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The right to be treated humanely when detained is universally recognized. Deficiencies in detention conditions and violence, however, subvert this right. When this occurs, proper medico-legal investigations are critical irrespective of the nature of death. Unfortunately, the very context of custody raises serious concerns over the effectiveness and fairness of medico-legal examinations. The aim of this manuscript is to identify and discuss the practical and ethical difficulties encountered in the medico-legal investigation following deaths in custody. Data for this manuscript come from a larger project on Death in Custody that examined the causes of deaths in custody and the conditions under which these deaths should be investigated and prevented. A total of 33 stakeholders from forensic medicine, law, prison administration or national human rights administration were interviewed. Data obtained were analyzed qualitatively. Forensic experts are an essential part of the criminal justice process as they offer evidence for subsequent indictment and eventual punishment of perpetrators. Their independence when investigating a death in custody was deemed critical and lack thereof, problematic. When experts were not independent, concerns arose in relation to conflicts of interest, biased perspectives, and low-quality forensic reports. The solutions to ensure independent forensic investigations of deaths in custody must be structural and simple: setting binding standards of practice rather than detailed procedures and relying on preexisting national practices as opposed to encouraging new practices that are unattainable for countries with limited resources., (Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

In this article we critically examine the principle of equivalence of care in prison medicine. First, we provide an overview of how the principle of equivalence is utilized in various national and international guidelines on health care provision to prisoners. Second, we outline some of the problems associated with its applications, and argue that the principle of equivalence should go beyond equivalence to access and include equivalence of outcomes. However, because of the particular context of the prison environment, third, we contend that the concept of "health" in equivalence of health outcomes needs conceptual clarity; otherwise, it fails to provide a threshold for healthy states among inmates. We accomplish this by examining common understandings of the concepts of health and disease. We conclude our article by showing why the conceptualization of diseases as clinical problems provides a helpful approach in the delivery of health care in prison.

Using Bronfenbrenner's ecological systems model, this study examined allegations of elder abuse made to Kentucky Adult Protective Services (APS) and the investigation that followed, in order to understand how APS addressed the needs of abused elders. Elder abuse allegations made to APS during the study week were collected using 3 study tools. Allegations and resulting investigations were analyzed. During the study week, APS received 1,002 calls alleging elder abuse. Of these, 483 were categorized as reports needing protective services, with 177 reports screened in for investigation and 167 actually investigated. Results describe characteristics of abuse calls, investigations, victims, perpetrators, and total investigation times. Substantiation ratio, recidivism, and whether investigation increased or decreased the risk of abuse were also assessed. An examination of APS casework through the lens of nested systems frames the study findings and discussion. Such an examination has the potential to improve the quality of services provided to older adults.

Background: Relatively little is known about the current health care situation and the legal rights of ageing prisoners worldwide. To date, only a few studies have investigated their rights to health care. However, elderly prisoners need special attention., Objective: The aim of this article is to critically review the health care situation of older prisoners by analysing the relevant national and international legal frameworks with a particular focus on Switzerland, England and Wales, and the United States (U.S.)., Methods: Publications on legal frameworks were searched using Web of Science, PubMed, MEDLINE, HeinOnline, and the National Criminal Justice Reference Service. Searches utilizing combinations of keywords relating to ageing prisoners were performed. Relevant reports and policy documents were obtained in order to understand the legal settings in Switzerland, England and Wales, and the U.S. All articles, reports, and policy documents published in English and German between 1774 to June 2012 were included for analysis. Using a comparative approach, an outline was completed to distinguish positive policies in this area. Regulatory approaches were investigated through evaluations of soft laws applicable in Europe and U.S. Supreme Court judgements., Results: Even though several documents could be interpreted as guaranteeing adequate health care for ageing prisoners, there is no specific regulation that addresses this issue completely. The Vienna International Plan of Action on Ageing contributes the most by providing an in-depth analysis of the health care needs of older persons. Still, critical analysis of retrieved documents reveals the lack of specific legislation regarding the health care for ageing prisoners., Conclusion: No consistent regulation delineates the provision of health care for ageing prisoners. Neither national nor international institutions have enforceable laws that secure the precarious situation of older adults in prisons. To initiate a change, this work presents critical issues that must be addressed to protect the right to health care and well-being of ageing prisoners. Additionally, it is important to design legal structures and guidelines which acknowledge and accommodate the needs of ageing prisoners., (Copyright © 2012 S. Karger AG, Basel.)

