EXTERNAL CAUSES OF DEATH AMONG PERSONS WITH DEVELOPMENTAL DISABILITY - THE EFFECT OF RESIDENTIAL PLACEMENT

The authors analyzed death rates from external causes (accidents, inju ries, homicides, etc.) for persons with developmental disability in Ca lifornia. There were 520 such deaths during the 1981-1995 study period , based on 733,705 person-years of exposure; this represents all perso ns who received any services from the state. Compared with the general California population, persons with developmental disability were at lower risk of homicide, suicide, and poisonings (standardized mortalit y ratios, 0.31-0.68), but higher risk of pedestrian accidents, falls, fires, and, especially, drowning (standardized mortality ratio = 6.22) , A major focus of the study was comparisons between different residen tial settings. Persons in semi-independent living had significantly hi gher risk than did those in their family home or group homes, with hom icides rates being three times higher and pedestrian accidents rates b eing doubled, while persons in institutions had much lower risks with respect to most causes. Of the 28 deaths due to drug and medication ov erdoses, 79 percent occurred in supported living or small-group homes. Avoidable deaths could be reduced by making direct care staff more aw are of the risks and better trained in acute care, along with improved monitoring of special incidents.