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Suspicious Elder Deaths Rarely Investigated

January 2nd, 2012

True or false: All suspicious deaths are investigated so that justice can be done if foul play is discovered.

Answer: It depends on how old you are.

According to an article on the website ProPublica, a nonprofit investigative newsroom, and PBS’s Frontline, if a senior citizen died under suspicious circumstances, there’s no guarantee that anyone will ever investigate. Although it is impossible to know exactly how many suspicious deaths have been signed off as due to natural causes, the evidence uncovered points to a significant problem. When investigators look closely at deaths of elderly people, they discover many cases of mistreatment, abuse, and even murder.

Case in point: 76-year-old Joseph Shepter was living in a nursing home after a stroke paralyzed much of his body and dementia took away his ability to communicate. When he died, the nursing home’s chief medical officer listed the cause of death as heart failure. No one examined the death any further…until a tip from a staffer at the nursing home prompted the state to re-examine the case.

It was discovered that Shepter died of a combination of ailments related to poor care, including infected ulcer, pneumonia, dehydration, and sepsis. In addition, his death was hastened by antipsychotic drugs—drugs he didn’t need. (We have written about the problem of inappropriate use of dangerous antipsychotic medications. To read that blog, click here:  Antipsychotic Drugs Over-Prescribed in Elderly) According to ProPublica:

Dr. Michael Dobersen, a forensic pathologist and the coroner for Arapahoe County, Colo., said he worries about suspicious deaths in nursing homes. “Sometimes, if I don’t want to sleep at night, I think about all the cases that we miss,” Dobersen said. “I’m afraid we’re not looking very hard.”

How Can This Happen?

The reason so many suspicious deaths are overlooked is because of a number of systemic flaws:

  • When treating physicians report that a death is natural, coroners and medical examiners almost never investigate. But doctors often get it wrong. In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall.
  • In most states, doctors can fill out a death certificate without ever seeing the body. That explains how a Pennsylvania physician said her 83-year-old patient had died of natural causes when, in fact, he’d been beaten to death by an aide. The doctor never saw the 16-inch bruise that covered the man’s left side.
  • Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis found that the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.
  • And then there is what is arguably the most common reason of all:  Ageism.  According to geriatrician Kathryn Locatell, who specializes in diagnosing elder abuse, it all boils down to ageism. She said, “We don’t value old people. We don’t want to think about ourselves getting old.”

    Catherine Hawes, a Texas A&M health-policy researcher who has studied elder abuse for the U.S. Department of Justice, agrees, calling the issue a “hidden national scandal.” She interviewed 40 coroners and medical examiners about how they handled deaths among senior citizens. They told her that they were reluctant to perform autopsies.

    “Many of them made the blanket assumption that when an elderly person dies, it must have been because ‘their time had come,'” she said. “But they don’t make that assumption about any other part of the population.”

    A Need to Keep Eyes Open

    It’s a sad fact that many legislators work to pass laws that reflect their own experiences, which is why it is so difficult to understand why there are so few safeguards for the elderly. We’ve all had parents, grandparents, great-grandparents, and many of them have ended up in nursing homes. Is it that they were among the lucky ones who had perfect care for their loved ones? Or could it be that no one wants to believe that their loved ones were victims who died painful deaths?

    For example, Joe Shepter, the son of Joseph Shepter “used to think that his father ‘died a somewhat peaceful death’ surrounded by caring professionals. Instead, he now believes, his “father was lying in a hospital bed essentially dying of thirst, unable to express himself….”

    It’s a difficult thought to have to live with. There’s no going back from something like that. But it is worth knowing. In fact, some communities are developing new strategies for pinpointing suspicious deaths. For example, some counties formed elder death review teams made up of police, prosecutors, adult protective services, the medical examiner, emergency personnel, and others. They are similar to the kinds of teams used by child-abuse investigators. It’s a way to make sure that more than one set of eyes is responsible for looking for signs of abuse.

    It’s also a way to make sure that the elderly get justice…eventually, if belatedly.

    To read the full article on ProPublica.org, click here:  Gone Without a Case