wrongdoer, other emotional harm, and as in some cases involving persons with diminished capacity, difficulties in communicating what transpired.

Perhaps the starkest difference is that whereas children and younger victims of domestic violence are generally healthy and not expected to die, older people often have numerous underlying medical problems, and functional dependencies and are assumed to be more vulnerable to stressors causing death. Thus, when a younger person dies of unexplained causes, the cause of death is almost always carefully analyzed. The death of an older person, however, is rarely as carefully scrutinized, if at all, regardless of risk factors or indications of possible abuse or neglect. In addition, old age often brings medical conditions and physiological attributes that may mimic or mask the markers of elder abuse and neglect, further complicating the analysis and detection.

Despite these many complexities, a recent study—one of the few in the area—most clearly underscores the importance of increasing our understanding of these phenomena. That study (Lachs et al., 1998) demonstrates that elder abuse and neglect significantly shorten older victims’ lives, even controlling for all other factors. Incidents of mistreatment that many would perceive as minor can have a debilitating impact on the older victim. A single episode of victimization can “tip over” an otherwise productive, self-sufficient older person’s life. In other words, 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, serious complicating illness, and even death.

Unfortunately, there is a paucity of primary data relating to forensic markers of elder abuse and neglect, or even regarding the phenomena themselves. The ensuing discussion describes several potential forensic markers of elder abuse and neglect, including: abrasions, lacerations, bruising, fractures, restraints, decubiti, weight loss, dehydration, medication use, burns, cognitive and mental health problems, hygiene, and sexual abuse. We also are including financial fraud and exploitation because they often coexist with physical and emotional abuse and neglect. Some of the markers discussed are actual observations (such as bruises or fractures), whereas others are descriptions or conclusions based on underlying observations (for example, sexual abuse is a conclusion that might result from the observation of a vaginal tear or abdominal bruise, and a conclusion of neglect might result from the observation of poor hygiene and burns). Some of the markers are also potential risk factors (for example, self-neglect, cognitive and mental health problems, and financial abuse). But the current evidence regarding risk factors does not tell us the amount of risk conferred or by what mechanism.

Where evidence-based data or other studies were found relating to the



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