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

2. 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

3. 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, 2000. The Clinical and Medical Forensics of Elder Abuse and Neglect. A Paper Commissioned by the National Academy of Science, 2000.

4. 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

5. 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

6. 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

7. Extreme Cases Shades of Gray

8. HowWhenWhy By Whom

10. Abrasions

11. Patterned Abrasion

13. Blunt Trauma

15. FRATURED HIP

16. POST SURGICAL REPAIR

17. Better care for elderly hard to find

20. Deadly bed rails

21. 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.

22. 'She's not my resident'

23. Criteria For External Exam 40-50 Years-old with documented Cardiac Hx 40-50 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

24. 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

25. 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

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

27. 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

28. 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

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

30. ICEBERG

31. 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