Documenting, investigating and preventing the arbitrary deprivation of life of older persons

The percentage of older persons in the world today is higher than ever before. As life expectancy increases globally, the Secretary-General of the United Nations has reported that the number of persons aged 65 years and over is projected to nearly double by 2050, rising to 17% from 10% in 2021.¹ Yet as the population of older persons grows, so do the gaps in the realization of their right to life. Pervasive assumptions about older persons’ frailty, dependency and social worth fuel stereotyping, discrimination and marginalization, with cascading consequences. These perceptions often obscure the cause and manner of death, recasting what may be State failure to respect, protect and fulfil their right to life as an inevitable consequence of old age. This dynamic is compounded by the systemic invisibilization of older persons within legal, institutional and policy frameworks, where their vulnerabilities remain chronically disregarded and their rights structurally undermined.

1. A/78/134, para. 46. ↩

States too often fail to exercise due diligence in enacting protective measures, to allocate adequate resources or to establish accountability mechanisms to investigate, prevent and remedy potentially unlawful deaths of older persons.² As a result, world-over, unlawful deaths of older persons are underreported, underinvestigated‍³ and underresearched,‍⁴ making this growing population susceptible to violations of their right to life. In addition, States’ failures to reliably investigate these unlawful deaths can themselves constitute violations of the victims’ right to life.⁵ Reliable investigations and adequate justice mechanisms are essential for truth, reparations for the victims and their families, and the effective prevention of unlawful deaths of older persons.

2. A/HRC/54/26. ↩
3. Ibid., paras. 29 and 33. ↩
4. Claudia Casella and others, “Is there a lesser value type of violence? Older people abuse: ‘the silence of the lambs’”, Legal Medicine, vol. 66 (February 2024). ↩
5. Human Rights Committee, general comment No. 36 (2018), paras. 27–29. ↩

While the right to life is non-derogable and requires States to take all necessary measures to reliably investigate and prevent the unlawful deaths of older persons, in practice, little attention is paid to the distinct risks of abuse and neglect faced by older persons. These risks intensify for older individuals who may experience the accumulated effects of lifelong discrimination and inequality across multiple dimensions of identity. Approaches to investigating, documenting and preventing violations of older persons’ right to life are too often fragmented and inconsistent, leaving substantial gaps in accountability and enforcement.⁶ The present report examines threats to the right to life of older persons and the measures required for its respect, protection and fulfilment. It explores why unlawful deaths of older persons often go undetected and recommends that States and stakeholders strengthen the investigation and prevention of future unlawful deaths.

6. Human Rights Watch, submission to the Open-ended Working Group on Ageing (November 2023). ↩

The report comes amid the establishment by the General Assembly of an open-ended intergovernmental working group for the elaboration of a legally binding instrument on the promotion and protection of the human rights of older persons. As the Deputy United Nations High Commissioner for Human Rights has proclaimed, the resulting framework can send an unequivocal message that “ageing with dignity is a universal human right, not a privilege”.⁷ This welcome initiative presents a unique opportunity for improving the protection of the right to life of older persons globally and should explicitly clarify and codify State obligations to investigate and prevent unlawful deaths of older persons, in line with article 6 of the International Covenant on Civil and Political Rights.

7. Nada Al Nashif, Deputy High Commissioner for Human Rights, Office of the United Nations High Commissioner for Human Rights (OHCHR), statement to the open-ended intergovernmental working group for the elaboration of a legally binding instrument on the promotion and protection of the human rights of older persons, Geneva, 19 February 2026. ↩

In preparing the present report, the Special Rapporteur received 21 submissions from States, civil society organizations, academics and other experts and conducted an online expert consultation. He thanks all of those who contributed to the preparation of the report. In particular, he wishes to thank the University of Chicago Law School Global Human Rights Clinic and Pozen Family Center for Human Rights for supporting the research. He is also grateful to the former and the current Independent Expert on the enjoyment of all human rights by older persons, Claudia Mahler and Zvezdan Pirtošek, and the former Special Rapporteur on the rights of persons with disabilities, Gerard Quinn, for their valuable insights.

The right to life establishes State responsibility not only for unlawful deaths caused by or attributable to the State, but also for deaths resulting from the State’s failure to protect life.⁸ Accordingly, States must refrain from arbitrarily depriving persons of life and avoid actions or policies that deliberately or recklessly endanger life.⁹ Furthermore, States are required to take positive measures to exercise due diligence and safeguard life from all threats which could be reasonably foreseen, including those from private actors, to investigate and prosecute all potentially unlawful deaths and provide an effective remedy.¹⁰ States must protect the right to life “without distinction of any kind”.¹¹

8. Human Rights Committee, general comment No. 36 (2018), paras. 3 and 6. ↩
9. Ibid., para. 7. ↩
10. Ibid., paras. 4, 18, 19 and 27. ↩
11. International Covenant on Civil and Political Rights, art. 2 (1). ↩

The right to life also has a procedural component, which requires States to investigate all potentially unlawful deaths. States must carry out investigations in a prompt; effective and thorough; independent and impartial; and transparent manner. The Principles on the Effective Prevention and Investigation of Extra-legal, Arbitrary and Summary Executions, adopted by the Economic and Social Council in 1989, and the revised Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016) provide important guidance for the implementation of such investigations.

While the right to life is robustly protected under international law, older persons experience substantial barriers in realizing and fulfilling their rights. As the Independent Expert on the enjoyment of all human rights by older persons highlighted, the “current legal framework does not have the means and capacity to systematically close existing gaps in the protection of the human rights of older persons”.¹² Notably, no binding global instrument adequately establishes a clear, uniform standard governing the obligation of every State towards its older population. This normative gap contributes to inconsistent protection, fragmented data collection and the weakened ability of humanitarian and human rights systems to systematically identify and address age-specific risks, including those that may threaten older persons’ right to life.

12. A/HRC/48/53, para. 95. ↩

Critically, the unique protection gaps faced by older persons are overlooked.¹³ Age, as a protected class requiring particular attention, is not explicitly mentioned in either general comment No. 36 or general comment No. 18 of the Human Rights Committee.¹⁴ This structural vulnerability leads to gaps in implementation and fulfilment and necessitates explicit codification to correct.

13. While the standard list of prohibited grounds of discrimination in international human rights instruments does not explicitly include age, it does include discrimination prohibitions based on “other status”. ↩
14. A/HRC/49/70, para. 22. ↩

The only international convention specifically acknowledging older persons’ rights is the Convention on the Rights of Persons with Disabilities. While general comment No. 6 (1995) and general comment No. 20 (2009) of the Committee on Economic, Social and Cultural Rights address the rights of older persons and recognize the need for enhanced protections, they focus on the enjoyment of a full life rather than protection against arbitrary deprivation of life. Similarly, Committee on the Elimination of Discrimination against Women general recommendation No. 27 (2010), on the protection of older women, and joint general recommendation No. 38 (2025) of the Committee on the Elimination of Racial Discrimination and general comment No. 7 (2025) of the Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families address discrimination and social protection for older persons, but do not contain explicit obligations regarding their right to life.

