Forensic Markers Associated with a History of Elder Mistreatment and Self-Neglect: A Case-Control Study

Abstract

Elder mistreatment (EM) and elder self-neglect (SN) are risk factors for mortality. Medical examiners (ME) seldom investigate EM and SN as potential influences of death in older adults. Recognizing forensic markers associated with EM and/or SN may lead to further investigation into EM and SN as potential contributors and thus, may impact the cause and manner of death.MethodsOne-hundred and ninety-two Adult Protective Services (APS)-substantiated EM and SN cases 65 years of age and older, residing in Houston, Texas in Harris County with ME records were matched on age, race, gender and socio-economic status to individuals with ME records and no APS history. A conditional logistic regression was conducted to identify variables that reliably predict ME cases with an APS history.ResultsAPS cases had significantly higher odds of having a history of pressure sores (OR: 2.4; 95% CI = 1.2 – 4.9), but had significantly lower odds of presenting with abnormally high body mass indexes (OR: 0.5; 95% CI = 0.3 – 0.9).ConclusionThese data suggest that forensic case information such as a decedent history of pressure sores may indicate a past history of elder mistreatment or self-neglect. In contrast, having an abnormally high body mass index may indicate a lack of APS history. More studies are needed to better define these predictors and to identify other predictors that may assist forensic pathologists in identifying deaths in older adults that may have been impacted by EM and/or SN.