The objective of this literature review is to discuss the multifaceted causes of premature mortality in older people with epilepsy (PWE).

Despite a worldwide decrease in overall epilepsy death rates and disability-adjusted life years due to epilepsy, there has been a significant increase in epilepsy evidence among individuals older than 65 years of age. Older PWE remains a significantly understudied demographic, and further research is needed to continue this essential investigation into premature mortality in this demographic.

We conducted a literature review using the following search strategy: (epilep*[Title/Abstract]) OR seizure [Title/Abstract] AND elderly [Title/Abstract] OR older adults [Title/Abstract] AND mortality [Title/Abstract] OR SUDEP [Title/Abstract]). The search was performed on Google Scholar, PubMed, and Medline till March 2024.

109 articles were reviewed. Investigated factors of mortality included sudden unexpected death in epilepsy (SUDEP) (14 articles), status epilepticus (9 articles), cardiac mortality (10 articles), polypharmacy and anti-seizure medications (16 articles), and external causes of mortality (3 articles). The review also discusses changing trends of mortality in PWE over 16 years of data (7 articles), and mortality outcomes in older PWE with specific neurological comorbidities (24 articles). This review delves into all of these factors in detail, as well as the significance of these factors on premature mortality in PWE.

Older PWE are prone to excess mortality due to a plethora of factors, unique from other populations of PWE. Future directions include implementing enhanced diagnostic protocols, developing treatment plans, and integrating real-time monitoring technologies to reduce the risk of sudden death and multifaceted premature mortality in this patient population. Increasing awareness among healthcare providers and families about the risks and management of epilepsy in older adults, along with fostering collaborative research efforts, is essential to improve mortality outcomes.