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The Fatal Five: An Overview for IDD Staff

The “Fatal Five” is a group of preventable conditions that are often fatal for people with intellectual and developmental disabilities (IDD) living in congregant residential settings. They include aspiration, dehydration, seizures, constipation, and sepsis. Identifying healthcare needs can be hard for anyone. Do you remember a time when you had symptoms you didn’t understand?

Recognizing healthcare needs can be even harder for someone with IDD. Sensory or communication challenges can make it hard for a person to know something is wrong or ask for help. As a result, people with IDD often depend on their support network, including direct support professionals (DSPs), to help them identify and respond to healthcare needs.

Why did the Fatal Four become the Fatal Five?

For years, these conditions were commonly referred to as the Fatal Four. The list included aspiration, constipation, dehydration, and seizures. Recent research into the causes and effects of these serious conditions among the IDD population, however, has revealed that a fifth condition, sepsis, can greatly affect the health and well-being of those with IDD.

Sepsis is the body’s extreme reaction to an infection and is considered a life threatening, medical emergency. While sepsis can occur in anyone with an infection, those with IDD are more predisposed to developing this condition. Why? Three of the Fatal Four conditions can directly lead to sepsis:

  • Aspiration, or the inhaling of food and/or drink particles into the lungs, can lead to pneumonia, which, if left untreated, can lead to sepsis.
  • Constipation can lead to infections in the colon or rectum if the patient has an untreated wound in those areas.
  • Dehydration, if left untreated, makes individuals more susceptible to infections and can increase the severity of these infections.

Additionally, if an individual with IDD experiences seizures, a seizure-related fall could lead to a wound, which, if unreported, could become infected. If this individual contracts an infection in that wound and develops sepsis, they are at a higher risk of having another seizure.

Compounding all of this, individuals with IDD may have trouble reporting the symptoms of aspiration, dehydration, constipation, and/or seizures, making it more likely that the condition will become severe and lead to an infection.

The interrelated nature of sepsis with these other conditions that are common among individuals with IDD have prompted experts to change the Fatal Four to the Fatal Five.

But how can you, as a DSP or IDD staff member, help to safeguard your clients against the Fatal Five?

Understanding your client’s baseline

A baseline is a starting point. A person’s baseline refers to how they normally act, feel, or look. As you get to know the people you support, you will learn their baseline. This includes:

  • Their typical appearance
  • Their usual moods
  • How they move
  • What, when, and how much they eat
  • Their usual sleeping patterns
  • How they interact with others

Any change from a person’s baseline could mean that something is wrong. When you see signs of a change, you should always consider if the person may have a new healthcare need.

Gathering information on your client’s health is crucial to preventing the Fatal Five

Sometimes a change has a simple explanation. A person might have had a hard time getting out of bed because of staying up late watching TV. However, sometimes being tired is a symptom of illness.

Your goal in exploring a change is not to diagnose the person’s healthcare needs. It is simply to gather information so you and other team members can decide how to respond to a change. Gathering information can help you learn:

  • If an observed change has a known cause
  • More details about the symptoms you observe
  • Other signs and symptoms to report

To gather information, you can:

  • Ask: Find out how the person is feeling and what is happening. You will need to know how they usually communicate to be able to interpret what they tell you. Some people can tell you what is wrong. Others will not.
  • Observe: Continue to observe the person and look for anything that might give clues to what is going on. Observing can include:
    • Watching their body language and facial expressions
    • Watching their behavior
    • Checking their body for physical changes
    • Checking their vital signs
  • Read: A person’s records may provide clues to what is happening and if the Fatal Five may be involved. A service plan or medical record will describe known health conditions or risks. Recent documentation may tell you if others have seen any signs of a health problem.

To learn more about the Fatal Five and how to keep your client’s safe, read our articles on each of the Fatal Five conditions:

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