An Investigative Tool for Detecting Elder Abuse. Issue 4 (December 2014) - Isaac, Carolyn V.
Elder abuse is estimated to affect one in ten individuals 60 years of age and older and has been significantly associated with an increased risk of mortality. However, no clear data exist on the number of deaths that result from elder abuse or neglect. The potential contribution of abuse and neglect to the death of an elder is rarely investigated, as natural deaths are expected with advancing age. Elders are often reliant on others for care making them a vulnerable population. Although the deaths of other vulnerable populations, including children, are routinely investigated, no protocols for elder death investigation have been enacted. We propose the implementation of an investigative tool to assess the elder decedent and residence for indicators of abuse or neglect. Investigations may assist in differentiating self-neglect and caretaker neglect. Decedent observations include: evidence of injuries, personal hygiene, malnutrition and/or dehydration, decubitus ulcers, evidence of restraint, unexplained vaginal or anal bleeding, and previous reports with Adult Protective Services. To differentiate between self-neglect and caretaker neglect, an assessment of the level of dependence on others for activities of daily living and the level of involvement of the caretaker are determined. The decedent's living condition assessment includes evidence of forced isolation; lack of food, water or utilities; soiled clothing and/or bedding; filthy or unsafe living conditions; and inappropriate administration of medications. With proper training, medical examiners can easily implement these protocols. Such information is extremely valuable for determining whether further investigation and examination of the decedent is warranted.