Neglect of Older People: Touching on Forensic and Pathophysiological Aspects

On tackling abuse of older people: The forensic challenges in fatal cases investigation

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.

Review on forensic importance of myiasis: Focus on medicolegal issues on post-mortem interval estimation and neglect evaluation

Myiasis is the infestation of live vertebrates by dipterous larvae that feed on living or necrotic tissues, liquid body substances or ingested food and develop in or on the vertebrate body. In both animals and humans, myiasis plays a fundamental role in forensic practice because of its implications in the evaluation of cases of neglect and in the mPMI (minimum post-mortem interval) estimation. The present study aims to provide a review of forensic issues related to myiasis. A retrospective analysis was conducted by exploring major electronic literature databases. Methodological evaluation of each study was performed according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) standards. Sixty-one papers were included in this review. Entomology shows great potentiality in forensic investigations, mostly because of its contributory role in mPMI estimation. Such evaluation, however, requires a careful consideration of the possibility of an ante-mortem myiasis infestation, which could complicate the correct assessment of the mPMI. Hence, forensic pathologists should pay attention to the entomological fauna on a corpse, in both fresh and decomposed bodies. Moreover, in cases with poor nutritional or hygienic conditions, myiasis should be carefully evaluated as an indicator of neglect.

A Guide to the Postmortem Investigation of Starvation in Adults

ABSTRACT

Starvation is a rare cause of death in developed countries and is a complex multifaceted pathological process. To complicate the forensic investigation of starvation further, many medical conditions independent of starvation may cause wasting. This article provides one of the first comprehensive guides to the postmortem investigation of starvation in adults, with reference tables on organ-specific macroscopic and microscopic features, as well as features for excluding alternative causes of wasting. The eclectic literature on this complex topic is summarized in an accessible and easily referenced format, including mechanisms of death and ancillary postmortem investigations.

When the Hidden Issue of Elder Abuse Leads to Death: Do Not Neglect Elder Neglect

ABSTRACT

It is well known that elder neglect entails a number of physical and psychological consequences, as well as being an independent risk factor for death. In the present study, we describe 5 forensic cases of death of older adults where the diagnosis of neglect only emerged postmortem through the combination of the scene investigation, the often-scarce circumstantial data, and the autopsy findings. The gathering of this information allowed the presence of risk factors-not previously assessed or reported-to be identified. Nevertheless, complete medical information was lacking both for the isolation of the victims with their caregivers and for the absence of every social and health support in self-neglect. More research is needed also in the forensic pathology field with standardized methods to contribute to prevention strategies and to avoid that victims of elder neglect remain hidden also after death.