Elder Abuse pp 387-416 | Cite as

Elder Abuse Forensics: The Intersection of Law and Science

  • Candace J. HeislerEmail author


Identification and intervention in elder abuse has historically been limited by funding to support research and the development of evidence-based practices. Elder abuse is increasingly recognized as a complex issue often requiring the expertise of many systems including medicine, mental health, social and protective services, and civil and criminal justice. The authority to act, the extent of that authority, and the kinds of remedies that may be available all begin with the identification of elder abuse, neglect, and exploitation. This chapter focuses on this intersection of law and science, and examines forensic issues, the application of science to questions in a legal system. The criminal and civil legal systems turn to science to answer critical questions such as: what are the forensic markers of elder abuse and neglect? Are there other possible explanations for these forensic markers, and if so, how is abuse or neglect differentiated? In cases of financial questions include: what is capacity? How is it assessed? Can a person appear able to manage his or her affairs and have significant brain impairment? The answers will determine if an action can be brought, the legal basis, and who can be protected and/or held accountable.


Elder abuse Neglect Sexual abuse Strangulation Capacity Assessment of capacity Expert witnesses Criminal and civil legal systems Forensic/forensics 



The author wishes to acknowledge the assistance of Dr. Dean Hawley of the Indians Indiana University School of Medicine, Dr. Diana Homeier of the University of Southern California, Keck School of Medicine, and Mr. Randy Thomas South Carolina State Law Enforcement Academy (retired) and thank them for their guidance, careful review, and suggestions.


  1. 1.
    Aamodt WW, Terracina KA, Schillerstrom JE. Cognitive profiles of elder adult protective services clients living in squalor. J Elder Abuse Negl. 2015;27(1):65–73.PubMedCrossRefGoogle Scholar
  2. 2.
    Agarwal S, Driscoll J, Gabaix X, Laibson D. The age of reason: financial decisions over the life cycle and implications for regulations. Washington, DC: Brookings Institution; 2009. http://www.brookings.Edu/~/media/Projects/BPEA/Fall%202009/2009b_bpea.
  3. 3.
    Alliance for Health Care Reform. Health care workforce: future demand v. supply. 2011.,%204.22.pdf. Accessed 12 Dec 2015.
  4. 4.
    Alt K, Nguyen A, Meurer L. The effectiveness of educational programs to improve recognition and reporting of elder abuse and neglect: a systematic review of literature. J Elder Abuse Negl. 2011;23(3):213–33.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
  6. 6.
    American Bar Association and American Psychological Association. Assessment of older adults with diminished capacity: a handbook for lawyers. 2005.
  7. 7.
    American Bar Association Commission on Law and Aging & American Psychological Association. Assessment of older adults with diminished capacity: a handbook for psychologists. 2008.
  8. 8.
    American Bar Association, American Psychological Association, and National College of Probate Judges. Judicial determination of capacity of older adults in guardianship proceedings: a handbook for judges. 2006.
  9. 9.
    American Board of Forensic Odontology. Guidelines for bite mark analysis. J Am Dental Assoc. 1986;112:383–6.CrossRefGoogle Scholar
  10. 10.
    American Psychiatric Association. “Hoarding Disorder” diagnostic and statistical manual of mental disorders. 2014.
  11. 11.
    American Psychological Association. Cognitive problems. 2015. Accessed 2 Jan 2016.
  12. 12.
    Anonymous. Protecting older americans: a history of federal action on elder abuse, neglect, and exploitation. J Elder Abuse Negl. 2002; 14(2/3):9–85.Google Scholar
  13. 13.
    Appelbaum PS. Assessment of patients’ competence to consent to treatment. N Engl J Med. 2007;357:1834–40.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    ASCP (American Society of Consultant Pharmacists). What is a consultant pharmacist? 2014. 2015. ASCP fact sheet.
  15. 15.
    Asp E, Manzel K, Koestner B, Cole CA, Denburg NL, Tranel D. A neuropsychological test of belief and doubt: damage to ventromedial prefrontal cortex increases credulity for misleading advertising. Front in Neurosci. 2012;6:1–9.CrossRefGoogle Scholar
  16. 16.
    Bardach, S.H. & Rowles, G.D. Geriatric Education in the Health Professions: Are We Making Progress?. The Gerontologist. 2012 Oct 52(5): 607–618. Accessed 12 Dec 2015.
  17. 17.
    Bartlett S. Autopsy cutbacks reveal ‘Gray Homicides.’ Part of the series: NPR news investigations: post mortem: death investigation in America. Co-published on broadcast media and web distribution by NPR(National Public Radio) All Things Considered, and PBS Frontline, Feb. 5, 2011. Accessed 24 May 2011.
  18. 18.
    Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R, Vliet MV, Nemeskal R, Leape LL, for the Bardach SH, Rowles GD. Geriatric education in the health professions: are we making progress?” Gerontologist. 2012;52(5):607–618. Accessed 12 Dec 2015.
  19. 19.
