elder abuse and neglect. Mortality rates associated with each marker also should be evaluated.

This research, among other things, should determine in a scientific manner the difference between age and unavoidable disease-related changes versus abuse and neglect. Very few studies of any of the 14 factors listed below have been done; more are needed. For example, descriptive studies of skin tears are needed that compare those with known causes to those with unknown causes. Burnight (2000) has suggested a national database of witnessed injuries. Many forms of trauma could be studied, beginning with witnessed falls, which occur commonly in hospitals and nursing homes. Research protocols should be designed to provide information applicable to minority populations and to both genders. The study by Langlois and Gresham (1991) was limited to whites; a study of bruising is needed for people of color. A few suggestions (there are many more) for research needed relating to the markers discussed in this paper include the following:

Fractures

The significance of type and location of fractures is not well understood relative to mechanism and degree of injury. Objective documentation of the degree and ensuing impact of osteoporosis is needed. Research into osteoporosis to determine its objective documentation postmortem and how it affects fracturing, mechanisms (i.e., degree of force required) would be useful to the forensic analysis.

Burns

The findings on burns and elder abuse or neglect are intriguing and could be further studied at U.S. burn centers. The high incidence of burns in cases of self-neglect raises the question: When does a history or propensity of an elder to set fires give rise to a duty by a caregiver to intervene? This inquiry would benefit from research to develop forensic markers to guide the analysis. The high mortality rates in elders as a result of burns make this public health issue a compelling research topic.

Cognitive and Mental Disorders

The existing data on cognitive and mental disorders raise many research questions. What is the impact of cognitive and mental disorders in cases of abuse or neglect? What is the prevalence of dementia, depression, and psychosis in abused or neglected individuals or perpetrators? Are mortality and morbidity higher in persons with cognitive or mental disorders? Because dementia and alcoholism are treatable and depression and



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