Elderly Abuse Douglas Posey, MD Diplomate, American Board of Pathology Anatomic Pathology, Clinical Pathology and Forensic Pathology Georgia Bureau of Investigation Decatur, Georgia Decatur, Georgia

Elderly Abuse Potential Markers of Abuse & Neglect Potential Markers of Abuse & Neglect Criteria For External Exam Criteria For External Exam Current Trends Autopsy Frequency Current Trends Autopsy Frequency

Elderly Abuse Dyer, C. B., M. T. Connolly and P. McFeeley. Dyer, C. B., M. T. Connolly and P. McFeeley. The Clinical and Medical Forensics of Elder Abuse and Neglect. A Paper Commissioned by the National Academy of Science, The Clinical and Medical Forensics of Elder Abuse and Neglect. A Paper Commissioned by the National Academy of Science, 2000.

Potential Markers of Abuse & Neglect Abrasions and Lacerations Abrasions and Lacerations Bruises(Contusions) Bruises(Contusions) Fractures Fractures Restraint Restraint Decubiti Decubiti Malnutrition Malnutrition Dehydration Dehydration

Potential Markers of Abuse and Neglect Medication Use Medication Use Burns Burns Cognitive and Mental Health Problems Cognitive and Mental Health Problems Hygiene Hygiene Sexual Abuse Sexual Abuse Financial, Fraud and Exploitation Financial, Fraud and Exploitation

Potential Markers of Abuse & Neglect H Potential Markers of Abuse & Neglect history Scene Investigation Case Presentation Case Presentation Forensic Science Cause and Manner of Death Diagnostic Dilemmas

Extreme Cases Shades of Gray

HowWhenWhy By Whom

Abrasions

Patterned Abrasion

Blunt Trauma

FRATURED HIP

POST SURGICAL REPAIR

Better care for elderly hard to find

Deadly bed rails

Elderly Abuse Apathy toward the Elders (antemortem) Apathy toward the Elders (antemortem) Apprehensions of Death Investigators Apprehensions of Death Investigators Attitude of the M.E. Attitude of the M.E.

'She's not my resident'

Criteria For External Exam Years-old with documented Cardiac Hx Years-old with documented Cardiac Hx 50 years-old or younger with terminal cancer, AIDS or other terminal condition. 50 years-old or younger with terminal cancer, AIDS or other terminal condition. >60 years-old with no outward or palpable signs of injury a benign scene. >60 years-old with no outward or palpable signs of injury a benign scene. Sustained accidental injury under Hospice care Sustained accidental injury under Hospice care Sustained a fractured hip and the injury is clinically documented Sustained a fractured hip and the injury is clinically documented

Criteria For External Exam Sustained accidental head trauma, clinically documented with a scene and circumstances consistent with an accidental manner of death. Sustained accidental head trauma, clinically documented with a scene and circumstances consistent with an accidental manner of death. Delayed death from MVA Delayed death from MVA Sustained fire-related injuries with clinical documentation and scene and circumstances are documented to be consistent with accidental manner Sustained fire-related injuries with clinical documentation and scene and circumstances are documented to be consistent with accidental manner

Criteria For External Exam An external examination may be performed on a decomposed body if the condition of the body permits identification and adequate assessment of potential trauma An external examination may be performed on a decomposed body if the condition of the body permits identification and adequate assessment of potential trauma

Current Trends Autopsy Frequency -- United States, approximately 14% of the 2,089,378 deaths approximately 14% of the 2,089,378 deaths the decline may have adversely affected the accuracy of determining the underlying cause of death the decline may have adversely affected the accuracy of determining the underlying cause of death

ADVERSE DRUG REACTIONS Up to 200,000 patients die each year from adverse drug reactions Up to 200,000 patients die each year from adverse drug reactions

Conclusion Multidisciplinary Team Work Multidisciplinary Team Work Research to Establish Forensic Markers Research to Establish Forensic Markers Special considerations in the Postmortem analysis Special considerations in the Postmortem analysis Forensic Psychiatric Autopsy Forensic Psychiatric Autopsy

Mark Malcolm, F-ABMDI Coroner of Pulaski County (501)

ICEBERG

Thank you for your attention. “To be conscious that you are ignorant of the facts is a great step to knowledge.” Benjamin Disraeli,