Tibetan elders have lived in exile since the failed uprising against Chinese rule in 1959. Using mixed methods approach, this study explored the perceived health and health behaviors of 30 older Tibetans living in India and Switzerland using Bronfenbrenner's Ecological Systems Model. Results indicate that elder Tibetans living in Switzerland enjoyed better health and well-being than those living in India. Because of the availability of old age benefits, pensions, and health insurance, participants in Switzerland had greater financial independence, and fewer problems with healthcare access and affordability than those in India. In addition to financial reimbursement, the contribution and importance of personal, familial, community, and religious factors to participant's health behaviors are examined. The study is a case example depicting the impact of different factors from micro to macro on the health and well-being of a refugee group. Its implications such as the implementation of old age benefits for older persons living in developing countries are discussed.

In 1998 Kentucky's Local Coordinating Councils on Elder Abuse (LCCEAs) were established to intervene in cases of elder abuse in local communities. As of 2008 there were 39 LCCEAs in the state, covering 112 of Kentucky's 120 counties. This study was an attempt to understand a concerted statewide multidisciplinary team (MDT) effort related to elder abuse. Survey questions examined the roles, processes, varieties, and accomplishments of these councils. Nearly half of the councils have been in existence for less than 3 years. Councils provided a range of services from expert consultation to service provided for keeping members up to date about services, programs, and legislation. Roles for the councils included identifying service gaps and systemic problems and advocating for change. Half the councils conducted case reviews, and of those, most examined all types of cases. Lack of funding was a major problem for all councils. Funding came from a patchwork of sources, which suggested that it was inadequate and unreliable. The LCCEAs appear to function largely as community educators. To ensure the long-term viability of the LCCEAs and to better integrate and unify their efforts, LCCEAs need committed staffs, constant funding, clear vision and goals, and uniform and consistent outcome measures.

In response to a growing and worldwide recognition of elder abuse, the WorldView Environmental Scan on Elder Abuse was undertaken. It represented an attempt to collect both information on the nature of the problem of elder abuse and responses to it from a global perspective. The first of its kind, the Scan gathered information about elder abuse as well as on related legislation and policy, services and programs, educational resources and needs, training, and past and ongoing research. A total of 53 countries responded to the survey questionnaire, with 362 respondents representing the six world regions designated by the World Health Organization. Findings revealed that factors contributing to elder abuse include changing social and economic structures, isolation of victims, inadequate knowledge of laws and services, intergenerational conflict, and poverty. Barriers to seeking resources to intervene and protect older adults include the culture of the country, language issues, literacy, stigma, lack of mobility, lack of funding, and insufficient familiarity with and access to the internet. The data serve as a catalyst to take action, both globally and nationally, while emphasizing the changes necessary to protect the rights and dignity of older adults.

This article highlights the brief 30-year history of major U.S. policies that address elder abuse. The history of elder abuse policy is checkered and incomplete, reflecting a lack of comprehensive federal legislation. We begin our review by discussing the scope of elder abuse policy and, in particular, the Social Security Block Grant, which has become the sole source of federal aid for Adult Protective Services programs. The other source of federal aid, typically for helping efforts by Area Agencies on Aging, is the Older Americans Act. We document the incremental but increasing attention paid to elder abuse by chronicling key initiatives, including early congressional reports and hearings; White House Conferences on Aging; and efforts by pioneers such as Mario Biaggi, Claude Pepper, John Breaux, and Orin Hatch-efforts that we believe have led to the various introductions of the Elder Justice Act.

This study examined elder mentors' and students' roles, functions, and satisfaction with the Elder Mentorship program at the Graduate Center for Gerontology, University of Kentucky. The Elder Mentorship program matches gerontology doctoral students with older adults in the community. Parallel surveys were constructed to evaluate the program from the perspectives of elder mentors and student mentees. Data were analyzed using descriptive frequency analyses, with open-ended questions analyzed thematically. Results show that students and elder mentors were mostly satisfied with their experiences. Elder mentors perceived their participation more positively than did student mentees. Future programs utilizing the elder mentorship model may benefit from matching students and elder mentors in terms of shared interests.