detection is crucial to law enforcement. Furthermore, even when there is detection or diagnosis, cases will not be prosecuted unless the suspected abuse or neglect is reported (which often is not the case even where there are mandatory reporting laws). Criminal and civil elder abuse and neglect prosecutions are pursued for many reasons, including to stop, redress, punish, and deter the wrongdoing, and to recoup government monies provided for care that was not rendered. However, the current state of legal, social science, and medical knowledge does not include an evaluation of which types of prosecution and which remedies and punishments best address these goals. By providing the tools necessary to detect and prove these cases, research on the forensic markers of elder abuse and neglect can help law enforcement make appropriate cases a priority.

DETECTING ABUSE AND NEGLECT IN ELDERS

The American Medical Association (1996) has defined physical abuse as an act of violence that may result in pain, injury, impairment, or disease. Neglect is the failure to provide the goods or services necessary for functioning or to avoid harm. A caregiver may be a family member, a friend, or an employee of the elder or of a nursing or other type of facility, or it may be the entity responsible for providing care. Definitions and intent standards may vary depending on discipline, entity, location, or jurisdiction, as well as the relationship of the victim and the perpetrator. Furthermore, intent in a legal proceeding is the province of the fact finder (judge or jury) and therefore opened to argument by both the plaintiff/prosecutor and the defendant. Thus, the above-provided descriptions are intended as a general guide and a way to frame the discussion, but not as specific legal definitions.

Actual abuse or neglect is rarely directly observed by medical, legal, or protective service professionals. In the absence of eyewitness testimony, law enforcement must rely on other circumstantial evidence to prove the existence of abuse or neglect. In most instances the experience of other direct observers is sought or the circumstances are deduced through investigation or physical examination. The state of current knowledge, however, does not always allow health care and social science professionals to link physical signs with a diagnosis of abuse or neglect. Further research will help identify and define useful forensic markers to help practitioners detect and treat elder abuse and neglect victims.

How, when, why, and by whom injuries have been inflicted on elderly victims are all important questions to be answered before actors in the legal system take any affirmative action to protect the victim and deter future wrongdoing. Thus, a fractured bone may heal and a bruise may resolve regardless of whether a practitioner can identify the cause. And yet, the



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