cians, odontologists, radiologists, and other specialists would be ideal to obtain baseline information, it is not practical financially and would overwhelm most medical examiner/coroner systems. Consideration should be given to a pilot study using statistically selected cases for investigation and autopsy to determine the prevalence of abuse and neglect and their contribution to death in an autopsied elderly population.

Medical examiners and coroners should exchange information with geriatricians and others, including being active members of multidisciplinary teams to review deaths, review reporting mechanisms, and identify system issues that work for and against adequate reporting and intervention. Development of additional scientific literature on all markers would be useful to support a medical examiner’s diagnoses and conclusions when challenged in court. It would be useful to study what number or percent of cases of elder abuse and neglect contributing to death are not investigated or autopsied. This research likely will require predicate research into the markers to enhance detection in the first instance.

To ensure better certification of elders’ deaths, researchers should document aspects of aging that are natural and compare them with features of injury due to accidental mechanisms and to malevolence. Training in recognizing signs and typical features of abuse and neglect is important for medical examiners, coroners, death investigators, law enforcement, and those who first respond to emergency calls reporting deaths, and should be enhanced. Policy makers should consider expanding elder death mandatory-reporting laws beyond institutional cases. Development of standardized protocols for examination of deaths in elders, particularly when there is a suspicion of abuse or neglect, is fundamental and could benefit from the expertise of all health care professionals concerned about fatal abuse and neglect of the elderly.

Research is needed to determine what types of criminal, civil, and administrative cases best protect elders in all settings. To date, there has been no research on the efficacy of current laws and existing remedies or how to develop more effective ones.

There is a wide divergence of views regarding whether reporting of elder abuse and neglect should be mandatory, whether mandatory-report-