Age estimation in cadavers, human remains and living individuals may clarify issues with significant legal and social ramifications for individuals as well as for the community. In such cases methods for estimating age should fulfil the following specific demands: (1) they must have been presented to the scientific community, as a rule by publication in peer-reviewed journals, (2) clear information concerning accuracy of age estimation by the method should be available, (3) the methods need to be sufficiently accurate and (4) in cases of age estimation in living individuals principles of medical ethics and legal regulations have to be considered. We have identified and summarized the methods that essentially fulfil these specific demands. In childhood and adolescence morphological methods based on the radiological examination of dental and skeletal development are to be recommended. In adulthood, the accuracy of most morphological methods is much reduced. Here a biochemical method based on aspartic acid racemization in dentine provides the most accurate estimates of age, followed by special morphological dental and skeletal methods. The choice of method has to take account of the individual circumstances of each case. Most methods require either the consultation of specialised and trained scientists or an adequate calibration by the "user". Very few attempts have been made to find common standardisation, calibration and evaluation procedures or to develop means of quality assurance for methods of age estimation. Efforts in these directions are necessary to guarantee quality standards and adequate answers to the important legal and social issue of age estimation in forensic medicine.
When analyzing human adult skeletal remains, it is often difficult to decide whether a single aging method will give a more reliable age estimation than a combination of methods. This study evaluates four macroscopic indicators for age estimation on 218 American White and Black individuals, ranging in age from 25 to 90 years of age, from the Terry collection. Individuals in the sample were selected to have a balanced race, sex, and age distribution. The following aging methods were applied to each skeleton by one experienced observer: the Suchey-Brooks (SB) pubic symphysis method, the Lovejoy auricular surface method, the monoradicular teeth Lamendin (LM) method, and the Işcan (IC) method for fourth ribs. The statistical study involved the evaluation of inaccuracy and bias (based on median age) for each age indicator and the combination of methods using Principal component analysis (PCA). Analysis was performed on the entire sample, then by race, then sex, and then age group (25-40 years, 41-60 years, and >60 years). PCA was the most accurate method for both racial groups when all age groups are analyzed together. When the sample was divided into age groups, SB was the most accurate for young adults (25-40 years) and LM was the most accurate for middle adults (41-60 years). After the age of 60, all methods are highly inaccurate, although IC gives the lowest inaccuracy. As regards bias, the study highlights the tendency of all methods to overestimate the age of young individuals and to underestimate in the older age group. No single skeletal indicator of age at death is ever likely to reflect accurately the many factors that accumulate with chronological age. In fact, one must use as many dental and skeletal indicators as possible. However, in order to maximize the potential of each method, in the final evaluation one should consider mainly the method or methods that have a higher accuracy for a particular age range.
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