    Bell-McGinty S, Podell K, Franzen M, Baird AD, Williams MJ. Standard measures of executive function in predicting instrumental activities of daily living in older adults. Int J Geriatr Psychiatry. 2002;17(9):828–34.PubMedCrossRefGoogle Scholar
  20. 20.
    Berlowitz DR, Brandeis GH, Anderson JJ, Ash AS, Kader B, Morris JN, Moskowitz MA. Evaluation of a risk-adjustment model for pressure ulcer development using the minimum data set. J Am Geriatrics Soc. 2001;49(7):872–6.CrossRefGoogle Scholar
  21. 21.
    Berry SD, Kiel DP. Falls. In: Durso SC, Sullivan GM, editors. Geriatrics review syllabus: a core curriculum in geriatric medicine. 8th ed. New York: American Geriatrics Society; 2013. p. 261–9.Google Scholar
  22. 22.
    Billioti de Gage S, Begaud B, Bazin F, Verdoux H, Dartigues JF, Peres K, Kurth T, Pariente A. Benzodiazepine use and risk of dementia: Prospective population based study. BMJ (Clin Res Ed). 2012;345:e6231.Google Scholar
  23. 23.
    Blakely BE, Dolon R. Another look at the helpfulness of occupational groups in the discovery of elder abuse and neglect. J Elder Abuse Negl. 2003;13:1–23.CrossRefGoogle Scholar
  24. 24.
    Blum B. Forensic evaluations: testamentary capacity. Psychiatric Times. 2015.
  25. 25.
    Bowden ML, Grant ST, Vogel B, et al. The elderly, disabled and handicapped adult burned through abuse and neglect. Burns Incl Thermal Inj. 1988;14(6):447–50.CrossRefGoogle Scholar
  26. 26.
    Brandl B, Dyer CB, Heisler CJ, Otto JM, Stiegel LA, Thomas RW. Elder abuse detection and intervention: a collaborative approach. New York: Springer; 2007.Google Scholar
  27. 27.
    Brown K, Streubert GE, Burgess AW. Effectively detect and manage elder abuse. Nurse Pract. 2004;29(8):22–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Brown AS. Patterns of abuse among native American elderly. In: Tatara T, editor. Understanding elder abuse in minority communities (ch. 10, pp. 143–159). Philadelphia: Brunner/Mazel; 1999.Google Scholar
  29. 29.
    Burgess AW, Hanrahan NP, Baker T. Forensic markers in elder female sexual abuse cases. Clin Geriatr Med. 2005;21:399–412.PubMedCrossRefGoogle Scholar
  30. 30.
    Burgess A, Ramsey-Klawsnik H, Gregorian S. Comparing routes of reporting in elder sexual abuse cases. Elder Abuse Negl. 2008;20:336–52.CrossRefGoogle Scholar
  31. 31.
    Burnett J, Achenbaum WA, Murphy KP. Prevention and early identification of elder abuse. Clin Geriatr Med. 2014;30:743–59.CrossRefPubMedGoogle Scholar
  32. 32.
    Burnett J, Mitchell RA Jr, Cloyd EA, et al. Forensic markers associated with elder mistreatment and self-neglect: a case-control study. Acad Forensic Pathol. 2013;3(4):458–67.CrossRefGoogle Scholar
  33. 33.
    California Courts. Elder abuse in tribal communities: a guide for California state judges. 2014.
  34. 34.
    California Courts. Definitions of elder abuse and settings in which abuse occurs, Chapter 2, abuse in later life bench guide. 2015. In press.Google Scholar
  35. 35.
    Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, Schubert CC, Munger S, Fick D, Miller D, Gulati R. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225–33.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Carriere I, Fourrier-Reglat A, Dartigues JF, Rouaud O, Pasquier F, Ritchie K, Ancelin ML. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Int Med. 2009;169(14):1317–24.CrossRefGoogle Scholar
  37. 37.
    Carson DK, Hand C. Dilemmas surrounding elder abuse and neglect within Native American communities. In: Understanding and combatting elder abuse in minority communities. Archstone Foundation; 1998. pp. 87–96.Google Scholar
  38. 38.
    Chang AL, Wong JW, Endo JO, et al. Geriatric dermatology Part II. Risk factors and cutaneous signs of elder mistreatment for the dermatologist. J Am Acad Dermatol. 2013;68(4):533.e1–10.CrossRefGoogle Scholar
  39. 39.
    Collins KA, Bennett AT, Hanzlick R. The autopsy committee of the college of american pathologists. Elder Abuse Negl. Arch Intern Med. 2000;160:1567–69.Google Scholar
  40. 40.
    Collins KA, Presnell SE. Elder neglect and the pathophysiology of aging. Am J Forensic Med Pathol. 2007;28(2):157–62.PubMedCrossRefGoogle Scholar
  41. 41.
    Collins KA. Elder maltreatment: a review. Arch Pathol Lab Med. 2006;130:1290–6.PubMedGoogle Scholar
  42. 42.
    Connolly MT, Brandl B, Breckman R. The elder justice roadmap: a stakeholder initiative to respond to an emerging health, justice, financial and social crisis. 2014. Accessed 7 Jan 2016.
  43. 43.
    Connolly MT. Where Elder abuse and the justice system collide: police power, parens patriae, and 12 recommendations. J Elder Abuse Negl. 2010;22(1/2):37–93.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Cooney LM, Kennedy GJ, Hawkins KA, et al. Who can stay at home? Assessing the capacity to choose to live in the community. Arch Int Med. 2004;164:357–60.CrossRefGoogle Scholar
  45. 45.
    Cooper C, Livingston G. Mental health/psychiatric issues in elder abuse and neglect. Clin Geriatr Med. 2014;30:839–50.CrossRefPubMedGoogle Scholar
  46. 46.
    Cooper C, Selwood A, Livingston G. Knowledge, detection and reporting of abuse by health and social care professionals: a systematic review. Am J Geriatr Psychiatry. 2009;17:826–38.PubMedCrossRefGoogle Scholar
  47. 47.
    Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis Int. 2014;25(10):2359–2381, viewed December 28, 2015.
  48. 48.
    Crane J. Injury interpretation. In: Stark MM, editors. Forensic science: a physician’s guide to forensic medicine. Totowa: Humana Press.Google Scholar
  49. 49.
    Del Carmen T, LoFaso VM. Elder neglect. Clin Geriatr Med. 2014;30:769–77.PubMedCrossRefGoogle Scholar
  50. 50.
    Denburg NL, Cole CA, Hernandez M, Yamada TH, Tranel D, Bechara A, Wallace RB. The orbitofrontal cortex, real-world decision making, and normal aging. Ann NY Acad Sci. 2007;1121:480–98.PubMedCrossRefGoogle Scholar
  51. 51.
    de Vries OJ, Peeters G, Elders P, Sonnenberg C, Muller M, Deeg DJ, Lips P. The elimination half-life of benzodiazepines and fall risk: Two prospective observational studies. Age Ageing. 2013;42(6):764–70.PubMedCrossRefGoogle Scholar
  52. 52.
    Dong X. Elder abuse in chinese populations: A global review. J Elder Abuse Negl. 2015;27(3):196–232.PubMedCrossRefGoogle Scholar
  53. 53.
    Dong X. Medical implications of elder abuse and neglect. Clin Geriatr Med. 2005;21:293–313.CrossRefPubMedGoogle Scholar
  54. 54.
    Dong X, Lachs MS, Tinette ME. Reporting patterns of elder abuse and neglect in connecticut: an analysis of statewide database from 1992 to 2001. J Am Geriatr Soc. 2002;50:147.Google Scholar
  55. 55.
    Dyer CB, Heisler CJ, Hill CA, Kim LC. Community approaches to elder abuse. Clin Geriatr Med. 2005;21(2):429–47.CrossRefPubMedGoogle Scholar
  56. 56.
    Dyer CB, Goodwin JS, Vogel M, et al. Characterizing self-neglect: a report of over 500 cases of self-neglect seen by a geriatric medicine team. Am J Public Health. 2007;97:1671–6.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Dyer C, Connolly M, McFeeley P. The clinical and medical forensics of elder abuse and neglect. In: Bonnie RJ, Wallace RB, editors. Elder mistreatment: abuse, neglect, and exploitation in an aging America. Washington, DC: National Academies Press; 2003. p. 339–81.Google Scholar
  58. 58.
    Falk E, Hoffman N. The role of capacity assessments in elder abuse investigations and guardianships. Clin Geriatr Med. 2014;30:851–68.PubMedCrossRefGoogle Scholar
  59. 59.
    Falk E, Mosqueda L, Schneider DC, Bernatz S, Wood S. Geriatricians and psychologists: essential ingredients in the evaluation of elder abuse and neglect. J Elder Abuse Negl. 2010;22(3/4):281–290.Google Scholar
  60. 60.
    Faugno D, Waszak D, Strack GB, et al. Strangulation forensic examination: best practice for health care providers. Adv Emerg Nurs J. 2013;3(4):314–27.CrossRefGoogle Scholar
  61. 61.
    Fick DM, Semla TP. American geriatrics society beers criteria: New Year, new criteria, new perspective. J Am Geriatr Soc. 2012;60(4):614–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.PubMedCrossRefGoogle Scholar
  63. 63.
    Friedman LS, Avila S, Tanouye K, et al. A case-control study of severe physical abuse of older adults. J Am Geriatr Soc. 2011;59(3):417–22.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Fulmer T, Guadagno L, Dyer CB, et al. Progress in elder abuse screening and assessment instruments. J Am Geriatr Soc. 2004;52:1–8.CrossRefGoogle Scholar
  65. 65.
    Gibbs LM. Understanding the medical markers of elder abuse and neglect: physical examination findings. Clin Geriatr Med. 2014;30:687–712.PubMedCrossRefGoogle Scholar
  66. 66.
    Gibson SC, Greene E. Assessing knowledge of elder financial abuse: a first step in enhancing prosecutions. J Elder Abuse Negl 2013;25(2):162–182.Google Scholar
  67. 67.
    Gill JR, Cavalli DP, Ely SF, Stahl-Herz J. Homicidal neck compression of females: autopsy and sexual assault findings homicidal neck compression of females: autopsy and sexual assault findings. Acad Forensic Pathol. 2013;3(4):454–7.CrossRefGoogle Scholar
  68. 68.
    Greenbaum AR, Horton JB, Williams CJ, et al. Burn injuries inflicted on children or the elderly: a framework for clinical and forensic assessment. Plast Reconstr Surg. 2006;118:46–8.CrossRefGoogle Scholar
  69. 69.
    Greenbaum AR, Donne J, Wilson D, Dunn KW. Intentional burn injury: an evidence-based, clinical and forensic review. Burns. 2004;30(7):628–42.PubMedCrossRefGoogle Scholar
  70. 70.
    Hansberry MR, Chen E, Gorbien MJ. Dementia and elder abuse. Clin Geriatr Med. 2005;21:315–32.PubMedCrossRefGoogle Scholar
  71. 71.
    Heisler CJ. Elder abuse and the criminal justice system: an uncertain future. Generations. 2012;36(3):83–8.Google Scholar
  72. 72.
    Hudson MF, Carlson J. Elder abuse: its meaning to caucasians, African Americans, and Native Americans. In: Tatara T, editor. Understanding elder abuse in minority communities, chapter 12. Philadelphia: Brunner/Mazel; 1999. pp. 187–204.Google Scholar
  73. 73.
    Griffith HR, Belue K, Sicola A, et al. Impaired financial abilities in mild cognitive impairment: A direct assessment approach. Neurology. 2003;60:449–57.PubMedCrossRefGoogle Scholar
  74. 74.
    Harning AT Initial findings in stargulation injury aren’t indicative of outcome. J Emerg Med Serv. 2015. Accessed 28 Dec 2015.
  75. 75.
    Hawley DA Death by strangulation or suffocation (chapter 6) in the investigation and prosecution of strangulation cases. Training Institute on Strangulation Prevention and California District Attorneys Association; 2013.Google Scholar
  76. 76.
    Hawley DA, McClane G, Strack GB. A review of 300 attempted strangulation cases part III: injuries in fatal cases. J Emerg Med. 2001;21:317–22.PubMedCrossRefGoogle Scholar
  77. 77.
    Hendrix LR. Ethnogeriatric curriculum module: health and health care of American Indian and Alaska native elders.
  78. 78.
    Homeier D. Aging: physiology, disease and abuse. Clin Geriatr Med. 2014;30:671–86.PubMedCrossRefGoogle Scholar
  79. 79.
    Howe A, Collins KA, King PS, Yeoman C. Investigation of elder deaths. Acad Forensic Pathol. 2014;4(3):290–304.CrossRefGoogle Scholar
  80. 80.
    Institute of Medicine. Risk and Protective Factors and Interventions: Health and Medical Factors. In: Dan G. Blazer, Kristine Yaffe, and Catharyn T. Liverman, editors. Cognitive Aging: Progress in Understanding and Opportunities for Action, Chapter 4B. Washington, DC: The National Academies Press; 2015. p. 149–186.
  81. 81.
    Iserson KV. Strangulation. A review of ligature, manual, and postural neck compression in juries. Ann Emerg Med. 1984;13:179–85.PubMedCrossRefGoogle Scholar
  82. 82.
    Johannesen M, LoGiudice D. Elder abuse: a systematic review of risk factors in community-dwelling elders. Age Ageing. 2013;42:292–8.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Johnson SC. Traumatic brain injury, Chapter 68. In: Halter JB, Ouslander JG, Tinetti ME, et al., editors. Hazzard’s geriatric medicine and gerontology. 6th ed. New York: McGraw-Hill; 2009.Google Scholar
  84. 84.
    Johnson K. Financial crimes against the elderly. Problem-oriented guides for police. Guide number 20. 2004.
  85. 85.
    Kalisch Ellett LM, Pratt NL, Ramsay EN, Barratt JD, Roughead EE. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc. 2014;62(10):1916–22.PubMedCrossRefGoogle Scholar
  86. 86.
    Kane R, Goodwin J. Pathologic fractures of the long bones in nursing home patients. Am J Med. 1991;90:263–6.PubMedCrossRefGoogle Scholar
  87. 87.
    Karch D, Nunn KC. Characteristics of elderly and other vulnerable adult victims of homicide by a caregiver: national violent death reporting system-17 US States, 2003–2007. J Interpers Violence. 2011;26(137):137–57.PubMedCrossRefGoogle Scholar
  88. 88.
    Karlsson MK, Magnusson H, von Schewelov T, et al. Prevention of falls in the elderly—a review. Osteoporos Int. 2012.
  89. 89.
    Karp N. Protecting older investors: the challenge of diminished capacity. Generations. 2012;36(2):33–8.Google Scholar
  90. 90.
