postmortem blood gas evaluation (measuring pH, oxygen, and carbon dioxide levels) provides scant if any information, whereas the same test in a living person may be quite valuable in determining the care needed and the extent of underlying disease. On the other hand, some postmortem examination procedures yield more information than physical examination and laboratory testing of a living patient. Antemortem computerized tomography and magnetic resonance imaging scans have significant limitations in detecting and evaluating such lesions as small central nervous system parenchymal or surface hemorrhages or pulmonary nodules. However, utilization of radiologic expertise to help document the number and location of fractures at autopsy can be quite valuable. Although these determinations in an elderly person with osteoporosis are complex, careful documentation of such findings along with estimates of age or time of occurrence are useful. As in evaluations of other types of domestic violence, maxillofacial (jaw and face) injuries should prompt suspicion of abuse, and estimates of age or time of occurrence are useful. As in evaluations of other types of domestic violence, maxillofacial injuries should prompt suspicion of abuse.

Injuries suggestive of defensive maneuvering, such as those on the back of the arms and hands, and injuries related to grasping, squeezing, or forcible restraint should also prompt suspicion (Brogdon, 1998). However, little is known and there are few studies, if any, that document the type and location of fractures relative to mechanism and degree of force required in the elderly. Such studies and published information would also be of great use to forensic pathologists testifying in court in criminal and civil cases.

Even if the cause of death may be obvious (for example, pneumonia), the manner of death (i.e. natural, accident, suicide, homicide, or undetermined) may vary depending on the contributions of other factors to the pneumonia. For example, if the pneumonia is secondary to rib fractures, the death could be accidental if the fractures were sustained in an accidental fall. However, if the rib fractures were numerous and serious enough that the patient should have received medical attention but no referrals or attempts to get treatment were made, the subsequent death could be considered the result of neglect and potentially considered a homicide. If the fractures were sustained in a beating, the manner would clearly be homicide.

Forensic Psychiatry

Some cases may necessitate a postmortem psychological or psychiatric evaluation. Although the performance of a psychological or psychiatric autopsy has been described in some instances of suspected suicides, the utilization of these somewhat specialized investigative tools has not been specifically described in investigation of elder deaths. The demonstrated



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