Study of death with the severely disabled.

Abstract

Objective: The characteristics of death in patients with severe mental and physical disabilities include, a short period from the onset of symptoms to death and sudden death in the young. However in recent years, it has not been rare for such patients to live to more than 50 years old. We examined the survival rate and current state of death within 24 hours among this patient population at our center. Methods: We identified 314 deaths from April 1 in 1969 to March 31 in 2013 and a total of 388 survivors during this date range. Based on confirmation, cases of death occurring within 24 hours from onset were extracted. The probability of survival was estimated and graphed using the Kaplan-Meier method, and factors influencing the characteristics of death within 24 hours and/or the survival rate were investigated using medical records after 1995. Results: The median age at survival was 56 years. The need for gastrostomy feeding was associated with a 2.4 times higher mortality rate than oral feeding. The survival estimate at 60 years for the cases of gastrostomy feeding was 34%, and the survival estimate at 70 years for the cases involving severe motor impairment was 34%. The age distribution showed no significant differences between the two groups, i. e.; cases of death within 24 hours and others. In the cases of death within 24 hours, the patients were tracheotomized and/or not followed with a monitor, which suggests that death may occur in all cases, irrespective of the patient’s condition. Conclusions: This study showed that patients with severe motor impairment may survive beyond 70 years of age. Death within 24 hours is not associated with a specific mortality age and can occur in any patient regardless of the severity of their condition, accounting for a relatively high proportion of causes of death, even now.