Unnatural death in the elderly: a retrospective study of medicolegal autopsies in Northern Tunisia

Abstract

BackgroundThe growing proportion of elderly implies that natural and unnatural deaths of the elderly will be increasingly confronted. The objective of our study was to determine the unnatural manner and causes of death in the elderly, defined as individuals at least 65 years of age at the time of death. We conducted a monocentric restrospective study based on police investigation reports and medicolegal autopsy reports collected from the Department of Legal Medicine of Charles Nicolle Hospital in Tunis, Tunisia between January 1st, 2016 and December 31st, 2017.ResultsDuring this period, 3837 autopsies were performed. Five hundred ninety-two (15.4%) were 65 years or older at the time of death. Of these, 264 deaths were categorized as accidental, suicidal, homicidal, or unknown. The mean age of victims was 75.3 years (± 6.7), unnatural deaths were higher in urban areas (64%) and victims were living alone in 24.7% of cases. Accidents accounted for the majority of unnatural deaths (90.5%) and were more common in males. Traffic accidents accounted for 66.9% of accidental deaths; they were more frequent in pedestrians and more frequent on Monday. They were followed by accidental falls which accounted for 17.2% of accidents and occurred in the home especially or in the workplace. Charcoal brazier was incriminated in 11 cases of accidental thermal burns and in all cases of accidental carbon monoxide poisoning. Suicide and homicide were uncommon manners of death; they were observed in 16 and eight cases respectively. Hanging was the most used suicidal mean. Suicides were more common in males; they took place especially in the victim’s home, and history of psychiatric disorders was frequently elicited.ConclusionsAutopsies provide important statistical data that can be used for preventive strategies. For instance, actions must be carried out on the maintenance of public roads and raising awareness among public road users. Preventive measures should also include home improvement to help the elderly avoid accidental falls, installing smoke detectors, and the non-use of defective or rudimentary heating.