Neglect of Older People: Touching on Forensic and Pathophysiological Aspects

Abstract

Neglect of older people is common and may result in fatal and nonfatal outcomes. Normal changes of aging and disease-related symptoms may overlap with markers of neglect and lead to under-detection. This review aims to delineate medical, psychiatric, and pathophysiological indicators in the victim-identified in forensic case reports-to point out areas of overlap and raise awareness in Health Care Professionals. Medical and forensic databases were searched with the search terms: neglect, elder, elderly, forensic, homicide for detailed case reports on elder neglect. Cases were reviewed as to victim age, sex, medical/psychiatric diagnosis, perpetrator, victim-to-perpetrator relationship, cause of death (if fatal), location of incident, autopsy findings (if fatal), and ancillary studies. A total of 168 publications were retrieved, of these 11 publications, containing a total of 25 cases, yielded sufficient detail on each case to be included in the qualitative analysis. Neglect is associated with poor physical, psychological, and mental health. Neglect can be a direct cause of death or contribute to a fatal outcome by exacerbating existing conditions. Red flags of neglect included malnutrition, dehydration, poor hygiene, untreated decubitus ulcers, hypothermia, contractures, and an uncooperative caregiver. However, incontrovertible evidence of neglect is not always easy to obtain due to age and disease-related changes. The findings document the extent and seriousness of elder neglect and highlight the importance of detailed documentation as well as collaboration between clinicians, allied health professionals, law enforcement and medical forensic services to improve patient outcomes and reduce the risk of further incidents.