Premature mortality in older people with epilepsy (PWE) stems from a combination of age-related vulnerabilities, comorbidities, and epilepsy-specific risks. Key contributors include status epilepticus (SE), cardiac complications, psychiatric conditions, frailty, and polypharmacy. Antiseizure medications (ASMs) may exacerbate mortality risk through cognitive decline, metabolic effects, and increased fall risk. Sudden unexpected death in epilepsy (SUDEP) is also a concern, though likely underrecognized in older adults due to diagnostic challenges. Other contributors—such as stroke, dementia, and external injuries—are more common and severe in this population.
While epilepsy-related mortality has declined globally, rates among older adults continue to rise. This increase is driven by a growing burden of comorbid neurological conditions, extensive ASM use, and heightened frailty. Social isolation, stigma, and reduced access to care further complicate outcomes. Late-onset epilepsy, especially when paired with dementia, significantly raises the risk of early death. Addressing these risks with targeted strategies—such as optimizing ASM regimens, managing comorbidities, and improving SUDEP awareness—may help reduce mortality in this high-risk group.
Reference: Hashmi SA, Gundlapalli R, Zawar I. Mortality in older adults with epilepsy: An understudied entity. Epilepsia Open. 2025 Feb;10(1):15-30. doi: 10.1002/epi4.13098. Epub 2024 Nov 11. PMID: 39527018; PMCID: PMC11803281.