    Kennedy R. Elder abuse and neglect: the experience, knowledge, and attitudes of primary care physicians. Fam Med. 2005;37:481–5.PubMedGoogle Scholar
  91. 91.
    Kim L, Mitchell S, Dyer C. Do medical examiners determine elder mistreatment as a cause of death? Forensic Sci Med Pathol. 2007;3:9–13.PubMedGoogle Scholar
  92. 92.
    Koenig R, DeGuerre C. The legal and governmental response to domestic elder abuse. Orlando: Elsevier Saunders; 2005. p. 383–98.Google Scholar
  93. 93.
    Krauss D, Cassar D, Strother A. The admissibility of expert testimony in the united states, the commonwealth, and elsewhere. In: Krausee D, Lieberman J, editors. Psychological expertise in court. Burlington: Ashgate Publishing; 2009. p. 1–24.Google Scholar
  94. 94.
    Kuter DJ. Senile Purpura. Merck Manual, Professional Version. 2014. Accessed 29 Dec 2015.
  95. 95.
    Lachs MS, Pillemer KA. Elder abuse. New Engl J Med. 2015;373:1947–56.PubMedCrossRefGoogle Scholar
  96. 96.
    Lachs M, Pillemer K. Abuse and neglect of elderly persons. N Engl J Med. 1995;332:437–43.PubMedCrossRefGoogle Scholar
  97. 97.
    Lezak M, Howieson DB, Loring DW. Neuropsychological assessment. 4th ed. New York: Oxford University Press; 2004. p. 611.Google Scholar
  98. 98.
    Li J, Brown J, Levine M. Mild head injury, anticoagulants, and risk of intracranial injury. Lancet. 2001;357:771.PubMedCrossRefGoogle Scholar
  99. 99.
    LoFaso VM, Rosen T. Medical and laboratory indicators of elder abuse and neglect. Clin Geriatr Med. 2014;30:713–28.PubMedCrossRefGoogle Scholar
  100. 100.
    Lusardi A. Financial literacy and financial decision-making in older adults. Generations. 2012;36(2):25–32.Google Scholar
  101. 101.
    Lyder CH. Pressure ulcer prevention and management. JAMA. 2003;289:2.Google Scholar
  102. 102.
    Merriam Webster Dictionary (ND) “Forensic. Accessed 9 Dec 2015.Google Scholar
  103. 103.
    Marson DC. Clinical and ethical aspects of financial capacity in dementia: a commentary. Am J Geriatr Psychiatry. 2013;21(4):390–2. doi: 10.1097/JGP.0b013e31826682f4.CrossRefGoogle Scholar
  104. 104.
    Marson DC, Heber K, Solomon A. Assessing civil competencies in older adults with dementia: consent capacity, financial capacity, and testamentary capacity. In: Larrabee GJ, editor. Forensic neuropathology: a scientific approach. 2d ed. New York: Oxford University Press; 2011. p. 401–37.Google Scholar
  105. 105.
    Marson DC, Sabantino CP. Financial capacity in an aging society. Generations. 2012;36(2):6–11.Google Scholar
  106. 106.
    Marson DC, Sawrie SM, Snyder S, et al. Assessing financial capacity in patients with Alzheimer Disease: a conceptual model and prototype instrument. Arch Neurol. 2000;57(6):877–84. doi: 10.1001/archneur.57.6.877.CrossRefPubMedGoogle Scholar
  107. 107.
    Marson DC, Earnst KS, Jamil F, Bartolucci A, Harrell LE. Consistency of physicians’ legal standard and personal judgments of competency in patients with Alzheimer’s Disease. J Am Geriatr Soc. 2000;48(8):911–8.PubMedCrossRefGoogle Scholar
  108. 108.
    McClane G, Strack GB, Hawley DA. A review of 300 attempted strangulation cases part II: non-fatal assaults. J Emerg Med. 2001;21:311–5.PubMedCrossRefGoogle Scholar
  109. 109.
    McNamee CC, Murphy MB. Elder abuse in the United States. NIJ J. 2001;255.
  110. 110.
    Moskowitz S. Filial responsibility statutes: legal and policy considerations. J Law Policy. 2001;9(3):709–36.Google Scholar
  111. 111.
    Mosqueda L, Dong X. Elder abuse and neglect, “I don’t care anything about going to the doctor, to be honest. JAMA. 2011;306:532–40.PubMedCrossRefGoogle Scholar
  112. 112.
    Mosqueda L, Burnight K, Liao S. The life cycle of bruises in older adults. J Am Geriatr Soc. 2005;53(8):1339–43.CrossRefPubMedGoogle Scholar
  113. 113.
    Mosqueda L, Burnight K, Liao S, et al. Advancing the field of elder mistreatment: a new model for integration of social and medical services. Gerontologist. 2004;44(5):703–8.PubMedCrossRefGoogle Scholar
  114. 114.
    Moye J. Clinical frameworks for capacity assessment. In: Qualls S, Smyer M, editors. Changes in decision-making capacity in older adults: assessment and intervention. Hoboken: Wiley; 2007. p. 177–89.Google Scholar
  115. 115.
