Abuse among African-American elderly

This paper presents an overview of recent literature and research on elder abuse among African-Americans. Data about maltreatment of elders in the majority and minority races are presented, but persistent, unanswered questions and other issues also are raised. Characteristics of victims and perpetrators of elder abuse, the history and cultural traditions of Black families, differences between Black informal support networks and others, the phenomenon of violence and African-Americans, and concerns about access and utilization of formal support(s) are discussed. Interim recommendations are proposed.     

Sleeping accidents in the elderly

Two cases of dangerous sleeping environments in the elderly are reported to demonstrate similarities and differences of these "sleeping accidents" to similar episodes that occur in infants and children. CASE REPORTS: An 87-year-old wheelchair-bound man with a history of dementia was found in his nursing home room hanging off the side of the bed from a vertical metal bar, and an 87-year-old woman with epilepsy, ischemic heart disease, and insulin-dependent diabetes mellitus was found in hospital wedged between an inflatable mattress and the bars of her bed. These cases demonstrate that, as in the very young, relatively poor coordination and strength in the elderly often with limited comprehension and ability to deal with dangerous environments may predispose to sleeping accidents. Significant underlying organic disease may, however, make determination of the precise lethal mechanisms difficult. Modification of beds should only be undertaken when safety issues have been carefully evaluated.     

Silent suicide in the elderly

The suicide rate in the United States rises consistently with age. Silent suicide is defined as the intention, often masked, to kill oneself by nonviolent means through self-starvation or noncompliance with essential medical treatment. Silent suicide frequently goes unrecognized because of undiagnosed depression and the interjection of the personal belief systems of health-care providers and family members. Elderly individuals committing silent suicide are often thought to be making rational end of life decisions. However, the elderly committing silent suicide must be distinguished from terminally ill patients who refuse further treatment in order not to prolong the act of dying. The clinical/legal issues surrounding silent suicide will be discussed.     

Protection of incapacitated elderly in medical research

The widened scope of medical research has resulted in the establishment of multiple international, European and national rules and norms. Firm regulation of medical research is especially important when vulnerable people like incapacitated elderly are involved. The protection of incapacitated elderly is at stake when rules and norms are multi-interpretable, unclear and conflicting.     

Assessing civil competence in the elderly.

This study was designed to establish reliability of the Community Competence Scale-Revised (CCS-R) and provide evidence for its validity in making discriminations relevant to civil competence in the elderly. The CCS-R is an individually administered structured interview of 17 subscales. Criterion groups were formed by drawing a sample of research participants from a retirement complex with various levels of care and with nurses having extensive knowledge of the residents' level of functioning. The study demonstrated high reliability and found converging evidence for the effectiveness of the CCS-R in making discrimination about competence in the elderly. The study had added to the growing evidence that it is possible to standardize the assessment of civil competence, thereby making the adjudication process a more accurate one.     

Eyewitness identification by elderly and young adults

Elderly men and women and young males and females observed a simulated assault and theft of a wallet by a male assailant on a male victim. Two other people also were present in the criminal scenario, a female friend of the victim, and a female witness bystander. Young subject-witnesses were significantly superior to the elderly in verbal recall of details of the criminal episode. However, no reliable differences were found between the two age categories in recognition of the assailant, the victim, or friend. Women were superior to men and young people were superior to the elderly in identifying the bystander. Identification of the assailant was influenced by complex interactions of guilty or innocent facial appearances of the assailant and the victim, as well as the sex and age of the witnesses.     

Health care of the disadvantaged: the elderly

This paper explores threats to the maintenance and expansion of public commitment to financing health care for the elderly. Threats come from rising costs that increase financial burdens, especially on low-income elderly; efforts to contain costs that may undermine benefits; and financing initiatives that treat the elderly as the sole revenue source for addressing problems in that age group. A review of these threats provides lessons not only for sustaining and improving health care for the elderly, but also for policy toward equally or more disadvantaged groups.     

Morphometric investigation of emphysema aquosum in the elderly

We compared the lungs of six drowned and six non-drowned persons over 70 to determine whether there is evidence of acute overinflation in drowning that can be distinguished from senile lung emphysema. All left lungs underwent intrathoracic formalin fixation to preserve their state of insufflation. To assess the effects of lung collapse, all right lungs were sectioned as usual and then immersed in formalin. After histological processing, microphotography and image processing of 12 specimens per corpse, 50 binary images of each specimen were measured by computerized morphometry. Intrathoracic fixation resulted in significantly less tissue area (and more airspace) in the left than in the right lungs of both groups. Comparing both groups' left lungs revealed that the interalveolar septa were thinner and the area occupied by connecting nodes smaller in drowning; these single nodes also tended to be smaller. There was a tendency for less alveolar tissue area per image in drowning than in control lungs and for narrow tissue structures to comprise a higher percentage of both the total tissue area and total tissue perimeter per image. We conclude that there is morphological evidence of acute overinflation even in senile lungs, but this is masked by postmortem lung collapse as suggested by the overlapping values of the right lungs. Support to the diagnosis of drowning among drowned elderly patients can only be available in lungs subjected to intrathoracic postmortem fixation.     

