This study examined the process used in California when making decisions about the investigation of suspicious deaths of elderly persons.
At least since 1999, coroner/medical examiners (CMEs) in California counties have participated in Elder Death Review Teams, which study and learn from suspicious deaths of elderly persons, as well as improve communication among public agencies in identifying barriers and fill systems gaps. These efforts are identifying concerns and generating local improvements. The current study reconfirmed a finding of Elder Death Teams, i.e., that CME offices are failing to assume jurisdiction over elder deaths that should be investigated. Some other concerns revealed in interviews and from data analyses are that some agencies' policy is not to investigate all accidental deaths of elderly persons; that there are impediments to obtaining information from the most efficient data source on an elder death, i.e., reporting parties already at the death scene; and that the lack of data-collection standards among CME agencies complicates any effort to set a baseline or measure future progress toward improving processes for detecting suspicious elder deaths. The authors conclude that the science of elder death investigation is unlikely to advance if CME agencies are not investigating suspicious deaths. Also, reporting parties and CME investigators are not receiving training on what little is known about signs and factors associated with caregiver neglect and elder abuse. In addition, CME decisionmakers are biased against investigating elder deaths, since a natural death is more likely with advanced age. Finally, CME agencies are under pressure because of limited funding and heavy workloads, which increases the likelihood that decisionmakers will initially assume that a natural death is likely when the deceased is elderly. 1 exhibit and 9 references