    Moye J, Marson D. Assessment of decision-making capacity in older adults: an emerging area of practice and research. J Gerontol B Psychol Sci Soc Sci. 2007;62(1):3–11.CrossRefGoogle Scholar
  116. 116.
    Naik AD, Lai JM, Kunik ME, et al. Assessing capacity in suspected cases of self-neglect. Geriatric. 2008;63:24–31.Google Scholar
  117. 117.
    Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JLC, Chertkow H. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9.PubMedCrossRefGoogle Scholar
  118. 118.
    National Research Council. Elder Mistreatment: abuse, neglect, and exploitation in an aging America. In: Bonnie RJ, Wallace RBRB, editors. Washington, DC: National Academies Press; 2003.Google Scholar
  119. 119.
    Navarro AE, Gassoumis Z, Wilber K. Holding abusers accountable: an elder abuse forensic center increases criminal prosecution of financial exploitation. Gerontologist. 2013;53(2):303–12.CrossRefPubMedGoogle Scholar
  120. 120.
    Navarro AE. Improving outcomes for victims of financial exploitation: the effect of an elder abuse forensic center, dissertation. 2011. Accessed 12 Dec 2015.
  121. 121.
    Navarro AE, Wilber KH, Yonashiro J, Homeier DC. Do we really need another meeting? Lessons from the Los Angeles county elder abuse forensic center. Gerontologist. 2010;50(5):702–11.CrossRefPubMedGoogle Scholar
  122. 122.
    Nerenberg L, Davies M, Navarro A. In pursuit of a useful framework to champion elder justice. Generations. 2012;36(3):89–96.Google Scholar
  123. 123.
    Nusbaum NJ, Cheung VM, Cohen J, Keca M, Malley B. Role of first responders in detecting and evaluating elders at risk. Arch Gerontol Geriatr. 2006;43:361–7.PubMedCrossRefGoogle Scholar
  124. 124.
    O’Connor D, Hall MI, Donnelly M. Assessing capacity within a context of abuse or neglect. J Elder Abuse Negl. 2009;21(2):156–69.PubMedCrossRefGoogle Scholar
  125. 125.
    Payne BK, King PS, Manaois A. Training police officers about elder abuse: training needs and strategies. Int Perspect Victimol. 2009;4(2):40–9.Google Scholar
  126. 126.
    Plattner T, Bolliger S, Zollinger U. Forensic assessment of survived strangulation. Forensic Sci Int. 2005;153:202–7.PubMedCrossRefGoogle Scholar
  127. 127.
    Policastro C, Payne BK. Assessing the level of elder abuse knowledge preprofessionals possess: implications for the further development of university curriculum. J Elder Abuse Negl. 2014;26(1):12–30.PubMedPubMedCentralCrossRefGoogle Scholar
  128. 128.
    Powers JS. Common presentations of elder abuse in health care settings. Clin Geriatr Med. 2014;30:729–41.CrossRefPubMedGoogle Scholar
  129. 129.
    Prahlow JA. Investigation of deaths of chronically disabled persons and institutionalized persons. Acad Forensic Pathol. 2014;4(3):262–89.CrossRefGoogle Scholar
  130. 130.
    Rathbone-McCuan, Bricker-Jenkins. Self-neglect and adult protective services in social counselor certification resource handbook. Nashville, TN Department of Social Services; 1989. 301 (cited in Longres, Self-neglect among the elderly. J Elder Abuse Negl. 1995;7(1):69–86).Google Scholar
  131. 131.
    Reyes-Ortiz CA, Burnett J, Flores DV, Halphen JM, Dyer CB. Medical implications of elder abuse: self-neglect. Clin Geriatr Med. 2014;30:807–23.Google Scholar
  132. 132.
    Royall DR, Chiodo LK, Polk MJ. An empiric approach to level of care determinations: the importance of executive measures. J Gerontol A Biol Sci Med Sci. 2005;60A:1059–64.CrossRefGoogle Scholar
  133. 133.
    Safarik ME, Jarvis JP, Nussbaum KE. Sexual homicide of elderly females: linking offender characteristics to victim and crime scene attributes. J Interpersonal Violence. 2002;17:500–25.CrossRefGoogle Scholar
  134. 134.
    Samanez-Larkin GR, Levens SM, Perry LM, Dougherty RF, Knutson B. Frontostriatal white matter integrity mediates adult age differences in probabilistic reward learning. J Neurosci. 2012;32(15):5333–7.PubMedPubMedCentralCrossRefGoogle Scholar
  135. 135.
    Samton JB, Ferrando SJ, Sanelli P, et al. The clock drawing test: diagnostic, functional, and neuroimaging correlates in older medically ill adults. J Neuropsychiatry Clin Neurosci. 2005;7:533–40.CrossRefGoogle Scholar
  136. 136.
    Schneider DC, Mosqueda L, Falk E, Huba GJ. Elder abuse forensic centers. J Elder Abuse Negl. 2010;22(3/4):255–74.CrossRefPubMedGoogle Scholar
  137. 137.
