Of about 170 questionable deaths of the elderly in recent years in Wilkes County, north of Catawba, just five were sent for autopsy, or 2.9percent. Faced with chronic time constraints, medical examiners must decide daily which cases to take, and which to overlook. Cases of the elderly sometimes fall to the bottom of the list because investigations can be complicated. Most older people have a series of medical conditions, and it's often difficult to determine whether they died from natural illness or possible foul play. Conditions of aging can mirror signs of physical abuse - some medications, for example, cause excessive bruising.
Some people choose to die and ask their caregivers to stop providing food.
On the other hand, it's neither impossible nor is it the kind of thing that's not worthy of attention. On the front end, a sign of the system's weakness is the estimated 1,550 cases of accidental or violent deaths not investigated by medical examiners, largely because they were not reported. But experts point to another front-end flaw, one no one can quantify. When doctors don't know how an older person dies, they often assign some vague natural cause, potentially missing accidental or violent deaths. Doctors make those calls because most older people die of heart disease or stroke, and they at times take chances by not investigating further, says Dr. Page Hudson, North Carolina's first chief medical examiner and a respected forensic pathologist.