Criminal victimization of the elderly: An overview

This paper reviews existing literature and examines three questions : a) the nature and extent of criminal victimization of the elderly, b) the impact of crime on the lives of the elderly, and c) suggested crime prevention measures. One finds that contrary to popular opinion the elderly are less frequently criminally victimized than persons in younger age groups. The 1966 NORC survey, 1972 Denver Victimization Survey, and the 1973 LEAA Survey, all show that the elderly in comparison to younger age groups are victimized less frequently for most personal crimes. However, there is variability in regard to who among the elderly are more likely to be victimized. In profile the elderly at highest “risk” are single females who are socially isolated, have physical or mental impairments, incomes below $3000 per year, and live in or near high crime areas. Despite the fact that the elderly are less frequently victimized than others their “fear of crime” is greater, and has been increasing since 1965, than other age groups. Many factors are important in fueling their fear. Some of the more important concerns are the elderly’s physical and emotional vulnerability, especially in high crime areas, and their isolation (both socially and self-imposed) from others within a community. There are, however, efforts being made to further protect the elderly against crimes and to reduce their fear. Several examples of existing programs established in an effort to ameliorate the problems are specified. Also, suggestions, based on research findings, are made which could further deter crimes against the elderly and lessen the insidious fear of crime that exists.     

Residence patterns of the elderly in early eighteenth-century Iceland

In this article the 1703 Icelandic census is used to shed light on the living arrangements of the elderly during a period of harsh climatic and social conditions. The census is unique in the sense that it includes an entire population of a country at an early date. It was taken on the initiative of the authorities in Denmark with the objective of examining the dire conditions of the Icelandic population and, in particular, assessing the number of paupers and vagrants. The census therefore provides interesting possibilities to analyse the situation of the most vulnerable groups of the society. In a society with low nuptiality rates and a low sex ratio, the risk of becoming dependent on poor relief increased with age. Elderly persons who were not able to retire in the household of an offspring ran the risk of spending their last years as paupers. In the 75 and older age group, no less than 43.5% of women were in the position of a pauper. In line with other recent studies on intergenerational co-residence, this study indicates that the elderly preferred to co-reside with their offspring. Even though elderly couples preferred to remain in the position of head of household, most would co-reside with their children. As regards widowed persons, there were noticeable differences between elderly men and women. Elderly widows were thus more likely than widowers to resign from headship on entering widowhood in order to retire in the household of one of an offspring.     

Fear and criminal victimization among elderly public housing residents

The influence of crime among the elderly was investigated in this study. The study suggests that crime prevention programs among the elderly should be implemented with some reservations. Since the risks of criminal victimization are low among the elderly, it may not be possible to reduce those rates much further, even with elaborate security programs for the elderly. On the contrary, raising the salience of crime by placing great emphasis on preventive behavior may well foster social isolation among the elderly.     

Examination results and autopsy findings in assaults on elderly people

As the percentage of elderly people in the population grows, violence against persons of advanced age constitutes an increasing social problem. The findings of the clinical forensic examinations (CE group) and autopsies performed on elderly violence victims (> or = 60 years) between 1999 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In all, the study material comprised 55 victims of the CE group (35 females and 20 males, median age 73.5 years) and 55 autopsies (33 females and 22 males, median age 72.7 years). In most of the autopsy cases, the suspect was a family member or partner. In contrast, the alleged perpetrator was a stranger in most cases of the CE group. Blunt force injuries were most often found in the CE group victims (63.6%). Altogether, 38.2% (CE group) and 20.0% (autopsy cases) of the violent assaults were associated with robbery. In the majority of the CE cases, the victims suffered potentially or acute life-threatening injuries. In summary, the analysis shows that elderly people frequently become victims of robbery and blunt force injury. In most homicides of old people, the perpetrator is familiar to the victim. In surviving elderly violence victims, the assault is more likely to be reported to the police if the suspect is a stranger.     

Littre hernia--a rare cause of unexpected death in the elderly

A rare case of sudden and unexpected death is reported in an 87-year-old woman who was found dead at her home. At autopsy, the most striking finding was of a right-sided direct inguinal hernia containing a 20 mm infarcted Meckel diverticulum, with proximal small intestinal obstruction. Significant stenosing atherosclerosis was present in all three major epicardial coronary arteries, but with no histological evidence of acute or chronic ischemic myocardial damage. Death was attributed to small intestinal obstruction due to direct inguinal herniation (and infarction) of a Meckel diverticulum (a Littre hernia), complicating ischemic heart disease. Although Littre hernias are not a reported cause of sudden death in the elderly, congenital gastrointestinal anomalies may rarely play a significant role in terminal episodes well beyond childhood years. The autopsy assessment of sudden death at any age involves detailed examination of the entire length of the intestinal tract.