Analysis of Medico-legal Death Investigation on Allegations of Elder Abuse in Seattle, Washington

Abstract

Introduction: Elder abuse is reported in one in six elderly people worldwide, thus, identifying its characteristics is very much crucial. Therefore, this study aimed to describe the characteristics of the decedents, and their complainants and alleged perpetrators in the elderly population in Seattle, Washington over ten years from 2010.Methods: A total of 8,739 medico-legal death investigations in elderly people aged 65 years or older were perused retrospectively at the King County Medical Examiner’s Office in Seattle, Washington. The records (n=161, 002%) contained allegations of elder abuse or neglect and were selected for analysis to describe the characteristics of the decedents, complainants and alleged perpetrators. The data were presented in frequency distributions. The complainants were categorized into five (families, hospice, care facilities, law enforcement and health providers) and alleged perpetrators were categorized into four (families, hospice, care facilities and health providers) and these categories were compared to each other. The presence of pressure ulcers and dementia were described according to the manner of death.Results: Out of 161 cases, the majority (n=97, 60%) were females and the age ranges from 65 to 99 years with a mean of 80 years (standard deviation=6). Most of the deaths were certified as ‘natural’ (n=110, 63%), while, 22 cases (14%) were certified as ‘undetermined’. Most of the complainants were health providers (n=69, 43%). Entities identified as alleged perpetrators were primarily long-term care facilities (n=77, 48%) or families (n=71, 44%). Further, families were less likely to be complainants (n=3, 12%) and more likely to be the alleged perpetrator (n=13, 52%) in deaths certified as ‘undetermined’ (n=25). Long-term care facilities were more likely to be identified as alleged perpetrators in deaths associated with dementia (n=24, 60%). The presence of pressure ulcers was more common (n=14, 56%) than dementia (n=6, 24%) in the ‘undetermined’ manner of death certification.Conclusion: This study demonstrates the importance of a medico-legal death surveillance system. The long-term care facilities and families were identified as alleged perpetrators; therefore, further studies are needed to identify their associated factors. Dementia was under-represented as a potential impetus behind many allegations, thus, conducting prospective studies and neuropathological assessments are recommended. To identify the correlation of racial/socioeconomic disparity, legal consequences on allegations of elder abuse or neglect are required to better understand the context.