Sudden deaths in the mentally handicapped

Abstract

SynopsisTrends in the incidence and causes of sudden deaths in a hospital group for the mentally handicapped were identified during a 50-year period, and the two halves of the period were compared. There were significantly more deaths in the second 25-year period than in the first. Longevity was greater during the second period, and a decrease in deaths due to status epilepticus was outweighed by an increase in deaths from arterial degenerative disease in the larger number of older patients. In the second period there was also a significant rise in sudden deaths due to asphyxia, probably attributable to modern medication with side-effects giving rise to feeding difficulties.

Forensic issues in Down syndrome fatalities

“…Epilepsy has been described as not a common finding in Down syndrome and rarely documented as a cause of death in some studies, 23 contrasting with others who have found a high prevalence of epilepsy (8-17%) with an associated elevated mortality rate. 16 It appears that seizures occur in 5-7% of Down syndrome children, compared to 20-50% of children with other forms of mental impairment, but are found at a higher rate in adult Down syndrome individuals with dementia compared to those with Alzheimers disease in the general population.…”

“…Deep venous thromboses have been found in individuals with mental retardation who have not been mobilising, and fat embolism has been described following femoral fracture in older individuals. 23 Rarely, fatal coronary artery embolism with myocardial infarction may occur in Down syndrome. 24 …”

“…10,36 Asphyxial deaths have been reported in mentally handicapped individuals from a combination of factors including respiratory depression from major tranquillizers, autonomic instability and impaired swallowing reflexes. Bulimia and eating disorders may also predispose to food asphyxia, 23 however it is unclear whether these factors are significant in the subpopulation of those with Down syndrome. Bronchopneumonia and aspiration pneumonia may be causes of death.…”

Comorbid Conditions in Individuals with Intellectual Disabilities

“…Several investigations (Beange et al 1995;Fisher 2004;Kerr et al 1996;Whitfield et al 1996) have suggested that the health mismanagement of this population has a severe impact on mortality Durvasula and Beange 2001;Hollins et al 1998); morbidity (Beange et al 1995;); and quality of life (Hensel et al 2002). Many of these medical conditions may cause the child with IDD pain, yet due to their inability to convey their pain and to present their suffering, they are doomed to experience delayed diagnosis and management of painful medical conditions, causing setbacks in hospitalization and even death (Carter and Jancar 1984;Mata 1960;Roy and Simon 1987).…”

Predictors of asphyxiation risk in adults with intellectual disabilities and dysphagia

“…The risk of asphyxiation will be increased if the person is noted to have cognitive impairment and oral stage dysfunction (Carter & Jancar 1984; Feinberg et al . 1992; Finestone et al .…”