Characteristics of autopsies of 65 years and over, performed in Antalya Branch of Council of Forensic Medicine, between 2014-2018

Characteristics of Autopsies of 65 Years And Over, Performed in Antalya Branch of Council of Forensic Medicine, Between 2014-2018 World Health Organization defines being elderly as a decrease in the ability to adapt to environmental factors and people aged 65 and over are classified as "elderly". (2). Increased life-span, improvement of socioeconomic conditions and decreasing fertility in parallel with the developments in the field of medicine and technology, have caused an increase in the rate of the elderly population all over the world in recent years (3). Thus, more elderly people are encountered in Forensic Medical Practices. In this study, data of medico-legal autopsies related to deaths aged 65 and over in Antalya (socio-demographic characteristics, nationalities, distribution by months), the origin of deaths (accident, suicide, murder), autopsy findings, causes of deaths, histopathological examination and toxicological analysis results, and whether there are signs of elder abuse were analyzed to make a comparison with previous studies, to draw attention to the points that should be taken notice by forensic practitioners, and to shed light on the measures that can be taken to reduce the cases of death at the age of 65 and above. Additionally, if the manner of death is murder or suicide, their methods were analyzed as well. In our study, with the decision of (approved date: 20.05.2019, number: 21589509/2019/364) Education and Scientific Research Committee of Council of Forensic Medicine, we reviewed the records of autopsies between the dates of January 01, 2014 and December 31, 2018, and found a total of 896 cases (20.6%) aged 65 and over among the 4342 autopsies performed in Antalya. According to their records, 640 (71.4%) of them were male, 256 (28.6%) were female. The average age of the patients was 74.4 (65-103 years), 55.7% (n: 499) were in the 65-74 age group, 34.9% (n: 313) were in the 75-84 age group, 9.4 % of them (n: 85 84) were in the age group of 85 and over. Two-hundred-ninety-eight of the cases (33.3%) were foreign national, and 598 (66.7%) were citizens of the Turkish Republic. The cases were mostly in autumn with 287 (32.0%) cases, then in summer with 215 (24.0%) cases, and in terms of the month; most of the cases were in September with 136 (15.2%) cases, and least of them were seen in January with 51 (5.7%) cases. The manner of death was "natural" in 433 (48.3%) of the cases, "accident" in 216 (24.1%) cases, "suicide" in 71 (7.9%) cases, "murder" in 18 (2.1%) cases, and finally 9 of them (1%) were evaluated as "accidental + natural death". It is noted that in 149 (16.6%) of the cases, the manner of death could not be determined, 118 of them were negative autopsies, and in 31 cases the causes of deaths were determined, but there were no opinions about the manner of death. For suicide cases, women were found to be statistically significantly higher in number. The most frequent places of death were reported as homes (n: 317, 35.4%), followed by hospitals (n: 296, 33%) and hotels (n: 83, 9.3%). It was determined that most of the cases had been living with their families at home (n: 230, 25.7%), at a hotel for vacation (n: 191, 21.3%) and at home alone (n: 152, 17%). Although, the elderly living with their families constitutes a large percentage in our study, the rate remains low compared to other studies due to the higher number of people staying in hotels for touristic activities. The most common cause of death were natural causes (n: 433, 48.3%), and it was followed by asphyxia (n: 168, 18.8%), blunt trauma (n: 112, 12.5%), gunshot wound (n: 19, 2.1%) and stab wound (n: 9, 1%). There was a significant male dominance (female/male ratio: 1/18) in cases who died as a result of gunshot wounds. In addition, it was understood that there are 27 (3.0%) cases who died due to other reasons which were not classified, 10 (1.1%) cases died due to multiple reasons, and there are 118 (13.2%) cases whose causes of deaths could not be determined. It was found that the most frequent cause of blunt trauma was traffic accidents (n: 61), followed by falls from height (n: 31). The most common natural causes of death were ischemic cardiovascular disease (n: 278, 62.9%) and heart failure (n: 49, 11.1%). Multiple causes of 86 natural death were found together in 37 (8.3%) of the cases. In accidental deaths (n: 225), the most frequent cause was drowning (n: 99, 44%) and it is followed by traffic accidents (n: 61, 27.1%). It was determined that the cases of burning combined with CO poisoning were higher in women than men. It was recorded that 460 (51.3%) of the cases had histories of chronic diseases, while 76 (8.5%) did not have any chronic disease. In 360 (40.2%) of cases, there was no information whether there were any history of a chronic disease or not. It was determined that in 247 cases who were determined to use some form of therapeutic medicine for an underlying condition, most frequently used agents were (n: 100, 40.5%) cardiac agents and it was followed by antihypertensive (HT) (n: 88, 35.6%) agents. It was observed in the records that 104 of 182 cases with trauma history had hospital admissions, 78 cases did not have hospital admissions, and the cases with a trauma history have more hospital admissions than those without a trauma history. Within the 71 cases whose manner of death were thought to be suicide, 45 of them died by hanging, 10 by a firearm, 5 by drug intoxication, 5 by jumping from height, 1 by drowning in a well, and 5 with other methods. It was found that women used the hanging method at a higher rate than other methods while committing suicide. It was determined that 7 out of the 18 murder cases were killed by a firearm, 3 of them by strangulation, 2 of them by physical assault, and 6 of them by stabbing. Even though, the data obtained in our study were too small for a statistical interpretation, it was shown that the number of male murder victims was 2.6 times higher than the number of female murder victims. Moreover, men were killed by a gunshot wound 6 times more, and by a stab wound 2 times more than women. Additionally, the cases over the age of 65 who died as a result of physical assault were only men. It was found that 25 (2.8%) of the cases were victims of suspected physical abuse and 8 (0.9%) of them had findings of physical abuse (5 of these 8 cases are abused by individuals within the family). Decomposition signs were detected in 149 (16.6%) of the cases. When places of death and presence of decomposition signs were compared, it was found that 72 (48.3%) cases out of 149 cases with signs of decomposition had been 87 living alone at home, 25 (16.8%) cases had been staying with their family, and the incidence of decomposition signs was increased in cases living alone at home. As determined in our study, in parallel with the increase in the elderly population, the proportions of elderly in medico-legal autopsies were also increased. With the increasing percentage of the elderly population in societies, forensic practitioners encounter more and more medicolegal autopsy cases in elderly population and challenging cases become even more frequent. (8). It should not be kept in mind that most of the problems seen in elderly can be prevented or delayed (6), necessary economic, medical and social support should be created for the elderly to continue their life as a self-sufficient, independent individual. For the elderly who need care, if possible, options for taking care within the family should be looked for, primarily.. Economic, medical, social and psychological support should be sought for family members who take care of their elderly people. If the caregiver is alone, they should be provided with support at home on certain days of the week to be able to meet their own needs, even if the support provided is hourly, half-day or daily support. Some certain methods should be developed to increase the motivation of both the elderly and their caregivers in this long-lasting, tiring and regressive process (129).