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As life expectancy increases, the phenomenon of the neglect of elderly persons is becoming increasingly relevant in the fields of both medicine and social care. This work analyses the cases of two subjects whose deaths initially seemed to have been attributable to natural causes. The autopsy findings and the analysis of clinical data, however, were able to establish that neglect had played a determining role in their deaths. These cases highlight the need for healthcare workers to be more alert to the clinical signs of neglect. Finally, in cases of death, the forensic pathologist must conduct a meticulous post-mortem examination to detect the physical signs of neglect and to establish if abuse has been responsible for the death.

The term “Lotus Birth” identifies the practice of not cutting the umbilical cord and of leaving the placenta attached to the newborn after its expulsion until it detaches spontaneously, which generally occurs 3–10 days after birth. The first reported cases of Lotus Birth date back to 2004 in Australia. Supporters of such a procedure claim that the newborn is better perfused, endowed with a more robust immune system and “less stressed”. However, it should be pointed out that histopathological study of the placenta is increasingly being requested in order to investigate problems of an infective nature or dysmaturity affecting the foetus, and situations of risk affecting the mother. Moreover, from the legal standpoint, there is no uniform position on the question of whether the placenta belongs to the mother or to the newborn. Lastly, a proper conservation of the embryonic adnexa is very difficult and includes problems of a hygiene/health, infectivological and medico-legal nature. The authors analyzed all these aspect in the Italian legislative framework, reaching the conclusion that Lotus Birth is inadvisable from both the scientific and logical/rational points of view.

Background Elder abuse is a global problem, with literature indicating that one in six elderly individuals is a potential victim. Aims In this study, we delve into reported cases of elder abuse brought to the attention of the Judicial Authority in the Genoa area between 2020 and 2023. Our objective is twofold: first, to conduct a detailed analysis of epidemiological data to quantify the incidence and characteristics of this phenomenon; second, to critically examine the medico-legal and clinical aspects emerging from these cases, aiming to contribute to a deeper understanding and improved management of this social and health issue. Methods We analysed data on reports of abuse processed by the Court of Genoa from 2020 to 2023. These findings were then compared with data from the previous 10-year period and with existing literature. Results A total of 1011 reports related to offenses concerning violations of family assistance obligations, abuse of means of correction or discipline, maltreatment of family members and cohabitants, personal injury, abandonment of minors or incapacitated persons, and circumvention of incapacitated persons were identified. Among 24,144 judgments, 200 relevant to potential elder abuse situations were examined. Discussion The findings indicate that abuse was predominantly perpetrated within the domestic setting and primarily by the victims’ relatives. Key risk factors identified included the victim’s female gender, their dependency on others, and the perpetrator’s concurrent mental illness or substance abuse. Conclusion Elder abuse, therefore, constitutes an extremely complex and heterogeneous problem, presenting an infinite number of manifestations and facets, making it difficult to perceive and identify.

BackgroundElder abuse is currently a worldwide problem. The literature reports that one elderly person out of six is a potential victim.AimsTo analyse cases reported to the judicial authorities in the territory of Genoa in the period 2010–2019, to investigate the features of elder abuse, to assess the trend of this phenomenon and to propose preventive strategies.MethodsWe analysed the data on reports of abuse passed by the Court of Genoa in the period 2015–2019 concerning physical and mental maltreatment, abandonment and financial exploitation of elderly subjects. These data were compared with those recorded in the previous 5-year period and in the literature.ResultsIn the period 2015–2019, 156 cases of elder abuse were identified (versus 63 in the previous period): 18 cases of domestic violence, 5 cases of abuse of the means of correction, 18 cases of caregiver neglect, 76 cases of physical injury and 39 cases of financial exploitation.DiscussionAbuse was seen to be perpetrated most frequently in the domestic setting and by the victims' relatives. The main risk factors were female gender and the victim’s dependence on others, the maltreating subject’s mental illness and substance abuse.ConclusionsWe documented a progressive increase in the number of abuses reported to the judicial authority; this reflects greater awareness of the problem. However, our figures remained well below the incidence estimated in the literature. It is necessary to train healthcare personnel to identify and manage cases of suspected abuse, and to provide adequate support in situations at risk.

The worldwide spread of SARS-CoV-2 and the pandemic has resulted in a serious global crisis in the health, social and economic spheres. After an initial period of enthusiasm related to the efficacy of vaccines, in many European countries, a growing distrust in the population has matured, due to the reporting of severe adverse effects. Throughout the world, some cases of adverse events after the administration of the vaccine have been reported. In this communication, we want to discuss all the medico-legal aspects related to the global vaccination companion in terms of medical professional responsibility, informed consent and vaccination obligation, with particular attention to the Italian situation. Health professionals are tasked with promoting confidence in vaccination for the general population. Complete and detailed information and reliance on scientific research is essential to understand the great importance of the vaccination campaign. From a criminal point of view, we must avoid blaming health professionals in the case of side effects. At the same time, we must protect the population, ensuring compliance with the indications, guidelines, and an adequate method of administration. On the other hand, from a civil law perspective, it is correct to ensure full protection of those rare cases in which the administration of the vaccine is related to adverse events. Without a broad and global vaccination campaign, it will be impossible to overcome COVID-19.

