{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:06:58Z","timestamp":1787580418613,"version":"build-2736575974"},"reference-count":62,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T00:00:00Z","timestamp":1564099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,14]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Neglect of older people is common and may result in fatal and nonfatal outcomes. Normal changes of aging and disease-related symptoms may overlap with markers of neglect and lead to under-detection. This review aims to delineate medical, psychiatric, and pathophysiological indicators in the victim\u2014identified in forensic case reports\u2014to point out areas of overlap and raise awareness in Health Care Professionals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Research Design and Methods<\/jats:title><jats:p>Medical and forensic databases were searched with the search terms: neglect, elder, elderly, forensic, homicide for detailed case reports on elder neglect. Cases were reviewed as to victim age, sex, medical\/psychiatric diagnosis, perpetrator, victim-to-perpetrator relationship, cause of death (if fatal), location of incident, autopsy findings (if fatal), and ancillary studies. A total of 168 publications were retrieved, of these 11 publications, containing a total of 25 cases, yielded sufficient detail on each case to be included in the qualitative analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Neglect is associated with poor physical, psychological, and mental health. Neglect can be a direct cause of death or contribute to a fatal outcome by exacerbating existing conditions. Red flags of neglect included malnutrition, dehydration, poor hygiene, untreated decubitus ulcers, hypothermia, contractures, and an uncooperative caregiver. However, incontrovertible evidence of neglect is not always easy to obtain due to age and disease-related changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Implications<\/jats:title><jats:p>The findings document the extent and seriousness of elder neglect and highlight the importance of detailed documentation as well as collaboration between clinicians, allied health professionals, law enforcement and medical forensic services to improve patient outcomes and reduce the risk of further incidents.<\/jats:p><\/jats:sec>","DOI":"10.1093\/geront\/gnz084","type":"journal-article","created":{"date-parts":[[2019,5,20]],"date-time":"2019-05-20T11:07:40Z","timestamp":1558350460000},"page":"e449-e465","source":"Crossref","is-referenced-by-count":9,"title":["Neglect of Older People: Touching on Forensic and Pathophysiological Aspects"],"prefix":"10.1093","volume":"60","author":[{"given":"Annette","family":"Altendorf","sequence":"first","affiliation":[{"name":"Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Draper","sequence":"additional","affiliation":[{"name":"Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales"},{"name":"School of Psychiatry, University of New South Wales, Sydney"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanaka","family":"Wijeratne","sequence":"additional","affiliation":[{"name":"Sydney School of Medicine, University of Notre Dame"},{"name":"Department of Aged Care Psychiatry, Prince of Wales Hospital, Randwick, New South Wales"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Schreiber","sequence":"additional","affiliation":[{"name":"Clinical Forensic Medicine (CFM), Victorian Institute of Forensic Medicine (VIFM), Melbourne"},{"name":"Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniella","family":"Kanareck","sequence":"additional","affiliation":[{"name":"Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,26]]},"reference":[{"key":"2020081409064188300_CIT0001","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S1344-6223(02)00057-3","article-title":"Elder abuse and neglect: Social problems revealed from 15 autopsy cases","volume":"5","author":"Akaza","year":"2003","journal-title":"Legal Medicine (Tokyo, Japan)"},{"key":"2020081409064188300_CIT0002","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1080\/08946566.2011.584046","article-title":"The effectiveness of educational programs to improve recognition and reporting of elder abuse and neglect: A systematic review of the literature","volume":"23","author":"Alt","year":"2011","journal-title":"Journal of Elder Abuse and Neglect"},{"key":"2020081409064188300_CIT0003","volume-title":"The etiology of elder abuse by adult offspring.","author":"Anetzberger","year":"1987"},{"key":"2020081409064188300_CIT0004","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1111\/1556-4029.12121","article-title":"Analysis of bone healing in a postoperative patient: Skeletal evidence of medical neglect and human rights violations","volume":"58","author":"B\u00e1ez-Molgado","year":"2013","journal-title":"Journal of Forensic Sciences"},{"key":"2020081409064188300_CIT0005","volume-title":"Physical changes with aging.","author":"Besdine","year":".."