Dating bruises in elderly
There are numerous traps into which the clinician or the medical examiner can fall in evaluating and successfully maneuvering a case through the legal system. The evaluation of child abuse and death in childhood is a specialized area that includes a vast body of knowledge.
When this happens, blood leaks out of the vessels and initially appears as a black-and-blue mark.An elderly Cape Breton woman is speaking out after she was viciously attacked outside a Sydney Mines, N. Sheila Bradley finds herself in tears when she talks about what happened. I was on the sidewalk, and he still kept pulling me." Bradley’s right arm is now bruised and she says she is sore and has difficulty walking. She was dragged down a flight of concrete steps and onto the sidewalk before the assailant made off with her purse."It was not even - blink of an eye and he had me, he had me. Her attacker ran down an alley, where an image of him was caught on video surveillance.Police say they are looking for a white man in his late teens or 20s, about six feet tall.As a result, signs of abuse commonly recognized in younger decedents are missed in elders, and abuse is rarely seen as a cause of death. Final report submitted to the National Institute of Justice, January 2005, NCJ 209334.
These findings call for additional research on both the decision-making practices of medical examiners and the forensic markers of elder mistreatment.
They also highlight the need for medical examiners to receive additional training on this issue.Another study documented practices that 46 of the 58 California coroner/medical examiner (CME) agencies use to decide whether to investigate an elder's death.
This study confirmed that CME offices do not assume jurisdiction over many elder deaths that experts in the field of elder mistreatment thought should be investigated because of signs of potential abuse or neglect.In a subsequent phase of the project, the researchers worked with a Multidisciplinary Advisory Board to develop the Elder Suspicious Death Field Screen (ESDFS) and conducted a pilot study in three California CME agencies.
A follow-up study funded by NIJ found that: NIJ funded research examining the decision-making processes medical examiners and coroners use when investigating suspicious deaths.
One study found that medical examiners can rarely differentiate symptoms of illness from signs of abuse in elderly decedents. Role of Forensic Science in Identification of Mistreatment Deaths in Long-Term Care Facilities.
Based on current literature and published recommendations, this practice point will help clinicians to distinguish between accidental and inflicted bruises, to evaluate and manage bruising in the context of suspected child maltreatment, and to evaluate for an underlying medical predisposition to bruising.