•Aortic arch rupture in a 60-year-old woman occurred during a tracheostomy.•Autopsy showed an aortic arch rupture.•The lethal iatrogenic lesion was determined by the aortic arch traction.•The death was determined by hemorrhagic hypovolemic shock. The authors illustrate a rare case of aortic arch rupture in a 60-year-old woman, occurred during a tracheostomy performed using the Griggs method. The autopsy examination showed an aortic arch rupture in an intermediate position situated in the area between the brachiocephalic artery ostium and the left common carotid artery ostium, associated to a hemorrhage filling of the adjacent connective and muscular tissue. The death was therefore determined by cardiac arrest secondary to massive hemorrhagic hypovolemic shock caused by the aortic arch rupture. The lethal iatrogenic lesion was determined by the aortic arch traction caused by the dilatation. The surgeon's incautious use of the Howard–Kelly forceps introduced in the mediastinum was therefore hypothesized.

Introduction In Italy, 5% of the elderly are estimated to have suffered abuse. While the Penal Code refers to generic types of abuse, such as physical and psychological maltreatment, abandonment and financial fraud, it does not specifically protect the elderly as a category. Aims To assess the frequency and modalities of elder abuse in Genoa and its Province, and to compare these data with those reported in the literature, in order to provide a picture of the current situation that can be used by the authorities to combat this phenomenon. Methods We analysed the first-degree verdicts issued by the Court of Genoa regarding accusations of physical, psychological and moral abuse and maltreatment of elderly subjects (over 65 years) in the period 2010–2015. Results Only 85 of the 4028 court verdicts analysed involved elderly persons: 19 cases of domestic maltreatment, 3 of abuse of the means of correction or discipline, 18 of personal injury, 5 of abandonment and 40 of circumvention (deceiving someone, especially an elderly or mentally impaired person, to obtain a profit). Discussion and conclusions A gap was observed between the number of crimes reported to the judicial authorities (tip of the iceberg) and the estimated prevalence of the phenomenon in the literature. There is a need both to create a network of protection for the elderly involving medical and judicial specialists and to train healthcare professionals to better recognise and report cases of maltreatment.

Ageing of the global population represents a challenge for national healthcare systems and healthcare professionals, including medico-legal experts, who assess personal damage in an increasing number of older people. Personal damage evaluation in older people is complex, and the scarcity of evidence is hindering the development of formal guidelines on the subject. The main objectives of the first multidisciplinary Consensus Conference on Medico-Legal Assessment of Personal Damage in Older People were to increase knowledge on the subject and establish standard procedures in this field. The conference, organized according to the guidelines issued by the Italian National Institute of Health (ISS), was held in Bologna (Italy) on June 8, 2019 with the support of national scientific societies, professional organizations, and stakeholders. The Scientific Technical Committee prepared 16 questions on 4 thematic areas: (1) differences in injury outcomes in older people compared to younger people and their relevance in personal damage assessment; (2) pre-existing status reconstruction and evaluation; (3) medico-legal examination procedures; (4) multidimensional assessment and scales. The Scientific Secretariat reviewed relevant literature and documents, rated their quality, and summarized evidence. During conference plenary public sessions, 4 pairs of experts reported on each thematic area. After the last session, a multidisciplinary Jury Panel (15 members) drafted the consensus statements. The present report describes Conference methods and results, including a summary of evidence supporting each statement, and areas requiring further investigation. The methodological recommendations issued during the Conference may be useful in several contexts of damage assessment, or to other medico-legal evaluation fields.

The current trend toward an ever increasing aging population forces society to face the problem of how to care for elderly people who are exposed to the risk of so-called “elder abuse,” a phenomenon becoming increasingly widespread in Italy, as legislation does not provide a precise juridical definition of “elderly” nor does it provide for their specific protection. From a geriatric and medico-legal point of view, it is difficult to assess the cognitive performance of elderly individuals due to a number of factors, including the lack of evaluation tools with well-defined reference parameters for assessing decision-making capacities. Nonetheless, according to Italian penal code, abandoning a person incapable of self-support due to old age is considered a violation of the obligation of family assistance. Just as in the USA, which has instituted the Adult Protective Services, the Authors propose that the local health authorities provide help desks for the victims of elder abuse in Italy.

The current trend toward an ever increasing aging population forces society to face the problem of how to care for elderly people who are exposed to the risk of so-called “elder abuse,” a phenomenon becoming increasingly widespread in Italy, as legislation does not provide a precise juridical definition of “elderly” nor does it provide for their specific protection. From a geriatric and medico-legal point of view, it is difficult to assess the cognitive performance of elderly individuals due to a number of factors, including the lack of evaluation tools with well-defined reference parameters for assessing decision-making capacities. Nonetheless, according to Italian penal code, abandoning a person incapable of self-support due to old age is considered a violation of the obligation of family assistance. Just as in the USA, which has instituted the Adult Protective Services, the Authors propose that the local health authorities provide help desks for the victims of elder abuse in Italy.