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Giorgetti A, Pelletti G, Fiorentini C, Mazzotti MC, Fais P, Pelotti S. On tackling abuse of older people: The forensic challenges in fatal cases investigation. Leg Med (Tokyo) 2024; 67:102398. [PMID: 38237384 DOI: 10.1016/j.legalmed.2024.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/11/2023] [Accepted: 01/07/2024] [Indexed: 03/01/2024]
Abstract
The World Health Organization recently presented the priorities for tackling abuse of older people in a coordinated and strategic way. However, data on the forensic scenario is still lacking. In this context, the aim of the present work was to provide a comprehensive literature review of this inherently complex phenomenon in the post-mortem setting, in order to better characterize it from a forensic point of view. A comprehensive literature search was performed in three electronic databases following the PRISMA guidelines. Sociodemographic and medical data of victims and perpetrators, post-mortem data, types of abuse and risk factors were extracted from non-aggregated data. Forty-eight papers dealing with abuse in the post-mortem setting were included, with a predominance of case reports and case series. The review showed that neglect was the most common type of abuse and victims are predominantly older women who are abused in a domestic setting by trusted family member. To generate more and better data, expanded research in the forensic field requires standardized methods and the raise of professional awareness about abuse of older people.
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Affiliation(s)
- Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Guido Pelletti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Clara Fiorentini
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | | | - Paolo Fais
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
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2
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Franchetti G, Cestonaro C, Giordano R, Callegari E, Giraudo C, Viel G, Cecchetto G. Severe starvation and restraint in a 47-year-old woman: Clinical, autopsy and histopathological evidence of abuse and neglect. Forensic Sci Int 2024; 355:111941. [PMID: 38290228 DOI: 10.1016/j.forsciint.2024.111941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
The recognition of abuse and/or neglect still represents a challenge for both clinicians and forensic pathologists. Whereas abusive behaviors have been largely described among pediatric and elderly populations, adults' abuse and neglect is less frequently encountered, and therefore investigated. We report a case of a middle-aged woman without any known organic or psychiatric disorders who died of a multiple organ failure (MOF) due to extreme cachexia and bed-resting syndrome. The integration of all clinical, autopsy and histopathological data highlighted a picture of severe malnutrition, restraint, and widespread traumatic injuries related to abuse and neglect. We believe that the case here presented could be useful for both clinicians and forensic pathologists as it underlines once again the importance of collecting and integrating all medical evidence (both in the ante- and post-mortem settings) for reconstructing the most probable pathophysiology of disorders and injuries, comparing that reconstruction with the allegations of the caregivers, and thus identifying any potential abuse and/or neglect behaviors.
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Affiliation(s)
- Giorgia Franchetti
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy.
| | - Clara Cestonaro
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Renzo Giordano
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Enrica Callegari
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Chiara Giraudo
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, Via Giustiniani 2, 35121 Padova, Italy
| | - Guido Viel
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Giovanni Cecchetto
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
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Bugelli V, Campobasso CP, Feola A, Tarozzi I, Abbruzzese A, Di Paolo M. Accidental Injury or "Shaken Elderly Syndrome"? Insights from a Case Report. Healthcare (Basel) 2023; 11:healthcare11020228. [PMID: 36673596 PMCID: PMC9859477 DOI: 10.3390/healthcare11020228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Subdural haemorrhage (SDH) as result of a traumatic brain injury (TBI) is a common cause of death in cases of fatal physical abuse. Since intracranial bleeding is a common finding in elderly due to age-related intracranial changes or increasing prevalence of anticoagulant medication, differential diagnosis between inflicted and non-inflicted head injury is challenging. A case of an elderly woman's death caused by TBI is reported. Autopsy showed multiple polychromatic bruises and a frontoparietal hematoma with bilateral subacute SDH. History excluded paraphysiological or pathological non-traumatic conditions that could justify SDH, while iatrogenic factors only played a contributory role. Since polychromatic bruises distributed on the face, the upper extremities and the chest were consistent with forceful grasping/gripping or repeated blows and SDH can form in absence of impact or by mild/minor blows, SDH was considered the result of repeated physical abuses. Differential diagnosis between traumatic and non-traumatic SDH is still challenging for forensic pathologists. As largely accepted in the pediatric population and occasionally described also in adults, however, violent shaking should be also considered as a possible mechanism of SDH-especially in elderly who do not have any sign of impact to the head.
