Mortality and cause of death in a hospital for the mentally retarded

Mortality of Elderly Mentally Retarded Persons in California

We examined the mortality experiences of 87,352 mentally retarded persons who were receiving services from the State of California between March 1984 and October 1987. Our purpose was to examine how demographic, diagnostic, and adaptive behavior characteristics were related to the mortality of older retarded people in comparison to their younger counterparts. The findings revealed that persons with Down's syndrome among other diagnostic categories, for example, infection and intoxication, unknown prenatal influences, and so on, had a relatively high mortality rate after age 55. Other characteristics related to high mortality among elderly retarded people included residence type, mobility, eating, and toileting skills. Of particular interest was the finding that regression in mobility, eating, or toileting skills among the older clients was associated with unusually elevated mortality rates.

Surgical correction of scoliosis in pediatric patients with cerebral palsy using the unit rod instrumentation

STUDY DESIGN

Retrospective clinical and radiographic consecutive case series of 2 surgeons.

OBJECTIVE

The purpose of this study was to present a large consecutive series of patients with cerebral palsy who were treated with the Unit rod instrumentation at a single institution. The goal was to report the incidence of surgical complications, degree of deformity correction, reoperation rate, prevalence of pseudarthrosis, and the caretakers' perceived outcome.

SUMMARY OF BACKGROUND DATA

Children with cerebral palsy frequently develop scoliosis that requires surgical correction. Segmental instrumentation has been the primary mode of treatment. There are no reported large series with long-term follow up.

METHODS

This study was a retrospective review of 287 children treated with the Unit rod instrumentation. This instrumentation with fusion included the whole spine (between C7 and T3 into the pelvis) with 242 posterior-only and 45 anterior-posterior procedures. Of this group, 241 patients were observed for more than 2 years. This review focused on the rate of complications and radiographic outcome of the treatment. Parent and caretaker interviews were conducted to define perceived functional outcome after surgery.

RESULTS

Scoliosis was corrected from a mean of 76 degrees to 25 degrees (68%). Pelvic obliquity was corrected from a mean of 17 degrees to 5 degrees (71%). In posterior-only procedures the average blood loss was 2.8 L, ICU stay was 4.9 days, and the hospital stay was 19.6 days. In combined procedures, the average blood loss was 3.4 L, ICU stay was 6.7 days, and the hospital stay was 24.5 days. Major complications included 3 perioperative deaths, 18 deep wound infections [12 early deep infections in a total of 287 patients (4.2%); 6 late deep infections in a total of 236 patients (2.5%)], and 2 patients with septicemia who recovered after prolonged antibiotic management. Caretakers' survey reported a 96% satisfaction rate.

CONCLUSION

The Unit rod instrumentation is a common standard technique and the primary instrumentation system for the treatment of pediatric patients with cerebral palsy and neuromuscular scoliosis because it is simple to use, it is considerably less expensive than most other systems, and can achieve good deformity correction with a low loss of correction, as well as a low prevalence of associated complications and a low reoperation rate.

The life expectancy of profoundly handicapped people with mental retardation

BACKGROUND

The life expectancy of people with mental retardation is shorter than that of the general population. Exact estimates of the length of survival for mentally retarded persons at especially high risk are not available, however.

METHODS

We collected data on mortality and other factors for 99,543 persons with developmental disabilities, including mental retardation, who received services from the California Department of Developmental Services between March 1984 and October 1987. Three subgroups were selected on the basis of the four characteristics identified in previous studies as the best predictors of mortality among mentally retarded people (deficits in cognitive function, limitations on mobility, incontinence, and inability to eat without assistance). In all three subgroups, the subjects had severe deficits in cognitive function and were incontinent; the subjects in subgroup 1 (n = 1550) were immobile and required tube feeding; those in subgroup 2 (n = 4513) were immobile but could eat with assistance; those in subgroup 3 (n = 997) were mobile (but not ambulatory) and could eat with assistance. Life tables were generated for each of the three subgroups.

RESULTS

Immobile subjects were found to have a much shorter life expectancy than those who could move about. Those who also required tube feeding (subgroup 1) had a very short life expectancy (i.e., four to five additional years). Those who could eat if fed by others (subgroup 2) had an average life expectancy of approximately eight additional years. In contrast, those who were mobile though not ambulatory (subgroup 3) had a life expectancy of about 23 additional years.

CONCLUSIONS

Severe mental retardation is associated with a decrease in life expectancy, particularly for those who were immobile.