Adult Fatality Review

Each year countless numbers of vulnerable and older adults suffer from abuse, neglect and exploitation at the hands of their families and caregivers. Using information from a wide variety of studies and sources, the National Center on Elder Abuse (NCEA) cites the following recent estimates of abuse impacting incapacitated and elder adults in the United States:

• Between 1 and 2 million Americans ages 65 or older have been exploited, injured or mistreated by someone responsible for their care or protection. The frequency of elder abuse is estimated at 2 to 10 percent of the population.
• Approximately 1 in 14 incidents of elder abuse in domestic settings comes to the attention of authorities.
• For every reported case of abuse, neglect or exploitation, roughly five go unreported.
• Estimates of abuse impacting vulnerable adults under age 65 are less widely available, but one study found that 30% of adults with disabilities report one or more types of mistreatment by their primary caregiver.

In Virginia, the Department for Aging and Rehabilitative Services’ Annual Report for fiscal year 2014 revealed 9,140 substantiated reports of abuse, neglect or exploitation of a vulnerable or older adult, reflecting 53% of all reports taken for investigation by a local Adult Protective Services Program. Three-quarters of these adults were 60 years of age or older and one-quarter were between the ages of 18 and 59. The adults were more commonly female (60%) and white (70%) or African American (24%). Adults were most frequently abused, neglected or exploited in their own homes (70%). Six percent were mistreated in a nursing facility and three percent in an assisted living facility. The most common forms of abuse were self neglect (55%) followed by neglect (19%), financial exploitation (10%), and physical abuse (7%).

In addition to poor social and health outcomes associated with this type of abuse, research suggests that adults who are victims of maltreatment are also at a much higher risk of death when compared with adults who are not abused. One recent estimate cited by NCEA noted that victims of elder abuse had a 300% higher risk of death when compared with their peers who were not abused. [1] The challenge in addressing this increased risk of death in the context of elder abuse is addressing the assumption that the death of an elderly or disabled adult is inevitable and therefore not preventable. This is the role and value of an adult fatality review team to a community.

Fatality review is a public health tool developed to help us understand how and why people die for the purpose of reducing or preventing future deaths through system improvements. Fatality review has been used widely in the fields of domestic violence and child death. Like child abuse or domestic violence, abuse and neglect of vulnerable and older adults is largely hidden, invisible, and underreported. Fatality review can assist in identifying fatal cases of abuse, neglect and exploitation and in crafting efforts to reduce the occurrence of this violence. As of July 1, 2015, Virginia law supports the formation of local and regional Adult Fatality Review Teams (AFRTs) to identify and review deaths involving abuse, neglect and exploitation of incapacitated and older adults in the Commonwealth. Resources to assist communities in forming AFRTs can be found at this site.

Virginia law supports the review of adult deaths at the state level and at the local and regional level.

• Adult Fatality Review at the State Level
• Adult Fatality Review in Virginia’s Communities

For more information about Adult Fatality Review in Virginia:
Ryan Diduk-Smith, PhD
Virginia Department of Health, Office of the Chief Medical Examiner
(804) 205-3856