extent that such answers exist, vary from state to state, and sometimes from community to community, complicating the analysis and any research of the issue.

Resolution of these difficult distinctions is beyond the scope of this paper. It is worth noting, however, that whether elder abuse and neglect has occurred is a conclusion drawn from a constellation of factors—some are medical (the individual’s medical condition), and some are legal (the jurisdiction’s definition of caregiver neglect). Developing consistent definitions and laws relating to elder abuse and neglect is critical to (a) developing useful forensic markers, (b) effective detection and diagnosis by health care professionals, (c) law enforcement’s determination of a violation of law and of what cases to prosecute, and (d) researchers’ and policy makers’ determination of the scope of the problem and of what new laws (including causes of action and remedies) and other measures are needed to adequately address it.

To the extent that the term forensic is defined as “pertaining to the law,” medical forensic markers also are relevant to guardianship, involuntary commitment, power of attorney, and other types of parens patrie cases. Because this panel is examining abuse and neglect, however, those applications of forensic markers are not specifically discussed in this paper.

Abuse and neglect may occur in community or institutional/residential settings. For most of the markers described, there is no literature describing the relevance of various settings to the medical forensic analysis. This, too, is a topic in need of study.

POTENTIAL MARKERS OF ABUSE AND NEGLECT

Fourteen potential markers of elder abuse and neglect are discussed below, including for each a brief definition, a description of age-related changes, and a review of what is known about each as a medical forensic marker of elder abuse and neglect. Most of the forensic markers discussed in this section apply both to living persons and to postmortem evaluations. Factors pertaining peculiarly in the postmortem context are discussed in the next section.

Abrasions and Lacerations

Abrasions are superficial injuries involving the outer layer of skin; lacerations are characterized by full-thickness splitting of the skin. Abrasions are caused by movement of the skin over a rough surface; lacerations are the result of blunt force (Crane, 2000). Skin tears are a very common type of laceration seen in the elderly and are defined as a splitting of the



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