Elderly AbuseElderly Abuse

Douglas Posey, MDDouglas Posey, MDDiplomate, American Board of PathologyDiplomate, American Board of Pathology

Anatomic Pathology, Clinical Pathology and Forensic PathologyAnatomic Pathology, Clinical Pathology and Forensic PathologyGeorgia Bureau of InvestigationGeorgia Bureau of Investigation

Decatur, Georgia 30034Decatur, Georgia 30034Douglas.Posey@GBI.STATE.GA.USDouglas.Posey@GBI.STATE.GA.US

404-270-8189 404-270-8189

Elderly AbuseElderly Abuse

Potential Markers of Abuse & Potential Markers of Abuse & NeglectNeglect

Criteria For External ExamCriteria For External Exam Current Trends Autopsy FrequencyCurrent Trends Autopsy Frequency

Elderly AbuseElderly Abuse

Dyer, C. B., M. T. Connolly and P. Dyer, C. B., M. T. Connolly and P. McFeeley.McFeeley.

The Clinical and Medical Forensics The Clinical and Medical Forensics of Elder Abuse and Neglect. A of Elder Abuse and Neglect. A Paper Commissioned by the National Paper Commissioned by the National Academy of Science , 2000.Academy of Science , 2000.

Potential Markers of Potential Markers of Abuse & NeglectAbuse & Neglect

Abrasions and LacerationsAbrasions and Lacerations Bruises(Contusions)Bruises(Contusions) FracturesFractures RestraintRestraint DecubitiDecubiti MalnutritionMalnutrition DehydrationDehydration

Potential Markers of Potential Markers of Abuse and NeglectAbuse and Neglect

Medication UseMedication Use BurnsBurns Cognitive and Mental Health Cognitive and Mental Health

ProblemsProblems HygieneHygiene Sexual AbuseSexual Abuse Financial, Fraud and ExploitationFinancial, Fraud and Exploitation

H Potential Markers Potential Markers

of Abuse & Neglectof Abuse & Neglect

history

SceneInvestigation

Case PresentationCase Presentation

ForensicScience

Causeand

Mannerof

Death

Diagnostic DilemmasDiagnostic Dilemmas

Diagnostic Diagnostic DilemmasDilemmas

Extreme Cases Extreme Cases

Shades of GrayShades of Gray

Shades of GrayShades of Gray

HowHow

WhenWhen

WhyWhy

By WhomBy Whom

AbrasionsAbrasions

Patterned AbrasionPatterned Abrasion

Blunt TraumaBlunt Trauma

FRATURED HIPFRATURED HIP

POST SURGICAL REPAIRPOST SURGICAL REPAIR

Better care for elderly hard to find

Deadly bed rails

Elderly AbuseElderly Abuse

Apathy toward the Elders Apathy toward the Elders (antemortem)(antemortem)

Apprehensions of Death Apprehensions of Death InvestigatorsInvestigators

Attitude of the M.E.Attitude of the M.E.

'She's not my resident'

Criteria For External Criteria For External ExamExam

40-50 Years-old with documented Cardiac 40-50 Years-old with documented Cardiac HxHx

50 years-old or younger with terminal 50 years-old or younger with terminal cancer, AIDS or other terminal condition.cancer, AIDS or other terminal condition.

>60 years-old with no outward or palpable >60 years-old with no outward or palpable signs of injury a benign scene.signs of injury a benign scene.

Sustained accidental injury under Hospice Sustained accidental injury under Hospice carecare

Sustained a fractured hip and the injury is Sustained a fractured hip and the injury is clinically documentedclinically documented

Criteria For External Criteria For External ExamExam

Sustained accidental head trauma, Sustained accidental head trauma, clinically documented with a scene clinically documented with a scene and circumstances consistent with an and circumstances consistent with an accidental manner of death.accidental manner of death.

Delayed death from MVADelayed death from MVA Sustained fire-related injuries with Sustained fire-related injuries with

clinical documentation and scene and clinical documentation and scene and circumstances are documented to be circumstances are documented to be consistent with accidental mannerconsistent with accidental manner

Criteria For External Criteria For External ExamExam

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

Current Trends Autopsy Frequency -- Current Trends Autopsy Frequency -- United States, 1980-1985 United States, 1980-1985

approximately 14% of the 2,089,378 approximately 14% of the 2,089,378 deaths deaths

the decline may have adversely the decline may have adversely affected the accuracy of determining affected the accuracy of determining the underlying cause of death the underlying cause of death

ADVERSE DRUG REACTIONSADVERSE DRUG REACTIONS

Up to 200,000 patients die each year Up to 200,000 patients die each year from adverse drug reactionsfrom adverse drug reactions

ConclusionConclusion

Multidisciplinary Team WorkMultidisciplinary Team Work Research to Establish Forensic Research to Establish Forensic

MarkersMarkers Special considerations in the Special considerations in the

Postmortem analysisPostmortem analysis Forensic Psychiatric AutopsyForensic Psychiatric Autopsy

Mark Malcolm, F-ABMDICoroner of Pulaski Countycoroner@co.pulaski.ar.us(501) 340-8355

ICEBERGICEBERG

Thank you for Thank you for your attention.your attention.

““To be conscious that you are To be conscious that you are ignorant of the facts is a great ignorant of the facts is a great

step to knowledge.”step to knowledge.” Benjamin Disraeli, 1804-1881Benjamin Disraeli, 1804-1881