},{"key":"2020081409064188300_CIT0006","first-page":"718","article-title":"Hemoglobin and hematocrit.","volume-title":"Clinical methods: The history, physical, and laboratory examinations","author":"Billett","year":"1990","edition":"3"},{"key":"2020081409064188300_CIT0007","volume-title":"Elder mistreatment: Abuse, neglect, and exploitation in an aging America","author":"Bonnie","year":"2003"},{"key":"2020081409064188300_CIT0008","first-page":"434","article-title":"Age-related physiological changes and their clinical significance","volume":"135","author":"Boss","year":"1981","journal-title":"The Western Journal of Medicine"},{"key":"2020081409064188300_CIT0501","volume":"1"},{"key":"2020081409064188300_CIT0009","author":"Brnovich","year":"."},{"key":"2020081409064188300_CIT0010","first-page":"497","article-title":"Serum albumin and globulin.","volume-title":"Clinical methods: The history, physical, and laboratory examinations","author":"Busher","year":"1990","edition":"3"},{"key":"2020081409064188300_CIT0011","author":"Centers for Disease Control and Prevention","year":"2015"},{"key":"2020081409064188300_CIT0012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.23937\/2469-5858\/1510001","article-title":"Elder mistreatment and its subtypes across different sociodemographic and socioeconomic groups among U.S. chinese community-dwelling older adults","volume":"1","author":"Chen","year":"2015","journal-title":"Journal of Geriatric Medicine and Gerontology"},{"key":"2020081409064188300_CIT0013","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.5858\/2006-130-1290-EMAR","article-title":"Elder maltreatment: A review","volume":"130","author":"Collins","year":"2006","journal-title":"Archives of Pathology and Laboratory Medicine"},{"key":"2020081409064188300_CIT0014","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/PAF.0b013e31805c93eb","article-title":"Elder neglect and the pathophysiology of aging","volume":"28","author":"Collins","year":"2007","journal-title":"American Journal of Forensic Medicine and Pathology"},{"key":"2020081409064188300_CIT0015","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1093\/ageing\/afm194","article-title":"The prevalence of elder abuse and neglect: A systematic review","volume":"37","author":"Cooper","year":"2008","journal-title":"Age and Ageing"},{"key":"2020081409064188300_CIT0016","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.annemergmed.2016.02.008","article-title":"The forensic lens: Bringing elder neglect into focus in the emergency department","volume":"68","author":"DeLiema","year":"2016","journal-title":"Annals of Emergency Medicine"},{"key":"2020081409064188300_CIT0017","volume-title":"Handbook of forensic pathology","author":"Di Maio","year":"2007"},{"key":"2020081409064188300_CIT0018","volume-title":"Forensic pathology","author":"Di Maio","year":"2001","edition":"2"},{"key":"2020081409064188300_CIT0019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00000433-200203000-00001","article-title":"Homicide by decubitus ulcers","volume":"23","author":"Di Maio","year":"2002","journal-title":"American Journal of Forensic Medicine and Pathology"},{"key":"2020081409064188300_CIT0020","first-page":"13","article-title":"Risk factors for elder abuse","volume":"31","author":"Dolan","year":"1999","journal-title":"Journal of Insurance Medicine (New York, N.Y.)"},{"key":"2020081409064188300_CIT0021","first-page":"339","article-title":"The clinical and medical forensics of elder abuse and neglect.","volume-title":"Elder mistreatment: abuse, neglect, and exploitation in an aging America","author":"Dyer","year":"2003"},{"key":"2020081409064188300_CIT0022","author":"Elder abuse by adult children. Criminal Justice. Iresearchnet","year":"."},{"key":"2020081409064188300_CIT0023","volume-title":"Elder Abuse Prevention Unit","year":"2019"},{"key":"2020081409064188300_CIT0024","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1258\/msl.2011.011124","article-title":"Elder abuse","volume":"52","author":"Fox","year":"2012","journal-title":"Medicine, Science, and the Law"},{"key":"2020081409064188300_CIT0025","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1080\/08946566.2017.1352551","article-title":"Using clinical signs of neglect to identify elder neglect cases","volume":"29","author":"Friedman","year":"2017","journal-title":"Journal of Elder Abuse and Neglect"},{"key":"2020081409064188300_CIT0026","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1093\/geront\/45.4.525","article-title":"Dyadic vulnerability and risk profiling for elder neglect","volume":"45","author":"Fulmer","year":"2005","journal-title":"The Gerontologist"},{"key":"2020081409064188300_CIT0027","doi-asserted-by":"crossref","first-page":"2154","DOI":"10.1111\/jocn.13721","article-title":"Screening tools for identification of elder abuse: A systematic review","volume":"26","author":"Gallione","year":"2017","journal-title":"Journal of Clinical Nursing"},{"key":"2020081409064188300_CIT0028","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.cger.2014.08.002","article-title":"Understanding the medical markers of elder abuse and neglect: Physical examination findings","volume":"30","author":"Gibbs","year":"2014","journal-title":"Clinics in Geriatric Medicine"},{"key":"2020081409064188300_CIT0029","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1136\/pgmj.2005.037564","article-title":"Malnutrition and ageing","volume":"82","author":"Hickson","year":"2006","journal-title":"Postgraduate Medical Journal"},{"key":"2020081409064188300_CIT0030","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.cger.2014.08.001","article-title":"Aging: Physiology, disease, and abuse","volume":"30","author":"Homeier","year":"2014","journal-title":"Clinics in Geriatric Medicine"},{"key":"2020081409064188300_CIT0031","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1093\/gerona\/glv205","article-title":"Which frail older people are dehydrated? The UK drie study","volume":"71","author":"Hooper","year":"2016","journal-title":"The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences"},{"key":"2020081409064188300_CIT0032","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1007\/s13524-013-0196-2","article-title":"Growing parental economic power in parent-adult child households: Coresidence and financial dependency in the United States, 1960-2010","volume":"50","author":"Kahn","year":"2013","journal-title":"Demography"},{"key":"2020081409064188300_CIT0033","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1177\/0886260510362890","article-title":"Characteristics of elderly and other vulnerable adult victims of homicide by a caregiver: National violent death reporting system\u201317 U.S. states, 2003-2007","volume":"26","author":"Karch","year":"2011","journal-title":"Journal of Interpersonal Violence"},{"key":"2020081409064188300_CIT0034","volume-title":"Elder abuse. Understanding issues, frameworks and responses. A report to the Australian Government Attorney-General\u2019s Department","author":"Kaspiew","year":"2015"},{"key":"2020081409064188300_CIT0035","volume-title":"Youth unemployment and health: A comparison of six European Countries","author":"Kieselbach","year":"2013"},{"key":"2020081409064188300_CIT0036","volume-title":"Abuse and maltreatment of the elderly. Causes and interventions","author":"Kosberg","year":"1983"},{"key":"2020081409064188300_CIT0037","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(02)11133-0","volume-title":"World report on violence and health","author":"Krug","year":"2002"},{"key":"2020081409064188300_CIT0038","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1001\/jama.280.5.428","article-title":"The mortality of elder mistreatment","volume":"280","author":"Lachs","year":"1998","journal-title":"JAMA"},{"key":"2020081409064188300_CIT0039","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.cger.2014.08.003","article-title":"Medical and laboratory indicators of elder abuse and neglect","volume":"30","author":"LoFaso","year":"2014","journal-title":"Clinics in Geriatric Medicine"},{"key":"2020081409064188300_CIT0040","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1108\/JAP-10-2016-0026","article-title":"Elder abuse screening tools: A systematic review","volume":"19","author":"McCarthy","year":"2017","journal-title":"Journal of Adult Protection"},{"key":"2020081409064188300_CIT0041","first-page":"119","article-title":"Denial and codependence in domestic violence by adult children on their elderly parents,","volume-title":"Marquette Elder\u2019s Advisor","author":"Mighdoll","year":"2005"},{"key":"2020081409064188300_CIT0042","doi-asserted-by":"crossref","first-page":"529","DOI":"10.3109\/09638288.2013.800596","article-title":"Contractures with special reference in elderly: Definition and risk factors\u2014a systematic review with practical implications","volume":"36","author":"Offenb\u00e4cher","year":"2014","journal-title":"Disability and Rehabilitation"},{"key":"2020081409064188300_CIT0043","author":"Ormsby","year":"2019"},{"key":"2020081409064188300_CIT0044","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s004140000173","article-title":"Fatal neglect of the elderly","volume":"114","author":"Ortmann","year":"2001","journal-title":"International Journal of Legal