Regional human rights instruments have taken the lead regarding the codification of protections for older persons. The Inter-American Convention on Protecting the Human Rights of Older Persons is the first legally binding instrument dedicated specifically to older persons. Article 6 explicitly safeguards the right to life and dignity in old age and calls on States Parties to “adopt all measures necessary to ensure older persons’ effective enjoyment of the right to life and the right to live with dignity in old age until the end of their life and on an equal basis with other segments of the population”.¹⁵ Similarly, while the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Older Persons in Africa does not explicitly address older persons’ right to life, it provides broad protections against threats to older persons’ lives, including abuse, harmful practices, gender-based violence and risks arising in conflict and disaster settings.

15. Organization of American States, Inter-American Convention on Protecting the Human Rights of Older Persons. ↩

Furthermore, the Inter-American Court of Human Rights found that Chile had violated the right to life of a 76-year-old man who died after being inadequately treated and prematurely discharged from a public hospital and established that the right to life for older persons encompasses informed consent procedures, access to emergency care and protection against medical negligence.¹⁶ The European Court of Human Rights also ruled, in the case of an older woman with Alzheimer’s disease who had disappeared after being negligently left unsupervised at a nursing home, that Bulgaria had violated her right to life for failing to provide adequate investigation and redress.¹⁷

16. Inter-American Court of Human Rights, Poblete Vilches et al. v. Chile, Judgment, 8 March 2018. ↩
17. European Court of Human Rights, Dodov v. Bulgaria, Application No. 59548/00, Judgment, 17 January 2008. ↩

Guidance and policy documents to advance the rights of older persons have built momentum towards recognition of the rights of older persons, beginning with the Vienna International Plan of Action on Ageing of 1982 and the adoption of the United Nations Principles for Older Persons in 1991.¹⁸ The Madrid International Plan of Action on Ageing, 2002, remains a primary overarching international policy document addressing the protection of older persons.¹⁹ Notably, these instruments do not specifically address the risk of arbitrary deprivation of the right to life of older persons. In 2025, however, the Human Rights Council established an open-ended intergovernmental working group with the mandate of elaborating a legally binding international instrument on the promotion and protection of the human rights of older persons.²⁰

18. General Assembly resolution 46/91. ↩
19. Political Declaration and Madrid International Plan of Action on Ageing, 2002. ↩
20. Human Rights Council resolution 58/13. ↩

Unlawful deaths of older persons are an underreported and underrecognized phenomenon, obscured by age-based misconceptions and generalizations about health and natural causes and the manner of death. Similarly, older persons often occupy a less conspicuous position in public life. As a result, what older persons do – and, inversely, what is done to older persons – may be less apparent to the outside world. In such circumstances, carers play the primary role of liaising between older persons and society at large and serve as a filter of information about the older person before it reaches the outside world, which leaves older persons particularly susceptible to abuse or neglect.

While the Minnesota Protocol provides essential guidance for investigating any potentially unlawful death, investigators must be aware of the specific challenges inherent in cases of suspicious death of older persons. These include identifying and documenting evidence of neglect and abuse, past and present, that may have culminated in death attributed to natural causes. Specific guidance complementing the Minnesota Protocol for the investigation of potentially unlawful deaths of older persons would be a valuable additional contribution to their effective documentation and prevention.

Natural physiological changes and a higher incidence of disease or disability often accompany the ageing process. These age-related changes increase the morbidity and mortality risk for older persons. Such changes may also contribute to a generalized profile of older persons, one which presumes that all older persons are infirm in some manner.²¹ Discriminatory age-based stereotypes depicting older persons as inevitably frail, sick and near death can normalize and depersonalize their deaths, causing potentially unnatural or preventable deaths to be falsely understood as merely the expected incidents of ageing.²²

21. World Health Organization (WHO), Global Report on Ageism (Geneva, 2021), pp. 3 and 10. ↩
22. Solomon Liao, “Preventing and detecting elder mistreatment”, American Medical Association Journal of Ethics, vol. 10, No. 6 (June 2008). ↩

These presumptions are sometimes embedded in systems governing the classification and investigation of older persons’ deaths. Doctors, for example, only rarely receive education and training on elder abuse, leading them to mistakenly attribute indicators of deliberate harm to the ageing process and thus underreport possible mistreatment.²³ This leaves jurisdictions that rely on medical professionals to make a preliminary determination of the lawfulness of the death particularly susceptible to underreporting potentially unlawful deaths from elder abuse.²⁴ Similar issues can arise downstream in coroners’ and medical examiners’ agencies. A 2012 report in the United States of America found that some coroners and medico-legal agencies “were under the mistaken impression that they could rely on clinicians who report deaths to have expertise in elder abuse and neglect”, and, just as concerningly, often dismissed investigating older persons’ deaths and attributed them to the natural process of ageing.²⁵ Likewise, a Swedish study concluded that inconsistencies in defining abusive behaviour and variations in training and interventions often led to elder abuse remaining unidentified.²⁶

23. D. Kay Taylor and others, “Assessing barriers to the identification of elder abuse and neglect: a communitywide survey of primary care physicians”, Journal of the National Medical Association, vol. 98, No. 3 (March 2006), pp. 403–404. ↩
24. Chisun Lee and A.C. Thompson, “Gone without a case: suspicious elder deaths rarely investigated”, ProPublica and PBS Frontline, 20 December 2011. ↩
25. Laura Mosqueda and Aileen Wiglesworth, “Coroner investigations of suspicious elder deaths”, paper prepared for the National Institute of Justice of the United States of America, October 2012, p. 3. ↩
26. Linda Johansson and others, “Health and social care staff’s recognition of elder abuse perpetrated by family members of persons with dementia: a mixed-method study”, Scandinavian Journal of Public Health, vol. 53, No. 6 (August 2025), pp. 600–610. ↩

Protections for older persons’ dignity and status as valuable members of society may serve as a bulwark against their social and physical marginalization, which can result in the arbitrary deprivation of their lives. Some States have taken the significant step of codifying such protections. Mozambique, for example, provides for special protections of older persons within article 124 of its Constitution. In many other contexts, research suggests that older persons may face a risk of being pushed towards the periphery of society as they age, a phenomenon known as social exclusion or social isolation.²⁷

27. Kieran Walsh, Thomas Scharf and Norah Keating, “Social exclusion of older persons: a scoping review and conceptual framework”, European Journal of Ageing, vol. 14 (2017), pp. 81–98. ↩

Social exclusion may result from any combination of structural drivers that exist at the national level (such as ageism, discrimination and both social and economic policies); environmental drivers relating to the living environment of older persons that exist at the local level (including institutionalization); and individual-level drivers such as relocation or disruptions in social networks and ill-health.²⁸ A paradigmatic example of the social marginalization of older persons is institutionalization in long-term care facilities, including retirement homes or assisted living facilities.²⁹ This marginalization is particularly acute for older persons nearing the end of life. Further implicit and explicit limitations on autonomy and legal capacity may compound these difficulties.

