title: Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends.
abstract: There is a paucity of research examining the utility of forensic toxicology in the investigation of premature external cause deaths of residents in nursing homes. The aim of this study is to describe the frequency and characteristics of toxicological analysis conducted in external cause (injury-related) deaths amongst nursing home residents in Victoria, Australia. This study was a retrospective cohort study examining external cause deaths among nursing home residents during the period July 1, 2000 to December 31, 2012 in Victoria, Australia, using the National Coronial Information System (NCIS). The variables examined comprised: sex, age group, year-of-death, cause and manner of death. One-third of deaths among nursing home residents in Victoria resulted from external causes (n = 1296, 33.3%) of which just over one-quarter (361, 27.9%) underwent toxicological analysis as part of the medical death investigation. The use of toxicological analysis varied by cause of death with a relatively low proportion conducted in deaths from unintentional falls (n = 286, 24.9%) and choking (n = 36, 40.4%). The use of toxicological analysis decreased as the decedents age increased. Forensic toxicology has the potential to contribute to improving our understanding of premature deaths in nursing home residents however it remains under used and is possibly undervalued.
authors.affiliation: Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. georgia.aitken@monash.edu.|Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. georgia.aitken@monash.edu.
authors.forename: Georgia
authors.initials: G
authors.lastname: Aitken
authors.affiliation: Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. briony.murphy@monash.edu.|Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. briony.murphy@monash.edu.
authors.forename: Briony
authors.initials: B
authors.lastname: Murphy
authors.affiliation: Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.|Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pilgrim
authors.affiliation: Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.|Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
authors.forename: Lyndal
authors.initials: L
authors.lastname: Bugeja
authors.affiliation: Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.|Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ranson
authors.affiliation: Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.|Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
authors.forename: Joseph Elias
authors.initials: JE
authors.lastname: Ibrahim
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000401:mortality; D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D053593:Forensic Toxicology / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D012189:Retrospective Studies
keywords: Forensic toxicology; Injury-related deaths; Medico-legal investigations; Nursing home; Older adults