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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
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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 • Criteria For External Exam • Current Trends Autopsy Frequency
Elderly Abuse • 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.
Potential Markers of Abuse & Neglect • Abrasions and Lacerations • Bruises(Contusions) • Fractures • Restraint • Decubiti • Malnutrition • Dehydration
Potential Markers of Abuse and Neglect • Medication Use • Burns • Cognitive and Mental Health Problems • Hygiene • Sexual Abuse • Financial, Fraud and Exploitation
H Potential Markers of Abuse & Neglecthistory Cause and Manner of Scene Death Case PresentationForensic Diagnostic Dilemmas Investigation Science
Diagnostic Dilemmas Extreme Cases Shades of Gray
Shades of Gray How When Why By Whom
Elderly Abuse • Apathy toward the Elders (antemortem) • Apprehensions of Death Investigators • Attitude of the M.E.
Criteria For External Exam • 40-50 Years-old with documented Cardiac Hx • 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. • Sustained accidental injury under Hospice care • Sustained a fractured hip and the injury is clinically documented
Criteria For External Exam • Sustained accidental head trauma, clinically documented with a scene and circumstances consistent with an accidental manner of death. • Delayed death from MVA • Sustained fire-related injuries with clinical documentation and scene and circumstances are documented to be consistent with accidental manner
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
Current Trends Autopsy Frequency -- United States, 1980-1985 • approximately 14% of the 2,089,378 deaths • the decline may have adversely affected the accuracy of determining the underlying cause of death
ADVERSE DRUG REACTIONS • Up to 200,000 patients die each year from adverse drug reactions
Conclusion • Multidisciplinary Team Work • Research to Establish Forensic Markers • Special considerations in the Postmortem analysis • Forensic Psychiatric Autopsy
Mark Malcolm, F-ABMDICoroner of Pulaski Countycoroner@co.pulaski.ar.us(501) 340-8355
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