28. Marjaana Seppänen, Mia Niemi and Sofia Sarivaara, “Social relations and exclusion among people facing death”, European Journal of Ageing, vol. 20 (2023). ↩
29. Jenny Paananen, Jenni Kulmala and Jari Pirhonen, “Social death of older adults residing in nursing homes in Finland”, Journal of Aging Studies, vol. 71 (December 2024). ↩

Social exclusion can occasionally lead to indifference and dehumanization, increasing older persons’ risk of abuse and neglect.³⁰ Particularly in long-term care contexts, the quality of care may decrease as less social value is imputed to older persons’ lives.³¹ Furthermore, decreased social connections, increased isolation, reduced physical well-being, mental health and mobility in later life are all risk factors for violence and fatal outcomes.³² Japan’s experience with kodokushi illustrates the phenomenon at its extreme; older citizens in particular, living away from their families and without strong social ties, may die alone and fail to be discovered for extended periods of time.³³

30. Charles P. Sabatino, “The marginalizing and dehumanizing of our sickest and oldest Americans”, American Bar Association, Human Rights Magazine, vol. 50, No. 5 (March 2025). ↩
31. Ibid. ↩
32. Jennifer E. Storey, “Risk factors for elder abuse and neglect: a review of the literature”, Aggression and Violent Behavior, vol. 50 (January–February 2020). ↩
33. Justin Nobel, “Japan’s ‘lonely deaths’: a business opportunity”, Time Magazine, 6 April 2010. ↩

Older persons requiring assistive care are left facing risks of inadequate support, abuse and ill-treatment by their carers. While carers themselves often suffer from significant stress, lack of adequate resources, expertise or compensation and poor working conditions, situations in which an older person is highly dependent on carers or is isolated may increase that person’s susceptibility to abuse, with cumulative effects on mortality.³⁴ These conditions can increase carers’ burden and reduce the likelihood that outsiders will detect escalating mistreatment before it becomes lethal.³⁵ Further, in many countries, older persons may be cared for primarily by informal institutions or networks operating entirely outside State oversight, monitoring and access to accountability mechanisms.³⁶

34. WHO, “Abuse of older people”, fact sheet, 15 June 2024. ↩
35. See United States National Research Council, “Risk factors for elder mistreatment”, in Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America, Richard J. Bonnie and Robert B. Wallace, eds. (Washington, D.C., National Academies Press, 2003). ↩
36. Nicolás Redondo and Peter Lloyd-Sherlock, Institutional Care for Older People in Developing Countries: Repressing Rights or Promoting Autonomy? The Case of Buenos Aires, Argentina, DEV Working Paper 13, School of International Development, University of East Anglia (Norwich, United Kingdom of Great Britain and Northern Ireland, 2009). ↩

In such contexts, carers may also become the authoritative, or sole, source of information about the older person’s injuries or death, even in situations where they are responsible for fatal mistreatment or abuse of their older charge. There is then a risk that an older person’s suspicious death may be wrongly certified as natural, thereby bypassing coroner, medical examiner or law enforcement review. This structure can allow carer-caused fatalities to be screened out as ordinary deaths, effectively insulating carer-caused fatalities from law enforcement investigation, accountability and prevention.³⁷

37. Amy C. Gruszecki and others, “Investigation of elderly deaths in nursing homes by the medical examiner over a year”, American Journal of Forensic Medicine and Pathology, vol. 25, No. 3 (September 2004). ↩

The recognition of the need for care offered to older persons to be respectful of human rights is included precisely in the Inter-American Convention on Protecting the Human Rights of Older Persons. States Parties must “take steps to ensure that public and private institutions offer older persons access without discrimination to comprehensive care, including palliative care; avoid isolation; appropriately manage problems related to the fear of death of the terminally ill and pain; and prevent unnecessary suffering, and futile and useless procedures, in accordance with the right of older persons to express their informed consent”.³⁸ This may serve as a model for the future universal binding instrument.

38. Organization of American States, Inter-American Convention on Protecting the Human Rights of Older Persons, art. 6. ↩

Violations of older persons’ right to life are often the foreseeable result of age-based assumptions that are deeply entrenched in administrative policy and practices, which also cause their fatal consequences to be routinely unrecognized and unaddressed. As defined by the Independent Expert on the enjoyment of all human rights by older persons, ageism refers to stereotypes, prejudice and/or discriminatory actions or practices against older persons that are based on their chronological age or on a perception that the person is “old”.³⁹ Invisibilization and discrimination further reinforce each other, perpetuating a cycle that systematically undermines older persons’ right to life. Indeed, the World Health Organization notes ageism as one of the most widespread and accepted forms of discrimination.⁴⁰

39. A/HRC/54/26, para. 14. ↩
40. WHO, Global Report on Ageism, pp. 9–10. ↩

Age-based discrimination of older persons further contributes to the chronic underenforcement of protections against abuse, neglect and abandonment that directly threaten life. For instance, the African Union and the Inter-American Commission on Human Rights have each identified elder abuse and neglect as widespread and systematically underreported forms of violence affecting millions of older persons.⁴¹ Some countries, such as Ecuador, have enacted laws and policies identifying protective and risk factors for older persons and established national entities responsible for monitoring and interventions.⁴² Where deaths resulting from abuse or neglect are attributed to age rather than being investigated as potential violations, States are effectively relieved of their obligations to investigate, prosecute and prevent them.

41. African Union, “Strategic policy framework and plan of action on ageing”, 2022; and InterAmerican Commission on Human Rights, “IACHR calls for the eradication of mistreatment of the elderly and guaranteeing lives free of violence”, 15 June 2025. ↩
42. Submission from Ecuador. ↩

Older persons do not experience discrimination from ageism in isolation from other forms of systemic inequities, including sexism, racism, ableism and migration status, leading to layered vulnerabilities that disproportionately impact their right to life.⁴³

43. A/HRC/48/53, paras. 51–58. ↩

Overlapping discriminations lead older persons from multiple protected groups to be at a greater risk of invisibilization from investigative and protective frameworks and permit preventable and potentially unlawful deaths to go unrecognized as human rights violations. Notably, the Inter-American Court of Human Rights addressed the sexual violence, torture and resulting death due to lack of medical attention of an older Indigenous woman in the case of Ascencio Rosario et al. v Mexico and condemned the State for initially attributing her cause of death as the natural consequence of age, illness and poverty. The Court further emphasized and reiterated that alleged violations against older persons must be analysed in an intersectional manner.⁴⁴

44. Inter-American Court of Human Rights, Ascencio Rosario et al. v. Mexico, Judgment, 30 September 2025, paras. 173, 221 and 261–264. ↩

Gendered ageism and gender-based violence against older women exemplify this phenomenon. Older women can experience higher rates of intimate partner violence, sexual assault and economic exploitation,⁴⁵ yet these harms are often routinely misattributed and not investigated.⁴⁶ A recent review of forensic literature found that up to 70% of victims of documented cases of unlawful deaths of older persons were women, and that these killings were often the fatal result of gender-based violence combined with abuse and neglect.⁴⁷ Likewise, Governments and civil society have documented substantial undercounting and inadequate responses to violence against older women.⁴⁸ It is hoped that the upcoming addendum to the Minnesota Protocol on the investigation of femicides⁴⁹ will also contribute to improving the investigation and prevention of gender-based killings of older women.

