The Fatal Four: Major Health Issues that Impact Individuals with Intellectual and Developmental Disabilities

There are four major health issues that are common among individuals with intellectual and developmental disabilities (IDD) residing in congregate care settings or in community based residential settings. These health issues, commonly referred to as “The Fatal Four”, include aspiration, dehydration, constipation, and seizures. Because the Fatal Four can be difficult to identify or diagnose in the IDD population, they often go unrecognized, and are therefore linked to a significant number of preventable deaths. It is very important for those who care for individuals with IDD to be aware of health problems that are common for this population.

Aspiration is the inhalation of food, fluid, medication or other foreign material into the trachea and lungs during or following swallowing. Aspiration is a major medical concern for persons with IDD in institutional settings due to risk factors of decreased alertness, chronic chest congestion, and behavioral issues related to eating. Once aspiration occurs, these individuals may develop pneumonia which is sometimes unrecognized until the patients become seriously ill. Additionally, these patients are often immunocompromised which puts them at risk for subsequent sepsis.

Dehydration occurs when the body loses more fluid than it produces. Most body systems and organ functions are affected by dehydration, and it can cause many serious health problems including decreased cognitive ability, constipation, increased seizure frequency, and in extreme cases coma and death. Individuals who need assistance with drinking or taking fluids and those who have an impaired response to thirst impulse are particularly likely to experience dehydration.

The most common causes of preventable death in people in community settings with IDD are due to complications related to constipation, such as bowel obstruction. Constipation occurs when an individual experiences difficulty or infrequency of passing stool. Many medications have constipating side effects resulting in prolonged periods without passing stools, which may be unrecognized in this population. Correction of constipation is increasingly difficult as stool becomes impacted, and may not respond to dietary or medical management.

Individuals with IDD have a higher incidence of seizure disorders or epilepsy. SUDEP, or sudden unexplained death in epilepsy, occurs not infrequently and for reasons that medical science has yet to explain. Additionally, patients may develop seizures due to drug toxicity. In this population, once a seizure occurs, there can be significant morbidity or mortality due to issues such as lack of ventilation or aspiration.

Click here to learn more about different interventions and treatments for The Fatal Four.