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