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A subcategory of elder maltreatment is the fatal outcome; or elder homicide. Some cases of elder homicide result from chronic abuse and/or neglect, while others appear to be sudden, with no pertinent history. The research and literature of elder homicide are lacking, making the investigation of each case difficult; the typical victim perpetrator scenario and cause of death are not known. Components of homicide such as sexual assault and toxicology also lack study. We analyzed all elder deaths over a 20-year period. Cases included those with victims greater than or equal to 65 years of age. These deaths totaled 2137; natural = 1506, accident = 344, suicide = 139, homicide = 127, and undermined = 21. Focusing on homicides, variables analyzed were age, race, gender, cause of death, location of death, time of year, motive, perpetrator, toxicology and sexual assault component. By identifying the typical victim- perpetrator scenario and autopsy findings, these cases can be more completely investigated and possibly prevented.