Elderly Abuse Douglas Posey MD Diplomate American Board

Elderly Abuse Douglas Posey, MD Diplomate, American Board of Pathology Anatomic Pathology, Clinical Pathology and Forensic Pathology Georgia Bureau of Investigation Decatur, Georgia 30034 Douglas. Posey@GBI. STATE. GA. US 404 -270 -8189

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

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

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

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

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

Diagnostic Dilemmas Extreme Cases Shades of Gray

Shades of Gray How When Why 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) n Apprehensions of Death Investigators n Attitude of the M. E. n

'She's not my resident'

Criteria For External Exam 40 -50 Years-old with documented Cardiac Hx n 50 years-old or younger with terminal cancer, AIDS or other terminal condition. n >60 years-old with no outward or palpable signs of injury a benign scene. n Sustained accidental injury under Hospice care n Sustained a fractured hip and the injury is clinically documented n

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

Criteria For External Exam n 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, 1980 -1985 approximately 14% of the 2, 089, 378 deaths n the decline may have adversely affected the accuracy of determining the underlying cause of death n

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

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

Mark Malcolm, F-ABMDI Coroner of Pulaski County coroner@co. pulaski. ar. us (501) 340 -8355

ICEBERG

Thank you for your attention. “To be conscious that you are ignorant of the facts is a great step to knowledge. ” Benjamin Disraeli, 1804 -1881