    Schmeidel A, Daly J, Rosenbaum M, et al. Health Care professionals’ perspectives on barriers to elder abuse detection and reporting in primary care settings. J Elder Abuse Negl. 2012;24(1):17–36.PubMedPubMedCentralCrossRefGoogle Scholar
  138. 138.
    Shany-Ur T, Poorzand P, Grossman SN, Growdon ME, Jang JY, Ketelle RS, Miller BL, Rankin KP. Comprehension of insincere communication in neurodegenerative disease: lies, sarcasm, and theory of mind. Cortex. 2012l;48:13329–1341. Accessed 16 Dec 2015.
  139. 139.
    Sherod MG, Griffith HR, Copeland J, Belue K, Krzywanski S, Zamrini EY, Harrell LE, Clark DG, Brockington JC, Powers RE, Marson DC. Neurocognitive predictors of financial capacity across the dementia spectrum: normal aging, mild cognitive impairment, and alzheimer’s disease. J Int Neuropsychol Soc. 2009;15(2):258–67.PubMedPubMedCentralCrossRefGoogle Scholar
  140. 140.
    Shields L, Hunsaker D, Hunsaker J. Abuse and neglect: a ten-year review of mortality and morbidity in our elderly in a large metropolitan area. J Forensic Sci. 2004;49(1):122–7.PubMedCrossRefGoogle Scholar
  141. 141.
    Simpson AR. Cultural issues and elder mistreatment. Clin Geriatr Med. 2005;21:355–64.PubMedCrossRefGoogle Scholar
  142. 142.
    Smith DJ, Mills T, Taliaferro EH. Frequency and relationship of reported symptomology in victims of intimate partner violence: the effect of multiple attempted strangulation attacks. J Emerg Med. 2001;21:323–9.PubMedCrossRefGoogle Scholar
  143. 143.
    Stahl S. Building consensus on research priorities in elder mistreatment. 2015. Accessed 7 Jan 2016.
  144. 144.
    Stapczynski JS. Strangulation injuries. Emerg Med Rep. 2010;31(17):193–203.Google Scholar
  145. 145.
    Stiegel L, Klem E, Turner J. Neglect of older persons: an introduction to legal issues related to caregiver duty and liability. 2007. Neglect. Retrieved from
  146. 146.
    Stiegel L. The changing role of the courts in elder abuse cases. Generations. 2000;24(11):59–64.Google Scholar
  147. 147.
    Strack GB, McClane G, Hawley DA. A review of 300 attempted strangulation cases part I: criminal legal issues. J Emerg Med. 2001;21:303–9.PubMedCrossRefGoogle Scholar
  148. 148.
    Suffla S, Seedat M. The epidemiology of homicidal strangulation in the city of Johannesburg, South Africa. J Foren Legal Med. 2016;37:97–107.CrossRefGoogle Scholar
  149. 149.
    Talamantes M, Aranda M. Cultural competency in working with latino caregivers. National Center on Caregiving; 2004.Google Scholar
  150. 150.
    Tannenbaum C, Paquette A, Hilmer S, Holroyd-Leduc J, Carnahan R. A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, gabaergic and opioid drugs. Drugs Aging. 2012;29(8):639–58.PubMedGoogle Scholar
  151. 151.
    Taylor T, Mulford C. Evaluating th Los Angeles County elder abuse forensic center. 2015.
  152. 152.
    Teaster PB, Dugar TA, Mendiondo MS, et al. The 2004 survey of state adult protective services: abuse of adults 60 years and older. Report prepared by The National Committee for the Prevention of Elder Abuse and The National Adult Protective Services Association. Washington, DC: National Center on Elder Abuse; 2007.Google Scholar
  153. 153.
    Terracina KA, Aamodt WW, Schillerstrom JE. Executive function impairment and recidivism in adult protective services clients referred for a decision making capacity assessment. J Elder Abuse Negl. 2015;27(2):91–9.PubMedPubMedCentralCrossRefGoogle Scholar
  154. 154.
    Tisdale M. Biology of cachexia. JNCI J Natl Cancer Inst. 1997;89(23):1763–73. Retrieved 9 Jan 2016 from
  155. 155.
    Triebel KL, Martin R, Griffith HR, Marceaux MA, Okonkwo OC, Harrell L, Clark D, Brockington J, Bartolucci A, Marson DC. Declining financial capacity in patients with mild cognitive impairment: a one-year longitudinal study. Neurology. 2009;73:928–34.
  156. 156.
    Triebel KL, Marson DC. The warning signs of diminished financial capacity in older adults. Generations. 2012;36(2):39–45.Google Scholar
  157. 157.
    Tronetti P. Evaluating abuse in the patient with dementia. Clin Geriatr Med. 2014;30:825–38.PubMedCrossRefGoogle Scholar
  158. 158.
    Twomey MS, Weber C. Health professionals’ roles and relationships with other agencies. Clin Geriatr Med. 2014;30:881–95.PubMedCrossRefGoogle Scholar
  159. 159.
