The purpose of this study was to gather information on the decision-making process of the coroner/medical examiner (CME) offices who are charged with investigating suspicious elder deaths and then to create an intervention to augment the decision-making process and pilot test it in CME offices.
The study consisted of two collection phases:
Phase 1: The first step was to use information from the California County Coroner's Offices to compile data on elder deaths and understand the processes employed in decision making. This data came from case data shared by participating coroner/medical examiner (CME) offices, publicly available data on elder deaths, and both phone and in-person interviews with CME investigators from participating offices. The second step was to develop a 'best practice' brief questionnaire or Elder Suspicious Death Field Screen (ESDFS), to assist county coroner's offices in their decision making regarding taking jurisdiction and investigating an elder death.
Phase 2: This phase consisted of the pilot test and evaluation of the effectiveness of the ESDFS in a selected subset of California counties. One-on-one training of each CME Investigator on the use of the ESDFS was performed and then ESDFS was implemented in three counties for a six-month data collection period. An expert panel known as Longitudinal Experts All Data (LEAD) panel reviewed a subsample of cases to assess whether CME investigators made appropriate decisions to investigate or not. Two alternative Satisfaction Surveys were also used: one for CME Investigators who used the ESDFS throughout the pilot study and the other (the Alternate Satisfaction Survey) for those who failed to use the ESDFS or stopped using it before the end of the pilot study. The latter survey administered in the form of a structured interview consisted largely of questions about barriers to implementation of the ESDFS. To wrap up the project, satisfaction surveys were administered on site as structured interviews with the investigators. The interviews were recorded and transcribed.
In phase one, 46 of the 58 coroner/medical examiner (CME) offices in California and the staff that worked in them were interviewed. This sample also includes elder death statistical information that was obtained from 30 of the 46 counties that participated in the phone interviews.
In phase two, elder deaths reported to participating CME investigators in 3 counties in California were used and the staff who worked at these counties were surveyed and interviewed.
Coroner/medical examiner (CME) offices in California; the CME investigators and staff that worked there from 2008-2011; and any cases of deceased elders reported to three California counties from May through November of 2011.
Interviews with coroner/medical examiner investigators
Public death certificates
administrative records data,
Coroners.Database.sav: This dataset contains a total of 168 variables and 46 cases. It represents phase 1 of the project and consists of the 46 coroner/medical examiner offices in California. The variables include:
- Demographics of coroner/medical examiner: age, sex, education, and work experience.
- Demographic statistics of deceased elder: size of males/females group; size of married, divorced and single groups; education levels; ethnicity; and race.
- Agency information: number of forensic pathologists and nurses, type of agency, number of investigations, location of office, whether screening tool is used, whether agency has an elder death review team and whether interest of prosecutors influences death investigation.
- County Demographics: population of county, elder population in county, total number of elder deaths in county, number of elder deaths investigated, number of investigations that included an autopsy and total number of homicide cases.
- Investigation information: place of death, whether an arrest was made, whether there was insufficient evidence, whether perpetrator was identified, and criminal charges outcome.
ESDFS database.sav: This dataset contains a total of 118 variables and 115 cases. It represents phase 2 of the project and consists of the completed sample of cases from the 3 sites that were administered the ESDFS. These variables include:
- Demographic of deceased elder: age, gender, and race.
- Scene of death information: reporting party, location of death, whether conditions were sanitary, whether unpleasant smell was present, whether scene was cluttered, and overall scene condition.
- Involvement of a caregiver: whether there was a responsible caregiver, relationship of caregiver to the decedent, and level of care.
- Condition of body: whether decedent had matted hair, unpleasant odor, dirty untrimmed nails, feces present, urine soaked diaper/clothing, was very thin, had broken skin, had marks/discoloration, and overall body condition.
- Activities of daily living (ADLs) variables: whether decedent was impaired by activities such as bathing, getting dressed/undressed, toileting, transferring, ambulation, and eating and hydration.
- Investigation information: whether various body parts were viewed by reporting party, whether there was evidence of neglect, appropriateness of investigation, and degree of certainty.
- LEAD variables: whether the investigative information was properly followed up on, including the appropriateness of investigation, degree of certainty in findings and whether there was a consensus on evidence of neglect.
This study also included statements compiled from interviews of CME investigators about what influences their decision to investigate an elder death. These statements describe their reliance on medical personnel to recognize evidence of abuse or neglect; the value of Adult Protective Services information; financial abuse information relating to an elder death; physical evidence of neglect such as bed sores; living conditions; age and medical history of the decedent; and whether the case was able to be prosecuted were considered. This data is not available in the current release.
Phase 1: 46 of 58 county coroner/medical examiner offices responded.
Phase 2: Eighteen Satisfaction Survey Interviews were conducted. Two of these were with CME Investigators who participated throughout the pilot study. The other 16 were Alternate Satisfaction Surveys with CME Investigators who did not participate fully although they were trained to use the ESDFS at the beginning of the pilot study. The remaining ten trained CIs were not available to be interviewed.