45. Neha Pathak, Rageshri Dhairyawan and Shema Tariq, “The experience of intimate partner violence among older women: a narrative review”, Maturitas, vol. 121 (March 2019), pp. 63–‍75. ↩
46. Ruthy Lowenstein Lazar, “Me too? The invisible older victims of sexual violence”, Michigan Journal of Gender and Law, vol. 26, No. 2 (2020), p. 209. ↩
47. Arianna Giorgetti and others, “On tackling abuse of older people: the forensic challenges in fatal cases investigation”, Legal Medicine, vol. 67 (March 2024), p. 1. ↩
48. Myrna Dawson, “Not the ‘golden years’: femicide of older women in Canada”, research paper for the Office of the Federal Ombudsman for Victims of Crime of Canada, April 2021. ↩
49. General Assembly resolution 79/176, paras. 3 (b) and 4. ↩

Similarly, older persons with disabilities, older persons from racial and ethnic minorities, Indigenous older persons and older migrants each experience ageism and face the risk of violence and neglect layered upon other systemic inequalities.⁵⁰ Effective prevention requires that States recognize and assess how age-based discrimination operates in conjunction with other forms of marginalization. This demands disaggregated mortality data, investigation protocols that explicitly examine intersectional vulnerabilities, emergency and healthcare frameworks designed with attention to compounded risks, and the meaningful participation of multiply marginalized older persons in policymaking that affects them. The reliable investigation of death is a cornerstone of sound preventive policies and measures.

50. A/74/186; and Chengxu Long and others, “Inequalities in the access to health services among older migrants: evidence from the China migrant dynamic monitoring survey”, International Journal of Public Health, vol. 68 (April 2023). ↩

States must both prevent potentially unlawful deaths and investigate when they occur.⁵¹ States are required to identify and mitigate risks before the loss of life, determine the circumstances and causes of death, and hold perpetrators accountable when the death is established to be unlawful.

51. Human Rights Committee, general comment No. 36 (2018), paras. 18–28. ↩

For older persons, many deaths are not simply isolated events but the foreseeable result of known vulnerabilities, protection needs and general societal conditions that may give rise to direct threats to enjoying the right to life with dignity. Some deaths are due to cumulative deficiencies in preventive measures, oversight and access to essential services.⁵² Rather than exclusively focusing on immediate medical causes, a comprehensive human rights approach requires States to address underlying conditions that make preventable deaths more likely, including institutional oversight and monitoring, access to healthcare, adequate staffing and training of carers and forensic scientists, and the justice system.⁵³

52. WHO, World Report on Ageing and Health (Geneva, 2015); and HelpAge International, “International human rights law and older people: gaps, fragments and loopholes”, 2012. ↩
53. European Union Agency for Fundamental Rights, Shifting Perceptions: Towards a Rights-Based Approach to Ageing (Luxembourg, 2018). ↩

Because these risks often develop gradually, early detection, data collection and monitoring are essential interventions. For example, the Protection of Elderly Persons Act of Mauritius established a Monitoring Committee for the Elderly and a Protection of the Elderly Network to track and coordinate prevention interventions. Positive measures include robust health screening, monitoring for abuse and neglect (malnutrition, infection or social isolation) and reporting mechanisms to identify unexpected deaths or emerging mortality trends.⁵⁴ Such measures seek to identify risks before they become fatal and to trigger interventions where systemic failures contribute to preventable harm.

54. United Nations, Department of Economic and Social Affairs, “Health inequalities in old age”, 9 April 2018. ↩

However, prevention alone is insufficient. An important element of the protection of the right to life is the obligation on States to investigate and, where appropriate, prosecute perpetrators in situations where they know or should have known of potentially unlawful deprivations of life.⁵⁵ Despite this legal obligation, deaths of older persons are chronically underinvestigated.⁵⁶ One critical oversight by State authorities is the identification of when such potentially unlawful deaths occur.⁵⁷ For example, sepsis can cause a natural death, but it may be the result of cumulative abuse and neglect. Unless properly investigated, such deaths can be misclassified as natural.

55. Human Rights Committee, general comment No. 36 (2018). ↩
56. Giorgetti and others, “On tackling abuse of older people”, p. 1. ↩
57. Johansson and others, “Health and social care staff’s recognition of elder abuse”. ↩

Invisibilization of and discrimination towards older persons sometimes fosters systematic blindness to suspicious circumstances surrounding the deaths of older persons. As a result, the threshold judgment triggering a State’s duty to document and investigate is often missed, leaving suspicious deaths not just inadequately investigated but not investigated at all. Even when States identify a death as “potentially unlawful”, thus triggering their obligation to investigate, compliance with the requirements of the Minnesota Protocol requires special attentiveness to features of older persons’ deaths that distinguish them from other death investigations.

To effectively capture the effects of neglect, death investigations of older persons should include the proactive search for and forensic documentation of specific circumstantial data and physical findings, including past injuries and infections. The person who has experienced neglect may have signs that are mistakenly ignored or masked by the physiological changes of ageing. The role of forensic medicine and pathology for the reliable investigation of suspected fatal elder abuse cannot be overstated. The Ontario Forensic Pathology Service in Canada is one of the world’s first forensic institutions to have developed and implemented special standard operating procedures for the post-mortem examination of suspected fatal elder abuse.⁵⁸

58. Submission from Dr. Rebekah Jacques. ↩

To address this gap, specific guidance for investigators that complements the Minnesota Protocol would strengthen both documentation and prevention efforts. The standard operating procedures developed by the Ontario Forensic Pathology Service exemplify the kind of practical standards needed internationally.

Investigations into potential violations of the right to life must occur whenever a State “knows or should have known of any potentially unlawful death”. The duty to investigate arises automatically when the State has caused a death, or it is alleged or suspected that the State caused a death.⁵⁹ The State also has a duty to investigate all potentially unlawful deaths caused by individuals, even where the State cannot be held responsible for failing to prevent the death.⁶⁰

59. Minnesota Protocol, paras. 15–16. ↩
60. Ibid., para. 18. ↩

However, invisibilization of and discrimination against older persons frequently distract or obscure unlawful deaths from review. A forensic study in the United States, for example, found that less than 1% of nursing home resident deaths were autopsied over a year.⁶¹ Even when States initiate an investigation into the death of an older person, institutional constraints may impede the investigation. Medico-legal offices may not have the capacity or expertise to adequately investigate deaths of older persons. Investigators must be aware of the particular challenge and the need for identifying and documenting evidence of neglect and abuse, which may have led to a seemingly natural death. Resource constraints may push for the prioritization of cases with higher community visibility; overall, these often involve younger potential victims. Even within the specific subset of older potential victims, some medico-legal offices may receive so many bodies of older persons, both those who die naturally and those who do not, that they must triage and allocate resources to the most “suspicious”. This runs the risk of less-obvious unlawful deaths being overlooked.