Medicine"},{"key":"2020081409064188300_CIT0045","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.jflm.2008.12.019","article-title":"The interaction of injury and disease in the elderly: A case report of fatal elder abuse","volume":"16","author":"Paranitharan","year":"2009","journal-title":"Journal of Forensic and Legal Medicine"},{"key":"2020081409064188300_CIT0046","volume-title":"Crime and elder abuse. An integrated perspective","author":"Payne","year":"2000"},{"key":"2020081409064188300_CIT0047","doi-asserted-by":"crossref","first-page":"S194","DOI":"10.1093\/geront\/gnw004","article-title":"Elder abuse: Global situation, risk factors, and prevention strategies","volume":"56","author":"Pillemer","year":"2016","journal-title":"The Gerontologist"},{"key":"2020081409064188300_CIT0048","author":"Porter","year":"2019"},{"key":"2020081409064188300_CIT0049","volume-title":"Elder abuse and neglect","author":"Quinn","year":"1997","edition":"2"},{"key":"2020081409064188300_CIT0050","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s004140100233","article-title":"Neglect-associated fatal Marchiafava\u2013Bignami disease in a non-alcoholic woman","volume":"115","author":"Rickert","year":"2001","journal-title":"International Journal of Legal Medicine"},{"key":"2020081409064188300_CIT0051","author":"Roy","year":"2006"},{"key":"2020081409064188300_CIT0052","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/ageing\/afx026","article-title":"Interventions for the prevention and treatment of disability due to acquired joint contractures in older people: A systematic review","volume":"46","author":"Saal","year":"2017","journal-title":"Age and Ageing"},{"key":"2020081409064188300_CIT0053","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.legalmed.2012.03.006","article-title":"Fatal Staphylococcus aureus bacteremia in the Felty syndrome: A maltreatment-suspected case","volume":"14","author":"Satoh","year":"2012","journal-title":"Legal Medicine (Tokyo, Japan)"},{"key":"2020081409064188300_CIT0054","volume-title":"Identifying and characterizing elder abuse","author":"Sengstock","year":"1982"},{"key":"2020081409064188300_CIT0055","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1520\/JFS2003161","article-title":"Abuse and neglect: A ten-year review of mortality and morbidity in our elders in a large metropolitan area","volume":"49","author":"Shields","year":"2004","journal-title":"Journal of Forensic Sciences"},{"key":"2020081409064188300_CIT0056","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/s40520-018-0912-2","article-title":"Medico-legal aspects of deaths related to neglect and abandonment in the elderly","volume":"30","author":"Ventura","year":"2018","journal-title":"Aging Clinical and Experimental Research"},{"key":"2020081409064188300_CIT0057","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jamda.2009.04.010","article-title":"Contractures in nursing home residents","volume":"11","author":"Wagner","year":"2010","journal-title":"Journal of the American Medical Directors Association"},{"key":"2020081409064188300_CIT0058","volume-title":"European report on preventing elder maltreatment","author":"World Health Organization","year":"2011"},{"key":"2020081409064188300_CIT0059","volume-title":"World report on ageing and health","author":"World Health Organization","year":"2015"},{"key":"2020081409064188300_CIT0060","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1016\/S2214-109X(17)30006-2","article-title":"Elder abuse prevalence in community settings: A systematic review and meta-analysis","volume":"5","author":"Yon","year":"2017","journal-title":"Lancet Global health"},{"key":"2020081409064188300_CIT0500","volume":"0","journal-title":"European Journal of Public Health"}],"container-title":["The Gerontologist"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/gerontologist\/article-pdf\/60\/6\/e449\/33653055\/gnz084.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/gerontologist\/article-pdf\/60\/6\/e449\/33653055\/gnz084.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,18]],"date-time":"2022-09-18T08:39:41Z","timestamp":1663490381000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/gerontologist\/article\/60\/6\/e449\/5539612"}},"subtitle":[],"editor":[{"given":"Patricia C","family":"Heyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2019,7,26]]},"references-count":62,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,7,26]]},"published-print":{"date-parts":[[2020,8,14]]}},"URL":"https:\/\/doi.org\/10.1093\/geront\/gnz084","relation":{},"ISSN":["0016-9013","1758-5341"],"issn-type":[{"value":"0016-9013","type":"print"},{"value":"1758-5341","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,9]]},"published":{"date-parts":[[2019,7,26]]}}}