When skeletons hold secrets: ASU project helps identify hidden elder abuse
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When the death of an older adult is considered suspicious, their body is sent to the Maricopa County Office of the Medical Examiner.
The agency is required by law to investigate deaths identified as traumatic or unexplained based on the types of injuries found.
“The injuries are usually to the rib cage and the arms and legs,” said Laura Fulginiti, a forensic anthropologist for the county office and adjunct faculty at Arizona State University.
“We have seen rib fractures — both fresh and healed — shoulder, elbow and knee fractures, and even ankle and wrist fractures,” said Fulginiti, who is the former director of the American Board of Forensic Anthropology.
Identifying these injuries is just the first step. It can be difficult to determine the exact cause of them and decide whether abuse is to blame.
According to Katelyn Bolhofner, assistant professor of forensic anthropology in ASU’s School of Interdisciplinary Forensics, there is no exact science to identifying injuries that occur due to physical abuse.
“We don’t have a good working baseline for determining whether a skeletal trauma is due to abuse or neglect, or due to an accidental fall,” she said.
So Bolhofner — together with Fulginiti, ASU Regents Professor Jane Buikstra and a multidisciplinary team of experts — have embarked on a research project to help fill in the gaps.
The researchers have established a skeletal atlas of elder abuse that will elucidate the differences in skeletal patterns associated with abuse or neglect of an older person, and those commonly found in accidental ground-level falls.
The research also addresses the critical gap in understanding how the aging process affects healing time for older individuals with fractures.
The team hopes to educate the public about elder abuse, improve criminal justice procedures and help older adults while they are still alive.
It’s part of a five-year grant, awarded by the National Institute of Justice.
A growing need
According to the National Council on Aging, nearly 5 million older Americans are abused each year. And as the aging population grows, particularly in retirement destinations like Arizona, so too do the cases of abuse.
More women than men are abused, and in most cases, the mistreatment comes at the hands of a family member or spouse. Abuse also occurs regularly in nursing homes and other elder-care facilities.
Physical abuse is difficult to prove, requires expert medical testimony and may be masked when injuries are attributed to medication or an accident.
Bolhofner recalls an investigation involving an older woman who lived with a fractured arm for more than a year and though she complained about the pain, was never treated.
“She would have been in excruciating pain,” said Bolhofner, who has worked as a volunteer consultant for the Maricopa County Office of the Medical Examiner since 2015.
But when older adults must rely completely on family or others for care, they are not in the position to complain if they are being hurt, Bolhofner said.
She says there are other factors that put older adults in America at risk.
“There is this piece that’s cultural,” Bolhofner said. “We don’t necessarily take care of our elders or think about them in the same way as other cultures do. And this is reflected in the notion that we have a lot of diagnostic information and research studies on child abuse, but there is very little data on the abuse of older adults.”
Beginning with the bones
Since the study is, at its simplest level, based on bone fractures, Bolhofner and her team of graduate students started there.
Data came from the county’s reports taken from 2014 through 2019, in cases where physical abuse was suspected in a person’s death.
The group studied 235 instances of skeletal trauma and fractures from 150 reports where ground-level falls were witnessed. Bones retained in the office were also used for the study, which focused on deceased individuals 60 years and older.
Without the opportunity to talk to abuse victims, researchers were guided by specific criteria. The decedent must have been admitted for a full exam during their lifetime; associated with Arizona Adult Protective Services or law enforcement investigations; and have X-rays available for review.
They found that those adults who were physically abused prior to death had a different skeletal manifestation of their injury than those who experienced accidental falls.
Individuals involved in an accidental fall frequently displayed fractures in their hip and vertebrae. In contrast, for those identified as possible victims of abuse or neglect, fractures occurred most frequently in the ribs and the arms.
From the lab to real-life application
After gathering the data, the team used a laser scanner to create 3D digitized models of physical bone fragments.
Next, Bolhofner tapped Kevin Gary, an associate professor in the School of Computing and Augmented Intelligence, part of the Ira A. Fulton Schools of Engineering, to participate in the project. Gary’s research interests are in software architecture with a focus on applications in health care and e-learning.
“My part was turning the research into a tool that other people can utilize online,” Gary said.
Gary, together with several graduate students, worked with digitized models and created a case-study tool that will help researchers, detectives and members of the legal and medical community identify injuries and accurately determine their cause.
His user-friendly web and mobile computing platform will run the data against an underlying statistical model and provide error rates of probability and associated statistics.
Eventually, the platform will generate assessments, backed up statistically, that can then be used by doctors and professionals who are called to testify in court cases.
Read more
Find out more details about Gary’s work with the project.
In the past 10 to 15 years the Department of Justice and the National Institute of Justice has designated more funding and more resources towards investigating and stopping elder abuse, Bolhofner said.
“Basically, they have recognized that this is a a big issue,” said said. “So the urgency is that we have this rapidly aging population, and we, as of yet have not sorted out the diagnostic tools to assess abuse and the mediation tools we need to stop abuse.”
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