forensic markers discussed in this paper, they are referenced. But the majority of information on this topic currently is derived from working hypotheses based on the experience of clinicians and pathologists. Discussion of each factor includes (a) a definition of the phenomenon, (b) a discussion of how it is affected by age-related changes, and (c) what we currently know of clinical and forensic markers indicating abuse and neglect.

The term forensic is defined as pertaining to the law or employed in legal proceedings. Thus, medical forensic markers of elder abuse and neglect are factors that are relevant to medical and legal determinations of whether elder abuse or neglect has occurred. Consistent evidence-based medical definitions are urgently needed to assist health care and social service professionals in detecting, treating, responding to, referring, and better understanding this grave and increasingly important public health problem. Coherent legal definitions are needed for legal and public safety professionals to determine when the law may have been broken, what types of criminal, civil, or administrative cases may be pursued, and for lawmakers to determine what new laws should be proposed or enacted. Defining appropriate forensic markers will lead to more effective prevention strategies and medical, legal, social service, and public safety interventions.

Expanding our medical forensic knowledge base is vital to all the myriad ways in which the law is expected to address elder abuse and neglect. Potential legal interventions include the following: federal, state, and local law enforcement entities (including prosecutors, investigators, and police) may pursue criminal and civil cases relating to allegations of elder abuse and neglect. The government generally pursues such cases in its police power capacity—to punish, deter, remediate, and/or redress wrongdoing. Government also may use the law in its parens patrie capacity—pursuing guardian and commitment cases, primarily intended to protect those who cannot care for themselves. Almost all cases brought by government entities in this field rely on medical forensic evidence. Some government entities (such as the Departments of Justice and Health and Human Services) have resources to fund projects relevant to medical forensic issues. Private plaintiffs may file civil suits against health care providers depending on available medical forensic evidence. Federal and state legislative bodies can enact laws that provide for funding, create new entities, establish civil and criminal causes of action, and provide for other measures to address the problem. Federal and state regulatory bodies determine and/or enforce reimbursement, licensure, and administrative enforcement rules. Each legal aspect of this issue would benefit from being informed by more and better research.

Elder abuse and neglect are often not detected or diagnosed, precluding any intervention, including prosecution. Thus research aimed at improving



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement