Thymus of abused/neglected children.

Forty-six cases of child abuse/neglect autopsied during the period of 1967 to 1990 were investigated. The weight and histological findings of the thymus were compared with those of control children. In most abused and/or neglected children, the weight of the thymus decreased conspicuously. Involution correlated well to the degree and period of maltreatment. In cases without weight loss of the thymus, i.e. spasmodic abuse by a mentally deranged parent or foster parent, a short history of maltreatment was noted. On the other hand, marked involution was observed in cases of prolonged physical abuse and/or neglect. Microscopically, a decrease in the number and pyknosis of lymphocytes were observed in the involuted thymus. Atrophy of the thymus was more conspicuous in the cortex than in medulla. Immunohistochemically, CD-1a positive cells (immature thymocytes) decreased in cases with thymic involution. This involution appears to be an important index of the degree and duration of child abuse/neglect. Furthermore, thymic involution in the early stage of childhood may also be related to insufficiency of the immune system.     

The Neglect of Elder Neglect as a White-Collar Crime: Distinguishing Patient Neglect from Physical Abuse and the Criminal Justice System’s Response

While research on elder maltreatment has increased dramatically over the past three decades, few studies have considered elder neglect. Even fewer studies have addressed cases of patient neglect committed while older adults are receiving long-term care. In this study, we analyzed 252 cases of elder maltreatment to increase understanding about elder patient neglect and the way that patient neglect can be distinguished from patient abuse. The criminal justice system’s response to these crimes is also addressed. The results show that offenders in elder patient abuse and patient neglect cases receive similar sentences. However, the dynamics surrounding the offenses are different in important ways. Patient neglect cases are more likely than patient abuse cases to (1) involve multiple victims, (2) be committed in groups, (3) be white-collar crimes rather than occupational crimes, and (4) result in more serious consequences for victims. Implications for policy, theory, and research are provided.     

Understanding Elder Sexual Abuse and the Criminal Justice System's Response: Comparisons to Elder Physical Abuse

A great deal of research has considered the dynamics of sexual assault and the way that sexual assault cases are processed and handled in the criminal justice system. Most of this research has focused on sexual assault cases involving younger victims. Very little criminological research has considered the dynamics of elder sexual abuse. To fill this void, the current study uses a sample of 127 elder sexual abuse cases and 314 elder physical abuse cases to shed some light on the dynamics of elder sexual abuse and the way the justice system processes these cases. Attention is also given to the way that the processing of elder sexual abuse cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder sexual abuse cases are committed and these cases are processed differently than elder physical abuse cases. Implications are provided.     

Sudden infant death syndrome: Histological studies on adrenal gland and kidney

Histological observations were made on the adrenal glands and kidneys in ten cases of sudden infant death syndrome (SIDS). The amount of fetal cortex was excessive in the adrenal glands and many glomeruli of fetal form were observed in the kidneys. These findings suggest that the adrenal glands and the kidneys in SIDS cases are more or less immature in development. The immature development in these organs, especially in the adrenal glands, was considered to play a role in the cardiac or respiratory mechanisms in SIDS.     

Abuse and neglect: a ten-year review of mortality and morbidity in our elders in a large metropolitan area

Elder abuse and neglect refers to an act or omission resulting in harm, including death, or threatened harm to the health or welfare of an elderly person. Between one and two million elderly Americans experience some form of mistreatment annually. A ten-year (1992-2001) retrospective case review of morbidity and mortality among elders (age > 60 years) was conducted at a State Medical Examiner's Office serving a major metropolitan region in Kentucky and Indiana. This study addresses cases of two categories: 1) medicolegal autopsies and 2) examinations of living subjects pursuant to a Clinical Forensic Medicine Program. The authors present 74 postmortem cases, in which 52 deaths were attributed to a homicidal act and 22 deaths were suspicious for neglect. Of the 22 living victims of elder abuse and neglect, 19 cases constituted physical and/or sexual assault and three individuals suffered from neglect. This study summarizes the characteristic features of elder abuse in both postmortem and living cases and underscores the necessity for multi-agency collaboration in order to reach an accurate conclusion in case work. Policies established by a well-established elder abuse task force promote the collaborative interaction necessary to formulate criteria for prevention of abuse and death within this vulnerable population.     

Elder Abuse by Caregivers: A Study of Prevalence and Risk Factors in Hong Kong Chinese Families

This study aimed to establish preliminary estimates and related risk factors for elder abuse among Hong Kong Chinese families. A total of 276 elder Chinese participated in the study, among which 27.5% reported having experienced at least one abusive behavior committed against them by their caregivers during the surveyed year. The most common form of abuse was verbal abuse (26.8%), whereas physical abuse (2.5%) and violation of personal rights (5.1%) were relatively less common. There was no gender difference in the prevalence of elder abuse. Overall and verbal abuse were best predicted by participants' poor visual and memory abilities, dependence on the caregivers, and caregivers' nondependence on them. Physical abuse was best predicted by caregivers' nondependence on the participants as well as participants' dependence on the caregivers. Participants' age was the only significant predictor for violation of personal rights. Results, limitations, and implications of the study were also discussed.     

Police discretion and elder mistreatment: A nested model of observation,reporting, and satisfaction

This study examined police reporting behavior in elder mistreatment (abuse, neglect, and exploitation) cases. Relying on a survey of police officers in Alabama, this research investigates a nested model of mandatory reporting using linear regression techniques. Only about half of all elder mistreatment cases are reported to the proper authorities. Job experience, contact with the elderly, understanding of mistreatment laws, and positive attitudes toward reporting should increase detection, reporting, and overall satisfaction with the system. These causal factors, however, increased detection and reporting, but not satisfaction. Improvements in training and knowledge in elder mistreatment can be counterpro-ductive.     

Elder abuse in nursing homes: Prevention and resolution strategies and barriers

Recent concern about elder abuse prompted a great deal of research on the characteristics and risk factors for abuse. Most of this research, however, centered on the abuse of older persons living in a community-based setting. Much less research examined abuse occurring in nursing homes. Using routine activities theory as a guide, this article reports on a survey of seventy-six nursing home administrators with specific attention given to the elder abuse prevention and response strategies cited by nursing home administrators. Obstacles impeding successful prevention and intervention efforts were also considered.     

The impact of juror characteristics and victim health status on the perception of elder physical abuse

An experiment investigated mock juror perceptions of elder abuse using a community sample from Lexington, Kentucky. Two-hundred six men and women ranging in age from 18 to 88 read a fictional criminal trial summary of a case of elder physical abuse (EPA) in which the accuser was described as healthy, frail, or confused. In addition, the influence of participant age, participant gender, and attitude toward the elderly on juror perceptions of EPA was also investigated. Results showed that women had higher conviction rates than did men. Accuser health status, participant age, participant gender, and attitude toward the elderly affected other rating variables including accuser believability, accuser inaccuracy, defendant believability, and verdict confidence. Results suggest implications for how EPA cases are perceived in court.     

The Need for a Stronger Definition: Recognizing Abandonment as a form of Elder Abuse Across the United States

Elder abuse is a growing public health problem in the United States and statistics show that each year, hundreds of thousands of elders are abused in some manner. This Note discusses elder abuse while focusing specifically on the occurrence of elder abandonment and how the majority of states do not recognize elder abandonment as a form of elder abuse in their statutes. Moreover, this Note proposes a model statute to be adopted by every state in an effort for elder abandonment to become more widely reported. Elder abandonment is an unfortunate phenomenon and those who contribute to elder abandonment should face criminal liability similar to those abusers who engage in elder neglect or other types of elder abuse. Furthermore, this Note emphasizes that there should be a greater focus on how caregivers can seek assistance in order to prevent elder abuse in the United States.     

