Decomposition and medicolegal autopsy in geriatric in‑home non‑traumatic deaths: histopathological findings and a public health perspective.

backgroundDue to advanced morphological tissue degradation and chemical alterations resulting from putrefaction, challenges arise in identification as well as in histopathological and toxicological examinations. Consequently, it has been debated that autopsies performed on decomposed bodies may have limited diagnostic and forensic value and may not always yield satisfactory results. With this study, we aimed to mitigate concerns and biases in the literature-particularly the view that autopsy has limited value in decomposed geriatric cases-and to delineate the diagnostic yield, contributory value, and limits of applicability of autopsy and histopathological evaluation.

methodsWe examined 88 decomposed bodies cases arising from non-traumatic, in-home deaths among geriatric individuals. Detailed evaluations were conducted of autopsy, histopathological, toxicological, identification, medical history, and scene investigation findings. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS), version 25.0 (Chicago, IL, USA).

results83.0% of the cases were male, and the mean age was 70.9 years. 85.2% lived alone, and 70.5% had a history of chronic disease. On histopathological examination, the coronary arteries were the tissues most resistant to autolysis. Toxicological analysis detected therapeutic-range concentrations of pharmaceutical agents in 56.8% of cases and endogenous ethanol in 21.6%. Identification was achieved via DNA comparison analyses in 29.5% of cases. A cause of death was established in 69.3% of cases; the most common non-traumatic cause of death was cardiovascular diseases (48.9%).

conclusionContrary to common presumptions, forensic autopsy and histopathological examinations of decomposed bodies in our study successfully determined the cause of death in a substantial proportion of cases (69.3%), a finding that is broadly consistent with the literature. In particular, the systematic histopathological evaluation of tissues resistant to autolysis-such as the coronary arteries and myocardium-combined with modern toxicological analyses and the integrated assessment of scene investigation findings and medical history data, enables a forensically satisfactory determination of the cause of death.