61. Gruszecki and others, “Investigation of elderly deaths in nursing homes by the medical examiner over a year”, p. 209. ↩

Notably, some Governments have strengthened their investigative capacity by establishing cross-departmental older persons fatality review teams and safeguarding mechanisms that allow law enforcement, health officials and other relevant agencies to communicate and act collectively. For example, the United Kingdom of Great Britain and Northern Ireland has created cross-organizational mechanisms that have demonstrated success in identifying investigative barriers, improving understanding of how elder abuse can lead to death and generating systemic reforms.⁶² Colombia has similarly enhanced investigative coordination through collaboration between the Unit for the Search for Persons Deemed Missing and forensic identification services.⁶³ Implementing older-persons-specific policies and operating procedures domestically for ensuring the effective and reliable investigation of all potentially unlawful deaths of older persons also generates data and insights about institutional and structural risk factors. This information is in turn valuable for designing and implementing evidence-based measures for the protection of the right to life of older persons.

62. United Kingdom, Care Act 2014, chap. 23, sect. 44; and Michael Preston-Shoot, “What difference does legislation make? Adult safeguarding through the lens of serious case reviews and safeguarding adult reviews”, report for South-West Region Safeguarding Adults Boards, October 2017. ↩
63. Submission from Colombia. ↩

Investigations should be performed in accordance with relevant international standards, including the Minnesota Protocol.⁶⁴ Investigations must be conducted in a prompt, effective and thorough, independent and impartial, and transparent manner, and be carried out by impartial investigators acting at all times without bias, including on the basis of age. Conclusions must be drawn from the evidence objectively rather than on the basis of stereotypes or generalizations based on the decedent’s age.

64. Human Rights Committee, general comment No. 36 (2018), para. 27. ↩

Sources of potential evidence must be identified and analysed, without limitation to evidence supporting presumptions about the deceased’s health status as an older individual. Investigation data collection should be systematized and include critical data, such as on injuries, nutritional status or dehydration not consistent with reported natural disease, presence and staging of ulcers, evidence of restraint use, and personal and environmental hygiene, among other things.⁶⁵ Statements from the last individual to see the older person alive, the person to discover the body and the time of discovery should be taken.⁶⁶

65. Julie A. Howe and others, “Investigation of elder deaths”, Academic Forensic Pathology, vol. 4, No. 3 (September 2014), p. 290. ↩
66. Ibid., p. 302. ↩

Investigators should perform queries about living conditions, social/medical financial history, circumstances surrounding recent trauma, marks or injuries to the body, carers, medications, functional and nutritional status, physical appearance of the body, presence and stage of wounds (e.g. decubitus ulcers) and neurological status. Forensic investigations should include a comprehensive examination of the scene, a review of relevant medical, institutional and caregiving records, documentation of environmental conditions, and photographic documentation of the body and any injuries or indicators of neglect. A minimum set of photographs of the body should be obtained in all cases.⁶⁷

67. Ibid. ↩

Investigators should also carefully assess and document evidence suggestive of physical or sexual abuse.⁶⁸ Potential indicators of physical abuse may include abrasions, lacerations, patterned injuries or injuries inconsistent with the reported circumstances. In cases where sexual abuse is suspected, investigators should maintain a low threshold for conducting specialized examinations and collecting biological evidence necessary to preserve and evaluate potential forensic findings. Additionally, investigators should be alert to signs of neglect. Relevant indicators may include severely unsanitary or unsafe living conditions; poor personal hygiene, including unwashed hair, dirt-encrusted skin or inadequate oral care; evidence of malnutrition or dehydration; untreated infections; and other findings inconsistent with the level of care reasonably required by the individual’s condition.⁶⁹

68. Ibid., p. 294. ↩
69. Submission from Dr. Rebekah Jacques. ↩

Furthermore, investigators should take into account the higher risk of falling and injuries for older persons, and ask appropriate questions and make detailed observations about any recent falls, including time and date, witnesses, location, landing surface and the possibility of striking an intermediary object during the fall.⁷⁰ Investigators should perform a complete inventory of medications, including identifying all persons responsible for the administration of therapeutics. This should be compared with pharmacy records, and any absent medication or medication not administered as directed explained. All discrepancies should be documented, and any observations by the medico-legal death investigator that may alert the pathologist to red flags should be noted.⁷¹

70. Howe and others, “Investigation of elder deaths”, p. 291. ↩
71. Ibid., p. 292. ↩

In canvassing witnesses and potential suspects, investigators should follow procedures outlined in the Minnesota Protocol without biasing profiles drawn based on the age of the victim. Investigators must be mindful of carer-charge dynamics between the deceased older person and any family or institutional carer. An addendum to the Minnesota Protocol with specific guidance, including that which is outlined above, for the investigation of potentially unlawful deaths of older persons would be a valuable contribution to their effective documentation and prevention.

States hold critical duties and obligations across multiple contexts where older persons’ right to life is at acute risk, including settings of deprivation of liberty, within healthcare systems, during humanitarian emergencies and in armed conflict. In each of these contexts, documented patterns and research reveal how ageism and invisibilization become embedded in systems, oversight, accountability and State practice. These violations also frequently intersect with discrimination based on gender, race, disability, and other statuses or identities, creating compounded harms.

Older persons are deprived of their liberty when they are confined to a specific space or placed in a public or private institution without the ability to leave at will, and these arrangements were made without their free and informed consent, often by order of a judicial, administrative or other authority.⁷² Due to ageism and age discrimination, older persons are deprived of their liberty through inadequate or non-existent policies for their particular needs, abandonment by their families, and justifications that deprivation of liberty is in their “best interests”.⁷³ As a result, the situational powerlessness of older persons can also lead to de facto deprivations of liberty.⁷⁴

72. A/HRC/51/27, para. 10. ↩
73. Asia-Europe Foundation, Human Rights of Older Persons: Seminar Proceedings of the 20th Informal ASEM Seminar on Human Rights (Singapore, 2021), pp. 73–76. ↩
74. Maeve O’Rourke, “Deprivation of liberty for ‘care’”, in Human Rights and the Care of Older People: Dignity, Vulnerability, and the Anti-Torture Norm (Oxford, Oxford University Press, 2024) pp. 187–188 and 207. ↩

Places of deprivation of liberty relevant for older persons include prisons, pretrial detention facilities, caregiving establishments, hospitals, psychiatric institutions, private homes and immigration detention centres.⁷⁵ Because older persons face heightened risks of violence, abuse and neglect, deprivation of liberty can lead to the violation of the right to life for older persons.⁷⁶ Notably, the Inter-American Court of Human Rights has recognized in an advisory opinion that older persons require specialized consideration when deprived of their liberty to uphold and respect their rights.⁷⁷ States are obligated not only to prevent and punish violations of the right to life for older persons in State-managed institutions, but also violations by non-State actors.⁷⁸ In immigration detention contexts, overcrowding and an inability of facilities to sufficiently address the multiple and complex health issues prevalent among older persons have led international human rights bodies to regularly advise that older persons should be exempt from immigration detention.⁷⁹