Elder abuse detection in nursing facilities: using paid clinical competence to address the nation's shame

Each year, five million senior citizens are the victims of abuse in our country-and that figure is a likely underestimate. In California alone, it is estimated that over 225,000 seniors are abused annually. Nursing home residents are particularly vulnerable to abuse, with one-fifth to one-third of these institutions cited for abusive activities that result in actual harm. Regular violations of minimum care regulations by nursing homes have been documented in every state. Despite legal protections, as a practical matter, the review, assessment, and investigation of nursing home care and potential senior abuse is the primary responsibility of voluntary ombudsmen. These volunteers are responsible for regular visits and determination of nursing home quality and resident treatment. This Article contends that, despite their commitment to the cause, voluntary ombudsmen are not a sufficient cure for the scourge of elder abuse. Rather, clinically-trained personnel with legal knowledge must assume the role that lay volunteer ombudsmen are inappropriately expected to play. Use of clinical case managers, who have expertise in assessing clinical factors and can be trained in legal matters, offers significant potential to assist in the detection, and, further, reporting and prosecution of elder abuse. The author concludes that only through use of those with appropriate training and knowledge can the epidemic of elder abuse be effectively addressed.     

Clinical case management: a strategy to coordinate detection, reporting, and prosecution of elder abuse

Despite civil and criminal sanctions, elder abuse is a prevalent, underreported, and underprosecuted event in the United States. Traditional reporting legislation and common law remedies have had minimal effect on the incidence and prevalence of elder abuse. The epidemic nature of elder abuse is projected to increase exponentially as the elderly population grows disproportionately over the next several decades. The fragmented system of detecting, reporting, and prosecuting this abuse across a wide range of medical and legal settings creates a poor structure to effectively allow a potentially abused patient to have his/her abuse circumstance communicated to the relevant parties to protect the patient, have his/her situation reported and investigated, and, if necessary, have the perpetrator brought to justice. Emergency rooms and other facilities where elders present for care should be staffed by clinically trained persons who have familiarity interacting with patients and providers across settings of care, and who are trained to detect and report abuse. Nursing case managers fill this role well because they are able to coordinate efforts among acute and long-term care facilities while also being able to supply patients with legal and clinical information about elder abuse. In addition they may support prosecution efforts through their clinical observations and expertise. Hence, clinical case managers are able to coordinate efforts lacking in the current system to effectively evaluate, report, protect, and arrange for relevant services for the patient. Through clinical and special training in elder abuse, nursing case managers can provide support to prosecution efforts against the perpetrators of this most egregious crime.     

Postmortem serum catecholamine levels in relation to the cause of death

Catecholamines are major humoral factors and neurotransmitters that contribute to various stress responses. However, they have been considered unstable due to agony, terminal medical care and postmortem interference. The present study was a comprehensive investigation of postmortem serum levels of adrenaline (Adr), noradrenaline (Nad) and dopamine (DA) with regard to the cause of death in serial medicolegal autopsy cases (n=542) including fatalities from various traumas and diseases. There was a slight tendency toward postmortem increases of Nad and DA in cardiac blood as well as Adr and Nad in peripheral blood, a slight age-dependent decrease in Adr and DA in right heart blood, and a marked increase in serum DA due to administration during critical medical care. When these factors were taken into consideration, significantly higher cardiac blood levels were observed for Adr and Nad in injury and asphyxiation cases and for Adr in fatal methamphetamine (MA) abuse and other poisoning cases, whereas those levels were lower in fatal hypothermia. Drowning, fire fatality, acute cardiac death and cerebrovascular disease showed intermediate Adr and Nad levels. The DA level was elevated in cases of injury, hyperthermia, MA fatality and other poisoning. Topographical analyses suggested that the major sources of increased serum catecholamines in cases of injury was abdominal viscera including adrenal glands, and that in cases of asphyxiation, drowning, fire fatality, hyperthermia, MA fatality, other poisoning, acute cardiac death and cerebrovascular disease was the extremities in addition to abdominal viscera. However, there was in part a large case-to-case difference in each marker related to individual causes of death. These findings differed markedly from clinical observations and suggest that the postmortem serum catecholamine levels may reflect the magnitude of physical stress responses during the process of death in individual cases.     