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Affiliation(s)
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80138 Naples, Italy
- Correspondence:
| | | | - Arturo Abbruzzese
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria Pisana-Santa Chiara, 56100 Pisa, Italy
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
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Ventura F, Caputo F, Micera C, Molinelli A. Elder abuse: a retrospective analysis of autopsy cases from the department of legal medicine in Genoa from 2006 to 2017. J Elder Abuse Negl 2020; 32:388-398. [PMID: 32321379 DOI: 10.1080/08946566.2020.1755760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Elder abuse is a form of violence that is often misunderstood and still underestimated. This kind of abuse is classified in physical abuse, psychological abuse, financial abuse, sexual abuse, neglect and self-neglect. In this study, 784 cases of dead people over 65 years of age were retrospectively analyzed: in all cases, the cause of death was determined by the autopsy. Ten cases have been classified as victims of elder abuse: 7 females and 3 males aged between 67 and 91 (average age of 78.9 years). The types of abuse were as follows: neglect: 8 cases; physical abuse: 2 cases; psychological abuse: 2 cases; financial abuse: 2 cases; self neglect: 2 cases. In three cases, the victims had been subjected to two or more types of abuse. In 5 cases the victims had a neuro-psychic decay. In cases of neglect the cause of death was due to sepsis or dehydration. In a case of physical abuse, death was traumatic and related to physical violence. In cases of self neglect, death occurred due to cardiac causes. In cases of domestic abuse, the perpetrator was in most cases the elder's son and in one case the paid caregiver. In three cases, however, the abuses were committed against elderly guests in Nursing Homes. In three cases the perpetrator was affected by psychiatric disorders. Recognizing the elder abuse is often difficult and the understanding of the phenomenon in the case of death requires an integrated analysis of the autopsy data and the anamnesis of the victim.
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Affiliation(s)
- Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova , Genova, Italy
| | - Fiorella Caputo
- Department of Legal and Forensic Medicine, University of Genova , Genova, Italy
| | - Cristiano Micera
- Department of Legal and Forensic Medicine, University of Genova , Genova, Italy
| | - Andrea Molinelli
- Department of Legal and Forensic Medicine, University of Genova , Genova, Italy
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Prahlow JA. Investigation of Deaths of Chronically Disabled Persons and Institutionalized Persons. Acad Forensic Pathol 2014. [DOI: 10.23907/2014.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The investigation of deaths involving chronically disabled and/or institutionalized persons represents an important challenge to the medicolegal death investigation community. For the purposes of this review, the chronically disabled and/or institutionalized are considered to include three non-mutually exclusive subcategories: the disabled elderly, the severely disabled, and psychiatric patients. Because deaths within certain of these populations tend to be common and expected, a very important goal when such deaths occur is the appropriate referral of cases to the medical examiner/coroner. Although each subcategory has distinct issues of importance regarding death investigation, there is also a reasonable amount of overlap between the three groups. This review provides an overview of the three subcategories, the reasons such persons may be at risk for premature, unexpected, or unnatural death, the many important issues of concern when investigating deaths within these vulnerable populations, and important preventative strategies within each group.
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Affiliation(s)
- Joseph A. Prahlow
- Forensic Pathologist at The Medical Foundation in South Bend, IN, and a Professor of Pathology at Indiana University School of Medicine-South Bend
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Jackson SL, Hafemeister TL. How do abused elderly persons and their adult protective services caseworkers view law enforcement involvement and criminal prosecution, and what impact do these views have on case processing? J Elder Abuse Negl 2013; 25:254-80. [PMID: 23627431 DOI: 10.1080/08946566.2012.751843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined law enforcement and prosecution involvement in 71 cases of elder abuse where pure financial exploitation (PFE), physical abuse (PA), neglect (Neglect), or hybrid financial exploitation (HFE) (financial exploitation co-occurring with physical abuse and/or neglect) occurred in a domestic setting. Victims of elder abuse and assigned Adult Protective Services (APS) caseworkers were systematically interviewed. Law enforcement officials were involved in 54% of the cases, and 18% of the cases were prosecuted. PA was significantly more likely to trigger a law enforcement response and to be prosecuted than Neglect or PFE. HFE involved prosecution for assault rather than financial exploitation. Generally, the victims of elder abuse were not receptive to criminal justice involvement, which appears to have a significant impact upon the level of this involvement. The reasons for this reluctance are discussed, as well as the challenges and limitations of criminal justice system involvement and related implications for policy and practice.