75. A/HRC/51/27, para. 11. ↩
76. Ibid., para. 56. ↩
77. Inter-American Court of Human Rights, Differentiated Approaches with Respect to Certain Groups of Persons Deprived of Liberty, Advisory Opinion OC-29/22, 30 May 2022, para. 115. ↩
78. OHCHR, Update to the 2012 analytical outcome study on normative standards for older persons: working paper, 2021, para. 121. ↩
79. See, for example, Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families, general comment No. 5 (2021), para. 52; and A/HRC/51/27, para. 51. ↩

Detention is particularly detrimental for older persons and reduces their life expectancy.⁸⁰ Although incarceration accelerates ageing, adequate healthcare and services can mitigate early mortality in custody.⁸¹ However, prison doctors and correctional nurses are usually not trained in gerontological care and therefore fail to recognize early symptoms of acute and chronic life-threatening issues that are common among older persons.⁸²

80. Submission from Corporación Mujeres Libres. ↩
81. Canada, Office of the Correctional Investigator and Canadian Human Rights Commission, Aging and Dying in Prison: An Investigation into the Experiences of Older Individuals in Federal Custody (2019). ↩
82. American Civil Liberties Union, Trapped in Time: The Silent Crisis of Elderly Incarceration (2025), p. 27. ↩

At every stage of the criminal justice system, States must take into account the specific needs of older prisoners with respect to their age and health.⁸³ The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) establish that prison authorities must ensure equal access to services and facilities for the most vulnerable groups in prison settings, including older persons.⁸⁴ As detention facilities are often designed for younger prisoners, the layout and conditions of the facilities may cause life-threatening complications for older prisoners, such as through excessive heat or cold and overcrowding during disease outbreaks.⁸⁵ As life sentences and longer sentences are increasing due to stricter sentencing practices and the global trend towards abolishing the death penalty, States must adapt detention facilities to the increasing number of older prisoners.⁸⁶ As an example, Guatemala’s Law of the Penitentiary Regime (Law No. 33-2006) mandates the design of special detention centres for older adults.⁸⁷

83. A/HRC/51/27, para. 15. ↩
84. Ibid., para. 16. ↩
85. Ibid., para. 44. ↩
86. Ibid., para. 29. ↩
87. Submission from Guatemala. ↩

Older persons may be deprived of liberty through institutionalization in private and public care facilities, including nursing homes, hospitals and forced home confinement.⁸⁸ These facilities may have doors with exterior locks, wire fencing, bars on windows and surveillance systems.⁸⁹ Older persons may be forcibly placed in care facilities for various reasons, including their being perceived as lacking the capacity to consent to their own care arrangements,⁹⁰ the lack of other preferred forms of care,⁹¹ and abandonment by relatives.⁹² Because older persons are often fully dependent on their carers and unable to leave their care facilities,⁹³ they are exposed to heightened risks of violence, abuse and neglect. For instance, studies have found that older persons worldwide may be chemically restrained with antipsychotic drugs that increase mortality risk.⁹⁴ Older persons may also be reluctant or unable to report maltreatment or issues in such institutions when they rely on the very staff responsible for abuse for food, medication, hygiene and basic assistance.⁹⁵

88. A/HRC/51/27, para. 54. ↩
89. O’Rourke, “Deprivation of liberty for ‘care’”, p. 184. ↩
90. A/HRC/51/27, para. 55. ↩
91. Bridget Sleap, “‘Chemical restraints’ deprive older people of liberty”, Human Rights Watch, 19 September 2022. ↩
92. E/2012/51 and E/2012/51/Corr.1, para. 25. ↩
93. A/HRC/51/27, para. 55. ↩
94. O’Rourke, “Deprivation of liberty for ‘care’”, pp. 200 and 206–207. ↩
95. Eilon Caspi, “Residents’ fear of retaliation in America’s nursing homes: an exploratory study”, Journal of Applied Gerontology, vol. 43, No. 5 (May 2024). ↩

The right to life for older persons may be violated in healthcare settings, including care facilities that do not amount to deprivation of liberty. Healthcare settings can perpetuate harms against older persons, such as the denial of medication, overmedication or inadequate medication, physical and verbal abuse, isolation, abandonment and neglect, all of which increase mortality risk.⁹⁶ These harms may occur through individual behaviours of staff, such as the complete disregard for the opinion of older patients regarding their treatment, improper medical care, inaccurate medical diagnosis and objectification of older patients.⁹⁷ For instance, healthcare staff may overmedicate or sedate older persons with dementia.⁹⁸ Care facilities may also medicate older persons without an appropriate diagnosis or consent from them or their family members.

96. See Quynh T. Huynh and others, “Ageism toward older adults among healthcare workers and students: a scoping review”, International Journal of Nursing Studies Advances, vol. 10 (June 2026). ↩
97. A/HRC/48/53, para. 61. ↩
98. Human Rights Watch, “‘They want docile’: how nursing homes in the United States overmedicate people with dementia”, 5 February 2018. ↩

Palliative care aims to improve the quality of life for terminally ill individuals by preventing and relieving pain and suffering. The lack of informed consent is a prevalent issue in palliative care for older persons, as they are often perceived to have a diminished capacity to consent to medical treatment. As a result, older persons are more easily taken advantage of due to perceived ignorance and helplessness, as well as actual physical or mental frailty.⁹⁹ Financial disparities further exacerbate violations of the right to life for older persons in healthcare settings. Older persons who are unable to afford quality healthcare are at greater risk of poor treatment and care, and therefore also of earlier death.

99. A/HRC/18/37, para. 66. ↩

The coronavirus disease (COVID-19) pandemic illustrated how ageist assumptions translate into policies that cost lives. Healthcare rationing by age was widespread: a systematic review conducted in 2020 found that age determined treatment access in 85% of 149 studies.¹⁰⁰ In 2020, the Secretary-General affirmed older persons’ equal right to life and health and cautioned against the age-based discriminatory allocation of life-saving care.¹⁰¹ Regardless, many triage policies often assessed patients based on rough scores determining their likelihood of survival and ultimately deprioritizing older persons. For example, COVID-19 triage frameworks proposed or implemented in countries including Italy, Switzerland and Belgium frequently relied on age limits, life expectancy or maximizing “life years” saved, principles that deprioritized older persons for scarce intensive care resources.¹⁰² Many institutions later revised their policies to promote greater equity but, by that point, the harm had already occurred.¹⁰³

