What are the Fatal Five?

The Fatal Five are the top five conditions linked to preventable health deterioration or death of people with intellectual and developmental disabilities. As a caregiver, it is important to be aware of the fatal five, increase your knowledge of symptoms, and learn when to act. In this article, you will learn more about each of these conditions and some tips for increasing your awareness.


Aspiration is the act of breathing in a foreign object (or sucking food into the airway) and is the most common cause of death in congregate care settings. Factors that may lead to aspiration include improper or poor body positioning and behavioral issues related to eating. Aspiration often begins subtly and causes an increasing amount of damage to the airway. To aid in the prevention of aspiration ensure food is cut into small, bite-sized pieces (or ground) and that the person sits straight up when eating or drinking. They should also remain in an upright position (at least a 45-degree angle) for at least one hour after eating. Some subtle warning signs of aspiration to be aware of include: coughing (especially during eating), refusal to drink thin liquids, resistance to eating or drinking, recurrent pneumonia, and reactive airway disease.

Bowel Obstruction

Bowel obstruction occurs when something blocks the bowels and consequently, one’s digestive system is unable to function and an individual is unable to have a bowel movement or pass gas. Bowel obstruction is the most common cause of preventable death in community settings. Quite often, the root cause of this condition is the use of multiple medications with constipating side effects but can also be caused by a lack of mobility, poor diet, and PICA. It may be difficult for individuals to communicate their pain and other symptoms related to bowel obstruction and the risk of repeat obstructions is very high. Ensuring adequate active physical activity (walking or exercise), having a healthy diet comprised of adequate fiber and fluids, avoiding the use of irritant laxatives and the addition of probiotics can help prevent bowel obstruction.


Dehydration occurs when you use or lose more fluid than you take in and your body doesn’t have enough water and other fluids to carry out its normal functions. This can present itself more in individuals who do not swallow well, drool often, refuse fluids, or have fluids restricted by others in an effort to combat incontinence. Dehydration is more prevalent in the summer months as bodies normally lose liquids via perspiration. Ensuring individuals are taking in fluids is the easiest way to combat dehydration. Hint: Trial different types of fluids to see what works best for each person, including flavored water or seltzer water!


Seizures are an alteration in brain function which results in a change in awareness or function for a brief period of time. Seizures can present in multiple ways and can be the most severe of the Fatal Five. Seizures can have many contributing factors including constipation, infection, medication compliance issues, menses, shunt issues, head injury, stroke, electrolyte imbalance, and hypoglycemia. If an individual has seizures the most important factor is ensuring routine and regular follow-up with a neurologist who can support in determining key factors for prevention. One thing caregivers can do to support the neurologist is meaning an accurate seizure record including when the seizure started (awake or asleep), any known triggers (stressed or tired), position the individual was in, any warning signs noticed, among other factors. Tips for accurate record keeping and charting can be found here.


Sepsis, or blood poisoning due to failure of the immune system to respond to infection, is often referred to as the “silent killer.” Sepsis is very prevalent and has a high in-hospital mortality rate. Symptoms of sepsis include high temperature, rapid pulse, chills, low blood pressure, mottling (blotchy, red-purplish marbling) of skin, confusion, and lightheadedness. Every hour that passes without treatment for sepsis raises the death risk by 10%. Since many signs of sepsis can mimic other diagnoses it is important if sepsis is a possible option to see a doctor right away.

Remember, the most important part of fixing a problem is identifying what the problem is. You can play a role by recognizing early warning signs, never discounting reports made by family members or DSPs—often they know the person better than anyone!—and being an advocate for the ones we love. When in doubt, get it checked out!