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Affiliation(s)
- Shelly L Jackson
- Department of Psychiatry and Neurobehavioral Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia 22908-0660, USA.
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Mattoo KA, Shalabh K, Khan A. Geriatric forensics: A dentist's perspective and contribution to identify existence of elder abuse among his patients. J Forensic Dent Sci 2011; 2:81-5. [PMID: 21731345 PMCID: PMC3125958 DOI: 10.4103/0975-1475.81287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims and Objectives: To identify existence of elder abuse among the patients seeking prosthetic rehabilitation of missing teeth. Materials and Methods: This study was conducted on 300 patients aged 65 years and above. It included 238 males and 62 females. A questionnaire prepared by a psychologist was used to evaluate the patient in various aspects of neglect. Results: The results revealed that 40% of the total subjects that were studied were suffering from neglect in one way or the other. Conclusion: The results conclude that elder negligence was highly prevalent in elder patients who report to the dental office seeking oral prosthetic rehabilitation.
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Affiliation(s)
- Khurshid A Mattoo
- Department of Prosthodontics, Subharti Dental College, Subharti University, Meerut, Uttar Pradesh, India
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Abstract
Elder neglect, one of the 6 forms of elder maltreatment, is difficult to diagnose and is underreported both in the scientific literature and to law enforcement. Recognizing fatal neglect is even more challenging especially with concurrent organic disease. Many entities can mimic elder neglect, and many age-related changes can result in pathology that may be confused with maltreatment. We retrospectively reviewed all forensic cases of individuals age sixty-five years and older which were referred for autopsy. Cases of fatal neglect were analyzed as to age, sex, race, cause of death, location of incident, perpetrator, victim-to-perpetrator relationship, and autopsy and ancillary findings. The cases studies totaled 8. The age range was 74 to 94 years. Two were white, 6 black, one male, and 7 female. The causes of death were sepsis due to severe decubitus ulcers and severe dehydration. Five cases occurred in the victim's home, and 3 occurred in an institution (nursing home/care facility). In 5 cases, the perpetrators were family members. The pathophysiology of aging with respect to elder maltreatment is reviewed.
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Affiliation(s)
- Kim A Collins
- Department of Pathology, Forensic Section, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Abstract
Abstract
Context.—Elder maltreatment is not a new entity but is one that is recently recognized as a widespread and growing social problem. Unfortunately, few physicians are trained to recognize the different forms of elder maltreatment including physical abuse, sexual abuse, and neglect. The elder, age 65 years or older, is also a unique individual with respect to pathophysiology. The natural changes of aging must be considered when assessing any physical or laboratory findings.
Objective.—The practicing pathologist and resident/fellow in training must be familiar with the 6 forms of elder abuse, in particular the 3 forms that are seen in general and forensic pathology: physical abuse, sexual abuse, and neglect. Naturally occurring conditions must also be recognized so that these are not erroneously interpreted as trauma or neglect. Furthermore, the victims and perpetrators, scenarios and risk factors, common anatomic and clinical findings, the pathophysiology of aging, and possible imitators of abuse must be understood.
Data Sources.—This review explores the current medical and psychological understanding of elder maltreatment. Current scientific literature including peer-reviewed journal publications and texts is cited.
Conclusions.—As a prevalent form of domestic violence, we can only expect to see more cases of elder maltreatment as the number and percentage of elders in our population increase. The correct interpretation of physical and laboratory findings is needed to adequately classify these cases, certify the cause and manner of death, and prevent future incidents.
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Affiliation(s)
- Kim A Collins
- Department of Pathology and Laboratory Medicine, ForensicSection, Medical University of South Carolina, Charleston, SC 29423, USA.
