On a routine visit, Mrs. F was found by her adult protective service (APS) worker to have bruises on her arms and to be quite confused. When law enforcement was notified and arrived to investigate, they transported Mrs. F to the county emergency room. A forensic examination was performed by an emergency room physician, who found additional bruises oh her chest and stomach. The physician also documented dehydration and malnutrition. Mental-status screening substantiated confusion and loss of recent memory; Mrs. F was unable to provide information about how she was injured.
Law enforcement's investigation learned that Mrs. F was living with her son, an unemployed known drug abuser. The district attorney chose to prosecute the case-but the trial did not occur for 22 months. Even though Mrs. F died seven months after her visit to the emergency room, the use of forensic examination documentation obtained at her initial emergency room visit led to the perpetrator's conviction.
NOT ONLY TV'S CSI
Forensic criminal investigation is a household term today because of CSI and other television shows. In real life, though, elder abuse and neglect cases now benefit from using a forensic strategy to diagnose and document such violations. One of the major strengths of this approach to elder abuse is that it guides healthcare providers. In the aforementioned case, Mrs. F's bruises were readily identified by the emergency room doctor. But the fact that she was also neglected so severely that she was malnourished and dehydrated may well have been missed without a comprehensive, forensic evaluation.
The California Governor's Office of Emergency Services provided a grant for the development of a forensic examination form specifically for victims of elder and dependent-adult abuse. The form is modeled on other forensic examination forms already in use for documenting child abuse, sexual assault and domestic violence. Because elder abuse may consist of multiple concurrent crimes-such as assault, neglect, financial abuse, abandonment and sexual abuse-the forensic form needed to provide the examiner a checklist so that all crimes would be noted. In Mrs. F's case, the checklist led the emergency room doctor to do the appropriate blood tests to diagnose malnutrition and dehydration.
A common problem for elder abuse victims is that they may suffer from dementia. In addition to serious memory loss, they may have impaired ability to make safe and wise decisions. Therefore, evaluation of mental status is a key element of a good forensic examination. In the many months it takes for criminal proceedings to move forward to trial and for prosecution to proceed, mental-status screening documents the thinking ability of the victim at the time of the crime.
When elder abuse victims are vulnerable because of they have difficulty coping with basic skills necessary for independent living, investigators need to perform a special assessment to determine whether such elders can provide for themselves. Evaluation of activities of daily living, such as eating or using the toilet, and instrumental activities of daily living-for example, cooking or shopping for food-is included in the forensic examination. This kind of assessment is critical for a forensic examination because it underscores areas in which an elder or person with disabilities must depend on others. For instance, evaluation of daily activities might show that a person has difficulty with walking and managing financial …