Are Elder Deaths Due to Caregiver Neglect Going Undetected?

Background: A phone survey and site visits to California County Coroner/Medical Examiner (C/ME) offices uncovered concerns that Coroner Investigators (CIs) fielding reports of deaths are not detecting suspicious elder deaths due to caregiver neglect. Elder Death Review Teams have discovered many of these kinds of cases when it is too late to do an investigation. Methods: Three C/ME offices participated in a pilot study of the Elder Suspicious Death Field Screen (ESDFS). The tool was designed to detect evidence that a death was due to caregiver neglect for CIs who handle calls reporting elder deaths. After a six-month pilot test, cases were selected for review by an expert panel to determine if they had been investigated appropriately. Results: Use of the ESDFS was limited, and follow-up interviews provided insight on impediments to use, including reluctance of reporting parties to provide the needed information. Nevertheless, of the 115 elder deaths for which the ESDFS was used, the expert panel reviewed 55. The panel assessed that 67.3% were handled inappropriately. The reporting party failed to view the body as requested for 52.7%. Signs of neglect such as pressure ulcers or other injuries could not be ruled out in these cases. Conclusions: Police officers, nurses and other professionals who report deaths, are unaware of the need to rule out elder death by neglect, and laws do not require them to uncover the body for viewing. C/ME offices are unable to ensure detection of elder neglect cases, and prevalence of fatal neglect is unknown.