Public definitions and endorsement of the criminalization of elder abuse

A longitudinal cross sectional ten-year study was conducted measuring public attitudes toward the definition and criminalization of elder abuse. The study found that the public endorsed a fairly broad definition of elder abuse and that this definition of elder abuse was fairly stable over time. Subjects also strongly endorsed the creation of misdemeanor and felony statutes and strongly endorsed the use of prison to punish elder abusers. The subjects also believed that the criminalization of elder abuse would be effective in reducing elder abuse.     

A Path Analysis on Elder Abuse by Family Caregivers: Applying the ABCX Model

The purpose of this study was to investigate Hill’s ABCX model as an explanation for the caregiving stress process to elder abuse. However, due to ethical concerns on elder abuse studies, caregivers’ impulsive feelings to commit elder abuse were employed as an index to address elder abuse. The sample included 279 family caregivers for older adults with physical or cognitive impairments in South Korea. A path analysis was conducted to test the ABCX model. The results of path analysis did not statistically support the ABCX model as an explanation for caregivers’ impulsive feelings to commit elder abuse. Based on the findings of this study, the revised ABCX model was suggested for practitioners and researchers to better understand caregiving stress process to impulses of elder abuse.     

The portrayal of elder abuse in the national media

Over the last two decades, researchers and policy makers have begun to devote more attention to the problem of elder abuse. Still, compared to studies on other types of family violence, research on elder abuse is scarce. To better understand how elder abuse is portrayed in the media and using “newsmaking criminology” as a theoretical framework, this study considers how 11 newspapers describe the phenomenon. In all, 530 articles about elder abuse were content analyzed using standard rules of content analysis. Results suggest that certain types of elder abuse are excluded from the press. In addition, the press tends to define elder abuse as a crime, but not as a domestic violence offense. Implications are provided.     

An integrated understanding of elder abuse and neglect

In the past three decades, society has developed interest in what has come to be called elder abuse. Since interest initially appeared, concern about elder abuse has gone through different cycles regarding the conceptualization of the problem, appropriate responses, and explanations. A recent trend has witnessed a call for an interdisciplinary and integrated understanding of, and response to, elder abuse. This article describes what is meant by an integrated response to elder abuse. Ways to promote a broader response to the problem are suggested.     

Euthanasia: a reply to Bartels and Otlowski

This article counters arguments made by Bartels and Otlowski in 2010 regarding euthanasia. It suggests that the authors over-emphasised the importance of individual autonomy in its bearing on the euthanasia debate. Drawing on literature concerning elder abuse as well as the "mercy-killing" cases reviewed by Bartels and Otlowski, the article contends that legalising euthanasia may increase the risk that some patients are pressured, inadvertently or deliberately, to request access. Safeguards to detect and deter pressure may be of limited effectiveness against such pressure. Regarding slippery slope arguments, the article discusses the potential for an Australian euthanasia system to eventually be extended in scope to encompass mental suffering. The article encourages consideration of long-term potentialities, including changes in macro-economic conditions.     

Clinical applications of hair testing for drugs of abuse--the Canadian experience

During the last 2 decades there has been a substantial increase in illicit drug consumption in North America. It has been repeatedly shown that the personal history of drug use is far from being accurate. Fearing legal consequences and embarrassment of admitted illicit substance use, most users tend to deny or, to under-report illicit drug consumption. These facts have stressed an urgent need for a biological marker which does not lose its sensitivity within a few days after the end of exposure and which may yield a cumulative reflection of long term exposure to illicit drugs. Hair analysis has emerged as such a marker. A variety of illicit and medicinal compounds have been shown to be incorporated into hair including trace metals, barbiturates, amphetamines, opiates, phencyclidine, cocaine, nicotine and cannabis. Hair analysis for drugs of abuse provides long-term information on an individual's drug use; its window of detection is limited only by the length of the hair and typically, ranges from a week to several months. After establishing and validating several hair tests during the last decade, we have analyzed over 1000 hair samples for different drugs of abuse. We used RIA for screening and GC-MS for confirmation of positive results. The aim of this report is to illustrate the diagnostic usefulness of hair testing in different age groups (newborns, children, adults) and circumstances: (criminal cases, athletes, child custody cases, etc.).