[Suicide in advanced age--report on an unusual case of hanging in a lying position]

Hanging is still the most common suicide method among men and women, even in high age groups. There are many variations of hanging. As compared to the body weight, only a relatively small force is necessary to obstruct the carotid arteries. In this way hanging in a sitting, kneeling or even lying position is possible. Such an exceptional case is presented here. A 99-year-old, multi-morbid man (47 kg, 159 cm) was found lying strangled in his hospital bed. The ligature used was a stiff spiral cable for remote control of the bed, which was directly attached to the wall behind its head end. The position allowed compression of the neck vessels, which resulted in marked congestion of the head, numerous petechial and confluent haemorrhages in the facial skin as well as blood loss from both ear canals. In the cervical soft tissue above the ligature, bleeding into the muscles and connective tissue as well as multiple haemorrhages in the tongue were found. Reconstruction at scene showed that suicide was possible. In such unusual cases, extensive police investigations, forensic autopsy and reconstruction of the course of events to prove feasibility are essential.