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Paixão CM, Reichenheim ME. Uma revisão sobre instrumentos de rastreamento de violência doméstica contra o idoso. CAD SAUDE PUBLICA 2006; 22:1137-49. [PMID: 16751953 DOI: 10.1590/s0102-311x2006000600003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os dados sobre violência contra o idoso são escassos no Brasil. Para estudos adequados sobre a magnitude, fatores de risco e cuidados às vítimas, é necessária documentação sistemática e acurada. Este artigo revisou os instrumentos de rastreamento e avaliação de violência no idoso visando examinar o progresso no contexto internacional e brasileiro. Utilizando as bases de dados MEDLINE, PsycINFO, LILACS, CANE, OVIDs citations e livros de referência, realizou-se uma revisão sistemática da literatura para a seleção dos instrumentos. Fez-se, também, um escrutínio dos estudos de psicometria e utilização dos instrumentos, aplicando-se critérios para avaliar a qualidade dos estudos. Dos dezessete instrumentos encontrados, somente a Conflicts Tactics Scale foi adaptada para o Brasil, ainda que para uso em um grupo etário mais jovem. Alguns outros com boas características psicométricas também foram encontrados, como o Caregiver Abuse Screen, Elder Abuse Assessment Tool, Hwalek Sengstok Abuse Screening Test, Indicators of Abuse Screen, Qualcare scale e Vulnerability to Abuse Screening Scale. Ainda assim, de forma geral, há lacunas importantes nos processos de concepção, validação e adaptação desses instrumentos no Brasil e no exterior.
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Affiliation(s)
- Carlos Montes Paixão
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Wiglesworth A, Mosqueda L, Burnight K, Younglove T, Jeske D. Findings From an Elder Abuse Forensic Center. THE GERONTOLOGIST 2006; 46:277-83. [PMID: 16581893 DOI: 10.1093/geront/46.2.277] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The first Elder Abuse Forensic Center (EAFC) in the United States was instituted in 2003. People from a variety of disciplines, including Adult Protective Services social workers, law enforcement, the district attorney's office, a medical response team, public guardian deputies, ombudsmen, mental health services, a victim advocate, and a domestic violence expert work cooperatively on cases of elder and dependent-adult mistreatment. Researchers conducted an assessment of the EAFC's impact on the efficiency and effectiveness of the collaboration. DESIGN AND METHODS Mixed quantitative and qualitative methods included statistical analysis of data from outcome surveys of EAFC collaborators and illustrative case studies developed from case files and structured interviews. RESULTS Mean survey scores evaluating the efficiency and effectiveness of the collaboration were significantly better than neutral responses. Case studies show efficient and effective case management through cooperation of the collaborating agencies. Survey results clearly support perceptions exemplified in case studies. IMPLICATIONS An EAFC enhances the efficiency and effectiveness of those who address elder abuse in one community, which in turn leads to improved outcomes. Continued analysis to identify strengths, weaknesses, and cost effectiveness of the EAFC model is ongoing.
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Affiliation(s)
- Aileen Wiglesworth
- Program in Geriatrics, College of Medicine, University of California, Irvine, 200 S. Manchester, Suite 835, Orange, CA 92868, USA.
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Akaza K, Bunai Y, Tsujinaka M, Nakamura I, Nagai A, Tsukata Y, Ohya I. Elder abuse and neglect: social problems revealed from 15 autopsy cases. Leg Med (Tokyo) 2003; 5:7-14. [PMID: 12935644 DOI: 10.1016/s1344-6223(02)00057-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined the elder abuse cases that occurred in Gifu Prefecture, Japan between 1990 and 2000. We conducted a retrospective study of all the cases in which the victim was 65 years or older and autopsied in the Department of Legal Medicine, Gifu University School of Medicine. Fifteen victims were classified as elder abuse victims: five men and ten women. The victims ranged in age from 66 to 87 years (mean age, 74.5 years). The types of abuse were as follows: physical abuse, 13 cases; emotional abuse, five cases; neglect, four cases; and financial abuse, three cases. In eight cases, the victims were subjected to two or more types of abuse. The cause of death of the victims varied with the type of abuse. In the physical abuse cases, subdural hemorrhage was the most common cause, followed by other violence-related deaths and hypothermia. In the neglect cases, the victims died of either starvation or suffocation after the aspiration of food into the airway. In the domestic abuse cases, one of the victim's sons was the most common perpetrator, and little or no income was considered to be a risk factor for perpetrators. In the neglect cases, dementia and difficulty in performing activities of daily living were considered to be risk factors for victims, in addition to living in social isolation.
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Affiliation(s)
- Kayoko Akaza
- Department of Legal Medicine, Gifu University School of Medicine, Gifu 500-8705, Japan
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