Transcript 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
[email protected]
404-270-8189
Elderly Abuse
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Potential Markers of Abuse & Neglect
Criteria For External Exam
Current Trends Autopsy Frequency
Elderly Abuse
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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
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Abrasions and Lacerations
Bruises(Contusions)
Fractures
Restraint
Decubiti
Malnutrition
Dehydration
Potential Markers of Abuse and
Neglect
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Medication Use
Burns
Cognitive and Mental Health Problems
Hygiene
Sexual Abuse
Financial, Fraud and Exploitation
H
Potential Markers of
Abuse & Neglect
history
Scene
Investigation
Diagnostic Dilemmas
Cause
and
Manner
of
Death
Case Presentation
Forensic
Science
Diagnostic Dilemmas
Extreme Cases
Shades of Gray
Shades of Gray
How
When
Why
By Whom
Abrasions
Patterned Abrasion
Blunt Trauma
FRATURED HIP
POST SURGICAL REPAIR
Better care for elderly hard to find
Deadly bed rails
Elderly Abuse
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Apathy toward the Elders (antemortem)
Apprehensions of Death Investigators
Attitude of the M.E.
'She's not my resident'
Criteria For External Exam
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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
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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
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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
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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
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Up to 200,000 patients die each year from
adverse drug reactions
Conclusion
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Multidisciplinary Team Work
Research to Establish Forensic Markers
Special considerations in the Postmortem
analysis
Forensic Psychiatric Autopsy
Mark Malcolm, F-ABMDI
Coroner of Pulaski County
[email protected]
(501) 340-8355
ICEBERG
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