    Twomey MS, Jackson G, Li H, Marino T, Melchior LA, Randolph JF, Retselli-Deits T, Wysong J. The successes and challenges of seven multidisciplinary teams. J Elder Abuse Negl. 2010;22(3/4):291–305.PubMedCrossRefGoogle Scholar
  160. 160.
    Uekert BK, Keilitz S, Saunders D, Heisler CJ, Ulrey P, Baldwin EG. Prosecuting elder abuse cases: basic tools and strategies. National Center for State Courts; 2012.Google Scholar
  161. 161.
    Ulrey P, Brandl B. Collaboration is essential: king county’s response to a case of elder abuse and exploitation. Generations. 2012;36(3):73–8.Google Scholar
  162. 162.
    US Department of Health and Human Services & Elder Justice Coordinating Council. Report to congress. 2012–2014. Accessed 7 Jan 2016.
  163. 163.
    US Legal. Preponderance of the evidence. 2015. Accessed 28 Dec 2015.
  164. 164.
    Vognar L, Gibbs LM. Care of the patient. Clin Geriatr Med. 2014;30:869–80.CrossRefPubMedGoogle Scholar
  165. 165.
    Warren L, et al. The burden and outcomes associated with dehydration in the elderly, 1991. Am J Public Health. 1994;84:1265–9.PubMedPubMedCentralCrossRefGoogle Scholar
  166. 166.
    White House Conference on Aging. Final report. 2016.
  167. 167.
    Widera E, Steenpass V, Marson D, et al. Finances in the older patient with cognitive impairment ‘he didn’t want me to take over’. JAMA. 2011;305(7):698–706.PubMedPubMedCentralCrossRefGoogle Scholar
  168. 168.
    Wiglesworth A, Austin R, Corona M, et al. Bruising as a marker of physical elder abuse. J Am Geriatr Soc. 2009;57:1191–6.PubMedPubMedCentralCrossRefGoogle Scholar
  169. 169.
    Wiglesworth A, Mosqueda L, Burnight K, Younglove T, Jeske D. Findings from an elder abuse forensic center. Gerontologist. 2006;46:277–83.CrossRefPubMedGoogle Scholar
  170. 170.
    Wilbur L, Higley M, Hatfield J, et al. Survey results of women who have been strangled while in an abusive relationship. J Emerg Med. 2001;21(3):297–302.PubMedCrossRefGoogle Scholar
  171. 171.
    Wolf RS. Introduction: the nature and scope of elder abuse. Generations. 2000;24(11):6–12.Google Scholar
  172. 172.
    Wolfe DA. Elder abuse intervention: lessons from child abuse and domestic violence interventions. In: Bonnie RJ, Wallace RB, editors. Elder mistreatment: abuse, neglect, and exploitation in an aging America. Washington, DC: National Academies Press; 2003. p. 501–25.Google Scholar
  173. 173.
    Xue Q. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1–15. doi: 10.1016/j.cger.2010.08.009.CrossRefPubMedPubMedCentralGoogle Scholar
  174. 174.
    Young LA. Elder physical abuse. Clin Geriatr Med. 2014;30:761–8.PubMedCrossRefGoogle Scholar
  175. 175.
    Zelazo PD, Craik FI, Booth L. Executive function across the life span. Acta Psychol. 2004;115(2–3):167–83.CrossRefGoogle Scholar
  176. 176.
    Ziminski CE, Phillips LR, Woods DL. Raising the index of suspicion for elder abuse: cognitive impairment, falls and injury patterns in the emergency department. Geriatr Nurs. 2012;33(2):105–12.PubMedCrossRefGoogle Scholar


  1. 177.
    Berger v. United States (1935) 295 U.S. 78.Google Scholar
  2. 178.
    Daubert v. Merrell Dow Pharmaceuticals (1993) 509 US 579, 113 S. Ct. 2786.Google Scholar
  3. 179.
    Frye v. United States (DC, 1923) 293 F. 1013.Google Scholar
  4. 180.
    Glage v. Hawes Firearms Co. (CA, 1990) 226 Cal.App.3d 314, 276 Cal.Rptr. 430.Google Scholar
  5. 182.
    In re Angelia P. (CA, 1981) 28 Cal.3d 908, 171 Cal.Rptr. 637, 623 P.2d 198.Google Scholar
  6. 182.
    People v. Heitzman, (CA, 1994) 9 Cal. 4th 189, 37 Cal. Rptr. 2d 236, 886 P. 2d 1229.Google Scholar
  7. 183.
    People v. Miller (CA, 1916) 171 Cal. 649, 154 P. 468.Google Scholar
  8. 184.
    California Criminal Jury Instructions (CALCRIM) 220.Google Scholar
  9. 185.
    California Penal Code §1096.Google Scholar
  10. 186.
    California Penal Code §1096a.Google Scholar
  11. 187.
    Public Act 111–148, Title VI, Subtitle H—the Elder Justice Act, Subtitle B “Elder Justice”, Section 2011(18), available at

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Heisler and AssociatesSan BrunoUSA

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