100. Eleanor K. Johnson, “Death, dying and disparity: an ethnography of differently priced residential care homes for older people”, Ageing & Society, vol. 44, No. 11 (November 2024). ↩
101. United Nations, “‘Rights and dignity’ of older people must be respected during COVID-19 and beyond”, 1 May 2020. ↩
102. Hans-Jörg Ehni, Urban Wiesing and Robert Ranisch, “Saving the most lives: a comparison of European triage guidelines in the context of the COVID-19 pandemic”, Bioethics, vol. 35, No. 2 (February 2021). ↩
103. University of Pittsburgh, “Allocation of scarce critical care resources during a public health emergency”, 9 April 2021. ↩

Colombia’s Constitutional Court relied on the Inter-American Convention on Protecting the Human Rights of Older Persons when reviewing the legality of recommendations by the country’s Ministry of Health and Social Protection that allowed hospitals to make COVID-19 treatment decisions based on patients’ age or disability and ordered the State to issue binding and uniform triage guidelines irrespective of age.¹⁰⁴ The Independent Expert on the enjoyment of all human rights by older persons has highlighted the problems of triage protocols that effectively deny older persons their right to health and life on an equal basis with others, and has condemned both the abandonment of older persons in care homes and the failure to protect institutionalized older persons, failures ultimately contributing to premature death.¹⁰⁵

104. Constitutional Court of Colombia, Judgment T-237 of 2023, 4 July 2023. ↩
105. OHCHR, “‘Unacceptable’ – UN expert urges better protection of older persons facing the highest risk of the COVID-19 pandemic”, 27 March 2020. ↩

The right to life is not suspended during humanitarian emergencies, such as disease outbreaks, mass displacement and natural disasters.¹⁰⁶ Yet the right to life for older persons is often violated in humanitarian emergencies through the inability to evacuate and escape, information inequality and lack of State attention to the disruption of medical conditions.¹⁰⁷ These risks are compounded by persistent shortcomings in funding, humanitarian planning and data collection.

106. International Covenant on Civil and Political Rights, art. 4 (2). ↩
107. See Dug Cubie and Natalie Baird, “Protecting the rights of older persons in situations of risk and humanitarian emergencies through the proposed UN convention on the rights of older persons”, Human Rights Law Review, vol. 26, No. 2 (March 2026). ↩

A 2016 report examining humanitarian funding delivered through the United Nations consolidated appeals process found that of the 16,221 projects implemented between 2010 and 2014, only 6% (1,009) included one or more activities that either targeted older people or that included older people alongside other vulnerable groups.¹⁰⁸ Only 51% (513) of these projects were funded.

108. WHO, Global Report on Ageism, p. 29. ↩

Structural age discrimination resulting in specific failures in emergency preparedness and response similarly contributes to preventable deaths, including from climate change. Overall, older persons are disproportionately likely to die during heatwaves, floods, hurricanes and other disasters, in large part because emergency planning frameworks routinely fail to account for age-related vulnerabilities, mobility limitations, social isolation and digital exclusion.

During evacuations, older persons often face barriers to using emergency systems. After the 2011 earthquake in Japan, 69% of older people surveyed shared that their evacuation had been slowed by power failures, unreliable information, physical frailty and isolation.¹⁰⁹ In the 2024 floods in Valencia, Spain, those over 70 years of age accounted for the majority of deaths.¹¹⁰ As climate change intensifies the frequency and severity of emergencies, including floods, heatwaves, earthquakes and other disasters, these vulnerabilities will only deepen, placing older persons at even greater risk of preventable death.¹¹¹

109. HelpAge International, “Displacement and older people: the case of the Great East Japan Earthquake and Tsunami of 2011”, 2013. ↩
110. Jose M. Martin-Moreno and others, “Devastating ‘DANA’ floods in Valencia: insights on resilience, challenges, and strategies addressing future disasters”, Public Health Reviews, vol. 46 (April 2025). ↩
111. Hans Kluge, WHO Regional Director for Europe, “Europe lost 200,000 people to heat in 4 years, yet nearly all of them were preventable”, statement, 11 June 2026. ↩

Furthermore, older persons may not be able to access digitally distributed evacuation procedures.¹¹² Reports on ageing in the digital era found that only one in five Europeans aged 75 years or older were actively engaged on the Internet.¹¹³ Additionally, older persons may not be able to walk and queue for hours to receive basic aid and necessities.¹¹⁴ In some jurisdictions, estimates suggest that at least 80% of seniors have at least one chronic condition,¹¹⁵ increasing disaster risk.

112. A/80/203, para. 16. ↩
113. United Nations, Economic Commission for Europe, “Ageing in the digital era”, Policy Brief on Ageing No. 26, July 2021. ↩
114. A/74/170 and A/74/170/Corr.1, para. 32; and A/80/203, para. 15. ↩
115. Nancy Aldrich and William F. Benson, “Disaster preparedness and the chronic disease needs of vulnerable older adults”, Preventing Chronic Disease, vol. 5, No. 1 (January 2008). ↩

Healthcare services in displaced persons camps are often not equipped to adequately address the multiple and complex health conditions of older persons. Even when the camps are equipped, age discrimination causes older persons to be regarded as less likely to survive and therefore “less deserving” of medical treatment, which is exacerbated when resources are scarce. Such discrimination results in life-threatening situations for older persons, as they receive delayed treatment, medication and basic services.¹¹⁶

116. A/80/203, para. 38. ↩

In conflict, older persons face heightened risks of unlawful deaths. In Ukraine, older persons have accounted for nearly half of civilian deaths in cases where age could be verified.¹¹⁷ In South Sudan, civil society documented cases of parties to the conflict killing older people and people with disabilities unable to flee attacks.¹¹⁸ A combination of age-related factors, chronic health conditions, social isolation and exclusion from humanitarian planning, especially as it relates to evacuations, contribute to such disproportionate harm.

117. OHCHR, “Report on the human rights situation in Ukraine: 1 September–30 November 2024”, 31 December 2024. ↩
118. Human Rights Watch, “South Sudan: people with disabilities, older people face danger”, 31 May 2017. ↩

Older persons are often killed at disproportionate rates in conflict, sometimes by State and non-State actors, when they cannot flee due to factors such as limited mobility, injury, chronic illness and dependence on carers.¹¹⁹ In Gaza, 79% of older persons surveyed had been displaced three or more times, more than 70% reported difficulty walking or climbing stairs, and over 50% lived with a disability.¹²⁰ Many described being physically unable to travel long distances, navigate damaged roads or endure repeated displacements. As a result, some remained in areas of active hostilities because evacuation was not realistically possible.¹²¹

119. Human Rights Watch, “No one is spared: abuses against older people in armed conflict”, 23 February 2022; and HelpAge International, submission to the Independent Expert on the enjoyment of all human rights by older persons (2025). ↩
120. HelpAge International, “Pushed beyond their limits: the survival of older people in Gaza”, 2025. ↩
121. United Nations Relief and Works Agency for Palestine Refugees in the Near East, “Protection brief: the situation of older persons in Gaza”, June 2025. ↩

Failing to evacuate and staying in conflict zones often leaves older civilians exposed to direct violence. In some cases, older civilians are killed during military operations after younger residents have fled.¹²² Older persons may also be particularly vulnerable to retaliatory violence because they are often community leaders or targeted as hostages to intimidate their younger relatives, who play more active roles in the armed conflict.¹²³ Further, parties to conflict may fail to take the necessary precautions to protect older persons who cannot easily relocate.

