4.3 Article

Identifying gaps and improving investigation of fatal elder abuse and/or neglect

Journal

JOURNAL OF FORENSIC SCIENCES
Volume 66, Issue 6, Pages 2274-2282

Publisher

WILEY
DOI: 10.1111/1556-4029.14884

Keywords

abuse assessment; coroner; death investigation; elder maltreatment; elder mortality; forensic pathology; medical examiner

Funding

  1. Texas A and M University

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This study assessed the possibility of elder abuse and neglect by using simple screening criteria and a supplemental data collection tool. The results showed that a large number of cases were excluded using the screening criteria, leaving only a smaller percentage of cases for further investigation, which indicated the effectiveness of the screening process in identifying potential cases of abuse and neglect.
Death investigator and autopsy reports for decedents 65 years and older within a major metropolitan area over a five-year period were assessed for the possibility of elder abuse and/or neglect. The study consisted of two stages. A simple two-question screening criteria was used to determine whether the decedent was (1) dependent on another for at least one activity of daily living and (2) had a presence of at least one indicator of abuse and/or neglect. Second, only cases with affirmative criteria responses were reviewed to identify inconsistent or deficient variables that precluded (or if present, allowed) determination of abuse and/or neglect. A multidisciplinary panel of local and national experts, including forensic pathologists, law enforcement, and geriatricians assessed these indicators as indicative of presence of abuse/neglect, and these indicators were subsequently developed as a supplemental data collection tool. Of a possible 2798 cases, 2324 (83%) were excluded using the screening criteria. This reduced the number of cases that warranted further investigation to 474 (17% of elderly deaths in this timeframe). All 474 decedents were dependent on another for at least one ADL and 322 (68%) had unexplained injuries. In 180 (38%) cases had recorded notation of a suspicion of abuse and/or neglect at the time of death. The results support the premise that a simple, two-criterion screening can effectively identify cases of potential abuse and/or neglect and, when followed by a supplemental data collection tool, cases can be efficiently evaluated.

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