(See “Impediments to Pursuing Elder Justice.”)In one NIJ-funded study, researchers are examining bruising, one of the most common indicators of abuse and neglect.Although there is a body of research on the site, pattern, and dating of bruising in children, research on the differentiation between accidental and intentionally inflicted bruising in the geriatric population simply does not exist.They are also viewing autopsies to observe and offer geriatric consultation in elder death cases. [note 9] Because older victims usually have fewer support systems and reserves—physical, psychological, and economic—the impact of abuse and neglect is magnified, and a single incident of mistreatment is more likely to trigger a downward spiral leading to loss of independence, a serious complicating illness, and even death. Hanrahan, final report submitted to the National Institute of Justice, Washington, DC: 2006 (forthcoming). Because more than half of the victims were aged 80 to 95 years at the time of the assault, it is impossible to determine if the death was a distal effect of the assault. [note 12] Ibid., 9, citing Pillemer and Finkelhor (1998); Pavlik et al. The figure is expected to rise to almost 20 percent over the next two decades.By cross-referencing data from the Texas Department of Family and Protective Services–Adult Protective Services databank with the HCMEO database, Dyer’s team has discovered that since 1999, as many as 900 elder death cases (autopsies, external exams, and inquests) had previously been reported to Adult Protective Services. Although it is not possible to determine whether in each case the assault accelerated death, the fact that more than half of the victims died not from the assault itself but within months of the assault is clearly noteworthy. Burgess and Hanrahan, [note 14] Those who work in the field of elder abuse and neglect believe that the state of medical knowledge and forensic science regarding elder abuse and neglect is approximately equivalent to that of child abuse and neglect three decades ago and domestic violence 10 to 15 years ago.The study recommended that guidelines be established for conducting rape trauma examinations on elderly patients.
The perception of Cullen as a devoted caretaker came to an abrupt end in 2004, however, when he admitted that he intentionally administered fatal doses of medication to almost 40 patients in various institutions over a 16-year period.NIJ-funded researchers are also examining data on the deaths of elderly residents in long-term care facilities to identify potential markers of abuse. D., of the University of Missouri-Columbia, the study examined coroners’ reports of elderly nursing home residents in Arkansas over a 1-year period. Amassing data collected pursuant to an Arkansas law requiring nursing homes to report all deaths to local coroners, researchers studied the medical examiner’s investigative process to gather impressions about markers that might indicate mistreatment and identify barriers to accurate assessments of abuse.Although a majority of the coroner investigations did not raise suspicions of mistreatment, researchers identified four categories of markers that often led to referral to the Arkansas Attorney General for further investigation: Lindbloom’s multidisciplinary research team also conducted focus group interviews with medical examiners, coroners, and geriatricians across the United States to assess the state of forensic investigation of nursing home deaths and to determine ways to identify how abuse and neglect leading to mistreatment deaths might be identified.Even if a doctor suspects abuse, police officers are rarely trained to investigate elder abuse and thus may not know how to interview an older adult, work with a person who has dementia, collect forensic evidence, or recommend that criminal charges be brought when responding to reports of injuries at care facilities or in homes.Successful prosecutions are further impeded by the absence of a sufficient number of qualified experts to testify to a reasonable medical certainty that the injuries were the result of abuse or neglect.Researchers found that accidental bruising occurred in predictable locations in older adults: 90 percent of all bruises were on the extremities; no accidental bruises were observed on the ears, neck, genitals, buttocks, or soles of the feet.