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Forensic Elder Abuse Research

The forensic aspects of elder abuse and neglect are beginning to be explored and documented. In this section we present some recent research about several potential forensic markers.

European council of legal medicine (ECLM) offers guidelines for the examination of suspected elder abuse

Keller, E., Santos, C., Cusack, D., Väli, M., Ferrara, D., Ludes, B., ... & Vieira, D. N. (2019). European council of legal medicine (ECLM) guidelines for the examination of suspected elder abuse. International Journal of Legal Medicine133(1), 317-322.

The critical role of health care providers in elder abuse detection and management is increasingly being recognized. Members of the European Council of Legal Medicine (ECLM) published guidelines to provide healthcare professionals and forensic practitioners with a common examination framework for properly documenting and evaluating potential elder abuse victims. Additional factors that should be considered when determining whether an older adult has been the victim of elder abuse are outlined. Finally, recommendations for writing a report for the judiciary based on clinical records are provided.

Geriatric Injury Documentation (Geri-IDT) Tool

Kogan, A.C., Rosen, T., Navarro, A., Homeier, D., Chennapan, K., & Mosqueda, L. (2019). Developing the Geriatric Injury Documentation Tool (Geri-IDT) to improve documentation of physical findings in injured older adults. Journal of General Internal Medicine, 34(4), 567-574. DOI: 10.1007/s11606-019-04844-8

The link between injury and elder abuse is not often identified during a medical encounter. Incomplete or inadequate documentation of an older adult’s injuries by medical providers can significantly impact whether justice and protection can be achieved. To address this gap, this article describes the development of a tool for use among health care providers to document injuries in older adults for potential use in future forensic investigations of abuse and neglect. After drafting a tool based on a literature review, 11 key informant interviews were conducted, followed by two focus groups. The instrument, dubbed the Geri-IDT was revised accordingly. Next steps involve pilot testing the Geri-IDT in different medical contexts. Practical concerns such as the feasibility of incorporating this tool into clinical practice are discussed.

Hair samples reveal starvation to help document elder abuse and neglect

Baković, M., Vreča, P., & Mayer, D. (2017). Case of fatal starvation: Can stable isotope analysis serve to support morphological diagnosis and approximate the length of starvation? Journal of Forensic Science, 62(1), 258-264. doi:10.1111/1556-4029.13244

The authors conducted analysis of stable carbon and nitrogen isotope ratios in hair samples to investigate whether or not this type of analysis could support more traditional forms of starvation diagnosis based on anthropological measurements, visual, microscopic analysis, laboratory testing, and exclusion of other causes of death. They conclude that because hair growth rate of malnourished individuals has never been measured accurately, it is still not possible to determine the time frame of isotope change reliably. But future investigations of stable isotope changes in people deceased due to starvation, as well as comparisons of these with autopsy findings, could lead to advances in forensic medicine that would be useful for forensic medicine experts testifying in cases of suspected starvation.

Emergency room protocol to photograph injuries and evaluate abuse

Bloemen, E.M., Rosen, T., Schiroo, J.A.C., Clark, S., Mulcare M.R., Stern, M.E., Mysliwiec, R., Flomenbaum, N.E., Lachs, M.S., &Hargarten, S. (2016). Photographing injuries in the acute care setting:  Development and evaluation of a standardized protocol for research, forensics, and clinical practice.  Academic Emergency Medicine, 23(5), 653-659.  doi:  10.1111/acem.12955

The authors created and validated a standardized protocol for photographing and documenting injuries to elders in acute care Emergency Department settings. The protocol requires a simple ruler, color guide and a standard point-and-shoot digital camera. The protocol was accurate and reliable for different types of injuries to 33 different parts of the body when used by non-professional photographers with minimal training. The process took less than two minutes when photographing a single injury and less than five minutes for multiple injuries. The photos can be used in future legal/forensic processes as defensible evidence. 

Fracture repair healing continuum applied to elder abuse investigations

Boyd, D. C. (2017). The anatomical basis for fracture repair: Recognition of the healing continuum and its forensic applications to investigations of pediatric and elderly abuse. In C. C. Boyd & D. C. Boyd (Eds.), Forensic anthropology: Theoretical framework and scientific basis (pp. 151-200). Hoboken, NJ: John Wiley & Sons.

The author reviews the theoretical basis for fracture healing in pediatric and elderly populations, including bone growth and healing processes. She then presents a model, developed with the aid of digital light microscopy, that incorporates the healing continuum and allows for more accurate observation of the healing process. She thinks that this model could be developed further to refine time since injury estimates in pediatric and elderly non-accidental death investigations. 

Forensic markers of elder abuse and capacity assessment

Heisler, C.J. (2017). Elder abuse forensics:  The intersection of law and science.  In X. Dong (Ed.), Elder Abuse.  Research, Practice and Policy (pp. 387-416).  Cham, Switzerland:  Springer International Publishing AG.  doi:  10.1007/978-3-319-47504-2_18

This chapter is an excellent overview of the complexities involved in identifying elder abuse and forensic markers used for this purpose. Forensic markers for various types of elder abuse are presented along with alternative explanations for the etiology of the indicator. Careful consideration of the legal distinction between self-neglect and neglect by a caregiver is made so as to distinguish situations likely worthy of filing a criminal case. Various categories of capacity and competency are discussed along with the professional qualifications of individuals able to assess these neuropsychological characteristics. The chapter concludes with a discussion of the necessity and characteristics of successful collaborative teams and a review of training sites useful for various professionals dealing with elder abuse. 

Updated October 23, 2023