The forensic implications of lonely deaths (Kodokushi) - A South Australian study

Kodokushi is a Japanese term where 'a person dies without being cared for by anyone, and whose body is found after a certain period'. These cases have also been called 'lonely deaths'. Few forensic studies exist. Using decomposition as a surrogate marker for social isolation the following study was undertaken. Pathology files from Forensic Science SA (FSSA), Adelaide, South Australia were reviewed for all cases aged ≥60 years where death had occurred at home and where there was moderate to marked decomposition. Two five-year time periods were selected for comparison. There were 27 cases from 2000 to 2004, out of a total of 1673 autopsies (1.6 %), (M:F = 21:6; age range 60-90 years, ave. 72.8; post mortem intervals 3-60 days, mean 10.7 days). The majority of deaths were due to natural causes (N = 22), with 2 suicides and 3 undetermined. There were 67 cases between 2019 and 2023, out of a total of 696 autopsies (9.6 %), (M:F = 52:15; age range 60-91 years, ave. 69.4 years; post mortem intervals 3-240 days, mean 21 days). The majority of deaths were due to natural causes (N = 55), with 3 suicides and 9 undetermined. Comparing the two time periods showed a predominance of males (78 %) dying of ischaemic heart disease in each cohort (67 and 60 % respectively). The average ages were similar (72.8 and 69.4 years respectively). There was a significant increase in the number of cases over the two decades of the study: 27 to 67 (p < 0.001), with an increase in the post mortem interval from 10.7 to 21 days. It appears that increasing numbers of socially isolated elders are occurring in an Australia population. These individuals have higher rates of certain mental and physical disorders and may present unique diagnostic challenges.