122. Amnesty International, “Fleeing My Whole Life”: Older People’s Experience of Conflict and Displacement in Myanmar (London, 2019). ↩
123. A/80/203, paras. 33 and 46. ↩

Additionally, sexual violence against older women remains an overlooked but established feature of armed conflict. Older women have been subjected to rape and other forms of sexual violence by both State and non-State armed groups across multiple conflicts, challenging assumptions that conflict-related sexual violence primarily affects younger women and girls.¹²⁴ Despite these documented abuses, older survivors are frequently overlooked by humanitarian, medical and accountability mechanisms.

124. See, for example, Human Rights Watch, “No one is spared”. ↩

When older persons choose to and are able to evacuate from situations of armed conflict, humanitarian assistance systems frequently fail to account for their specific needs. Health facilities in refugee camps often focus primarily on emergency care and lack the necessary medication for chronic illnesses disproportionately affecting older persons.¹²⁵ In Rohingya refugee camps in Bangladesh, for example, older persons were often physically unable to reach medical centres.¹²⁶

125. Amnesty International, “Older persons in armed conflict and peacebuilding: submission to the Independent Expert on the enjoyment of all human rights by older persons”, 28 March 2025. ↩
126. Ibid. ↩

Displaced older persons also face difficulties registering for and obtaining humanitarian assistance, particularly where registration processes require travel, documentation, digital literacy or prolonged waiting periods.‍¹²⁷ Furthermore, humanitarian and accountability mechanisms frequently fail to collect age-disaggregated data, causing many age-specific vulnerabilities and violations to remain invisible.‍¹²⁸ These shortcomings can impede accountability efforts by obscuring the ways in which older persons experience harm.

127. HelpAge International and Internal Displacement Monitoring Centre, The Neglected Generation: The Impact of Displacement on Older People (London, 2012). ↩
128. HelpAge International, More at Risk: How Older People Are Excluded in Humanitarian Data (Chiang Mai, Thailand, 2019). ↩

As the world’s older population grows, so too does the urgency of confronting the structural conditions that render potentially unlawful deaths of older persons overlooked, unaccounted for and underinvestigated. Pervasive assumptions regarding frailty and ageing, compounded by the lack of explicit protections in legal and policy frameworks, continue to obscure abuse and neglect, threatening older persons’ right to life. This persistent pattern of invisibilization denies older persons equal protection in law and in practice. In the face of this, the development of a binding international instrument on the rights of older persons presents an opportunity to clarify State obligations to respect, protect and fulfil the right to life of older persons, including to prevent and investigate potentially unlawful deaths, address prevention gaps for the right to life of older persons, and affirm, unambiguously and explicitly, the right to age with dignity. This includes assurances of reliable investigations and the effective prevention of unlawful deaths of older persons everywhere.

To this effect, the Special Rapporteur offers the following recommendations, and reiterates the availability of his mandate to provide relevant technical assistance. States should:
(a) Expressly affirm the right to life of older persons in law and policy and ensure their equal protection without discrimination based on age or related stereotypes. The duty to reliably investigate any potentially unlawful death of older persons must be a cornerstone of fulfilling the obligation to protect their lives;
(b) Take meaningful steps to ensure the visibility of deaths of older persons by establishing coordinated systems across all government agencies and levels to identify and record all deaths of older persons across all settings, including private homes, healthcare facilities, residential care, prisons and detention centres, so that potentially unlawful deaths are not presumed natural and are instead investigated as required under international law;
(c) Ensure that investigations of potentially unlawful deaths of older persons are in accordance with the Minnesota Protocol on the Investigation of Potentially Unlawful Death, and that age-related vulnerability and signs of abuse and neglect are reliably assessed and documented. Investigative and forensic institutions should develop and implement specialized guidelines and procedures for the investigation of potentially unlawful deaths of older persons;
(d) Train and equip police, prosecutors, coroners, medical examiners and health professionals to recognize elder abuse, neglect and other causal factors of potentially unlawful death, including through appropriate scene examination, records review and medico-legal procedures;
(e) Ensure that medico-legal death investigation systems are adequately resourced, staffed and trained to conduct reliable investigations into potentially unlawful deaths of older persons. Investigative institutions should develop and implement specialized standard operating procedures and guidance tailored to age-related vulnerabilities and risk factors;
(f) Where unlawful deaths of older persons occur, investigate, prosecute where appropriate, and provide effective remedies, including truth, recognition, compensation, rehabilitation and guarantees of non-repetition;
(g) Systematically engage in data collection, analysis and monitoring of unlawful deaths of older persons. Data collection should be incorporated into and inform programmes aimed at respecting, protecting and fulfilling the right to life with dignity of older persons. Data should be disaggregated by victims, perpetrators and risk factors and include information on deaths occurring in all settings, including custody, care facilities and private homes, as well as specific attention to deaths of persons belonging to minority groups. Such data should also specify the cause and manner of death;
(h) Identify and mitigate the compounded risks of unlawful deaths facing older women, older persons with disabilities, Indigenous older persons, older migrants and racial and ethnic minorities;
(i) Prioritize prevention and protection measures by tackling abuse, neglect, unsafe conditions and arbitrary deprivation of liberty in hospitals, care facilities, prisons, detention facilities and other institutions, through effective standards, oversight, complaint mechanisms and regular screening. States must ensure that older persons have access to comprehensive care without discrimination. States should seek to develop dedicated emergency response centres for victims of neglect or abuse to seek timely assistance. Further, monitoring and reporting efforts can seek to identify malnutrition, infection, isolation, abuse and other foreseeable risks to life at an early stage and trigger timely intervention.

Humanitarian responses should be planned with older persons in mind, and humanitarian, protection and emergency personnel trained to identify age-related risks, recognize mobility and sensory impairments and ensure that older persons are not excluded. Evacuation procedures should provide physically accessible transport, support for older persons with disabilities, and continuity of carer assistance, healthcare access and access to assistive devices. During periods of humanitarian emergencies or armed conflict, relevant actors should maintain access to essential medications, chronic disease treatment, assistive devices and specialized care.

Academia, civil society and other relevant actors are encouraged to research and publish studies about the right to life of older persons, to better understand the specific challenges and risks that older persons face.

An addendum to the Minnesota Protocol on the investigation of potentially unlawful death of older persons should be developed in cooperation with the Special Rapporteur on extrajudicial, summary or arbitrary executions and the Independent Expert on the enjoyment of all human rights by older persons to address the specificities required for such investigations.

The Special Rapporteur welcomes the work of the open-ended intergovernmental working group for the elaboration of a legally binding instrument on the promotion and protection of the human rights of older persons and recommends that the future instrument include one or more articles on the right to life with dignity of older persons, including the duty of States Parties to reliably investigate and effectively prevent unlawful deaths of older persons in all circumstances.