Elder neglect and the pathophysiology of aging

Elder neglect, one of the 6 forms of elder maltreatment, is difficult to diagnose and is underreported both in the scientific literature and to law enforcement. Recognizing fatal neglect is even more challenging especially with concurrent organic disease. Many entities can mimic elder neglect, and many age-related changes can result in pathology that may be confused with maltreatment. We retrospectively reviewed all forensic cases of individuals age sixty-five years and older which were referred for autopsy. Cases of fatal neglect were analyzed as to age, sex, race, cause of death, location of incident, perpetrator, victim-to-perpetrator relationship, and autopsy and ancillary findings. The cases studies totaled 8. The age range was 74 to 94 years. Two were white, 6 black, one male, and 7 female. The causes of death were sepsis due to severe decubitus ulcers and severe dehydration. Five cases occurred in the victim's home, and 3 occurred in an institution (nursing home/care facility). In 5 cases, the perpetrators were family members. The pathophysiology of aging with respect to elder maltreatment is reviewed.