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Elderly Abuse

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

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  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 Douglas.Posey@GBI.STATE.GA.US 404-270-8189

  2. Elderly Abuse • Potential Markers of Abuse & Neglect • Criteria For External Exam • Current Trends Autopsy Frequency

  3. 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.

  4. Potential Markers of Abuse & Neglect • Abrasions and Lacerations • Bruises(Contusions) • Fractures • Restraint • Decubiti • Malnutrition • Dehydration

  5. Potential Markers of Abuse and Neglect • Medication Use • Burns • Cognitive and Mental Health Problems • Hygiene • Sexual Abuse • Financial, Fraud and Exploitation

  6. H Potential Markers of Abuse & Neglecthistory Cause and Manner of Scene Death Case PresentationForensic Diagnostic Dilemmas Investigation Science

  7. Diagnostic Dilemmas Extreme Cases Shades of Gray

  8. Shades of Gray How When Why By Whom

  9. Abrasions

  10. Patterned Abrasion

  11. Blunt Trauma

  12. FRATURED HIP

  13. POST SURGICAL REPAIR

  14. Better care for elderly hard to find

  15. Deadly bed rails

  16. Elderly Abuse • Apathy toward the Elders (antemortem) • Apprehensions of Death Investigators • Attitude of the M.E.

  17. 'She's not my resident'

  18. 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

  19. 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

  20. 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

  21. 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

  22. ADVERSE DRUG REACTIONS • Up to 200,000 patients die each year from adverse drug reactions

  23. Conclusion • Multidisciplinary Team Work • Research to Establish Forensic Markers • Special considerations in the Postmortem analysis • Forensic Psychiatric Autopsy

  24. Mark Malcolm, F-ABMDICoroner of Pulaski Countycoroner@co.pulaski.ar.us(501) 340-8355

  25. ICEBERG

  26. 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

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