificates for those with confirmed cases of Alzheimer’s disease did not mention that condition as a main or contributing cause of death. Alzheimer’s disease is the fifth leading cause of death among those aged 65 and older, according to 2004 statistics.

Instances of dementia-related deaths could be up to four times as high as are currently reported, and better understanding of the fatal nature of the disease could lead to fewer unnecessary medical procedures toward the end of life, they say. The research paper appears in the Dec. 10 issue of the Journal of the American Medical Association.