Deaths of people found alone in their homes only after several days have increased eightfold in northern Bangkok, reflecting growing social isolation in the capital, according to a forensic doctor at Bhumibol Adulyadej Hospital.
Lt. Cmdr. Dr. Atthasit Dulamnuay of the hospital’s forensic medicine department said that when he was a resident specialising in forensic medicine at Siriraj Hospital around 2016, he encountered about one decomposed body a month. Siriraj primarily covers Bangkok’s Thonburi side.
After moving to Bhumibol Adulyadej Hospital, which covers northern Bangkok including Bang Khen, Don Mueang, Sai Mai and nearby areas, he initially saw a similar number of cases. But the number has steadily increased.
From 10 cases a year to 70–80
Dr. Atthasit said records from Bhumibol Adulyadej Hospital’s coverage area show that the number of such cases increased from about 10 a year to 70–80 annually.
The hospital now encounters an average of about one case a week. During some periods, particularly hot weather, the number can rise to three cases a week.
“From just over 10 cases a year, it has now become 70–80 cases a year,” Dr. Atthasit said.
Northern Bangkok now sees about five to eight decomposed bodies a month, out of around 40–50 bodies undergoing autopsy each month. Such cases therefore account for more than 10% of the area’s autopsy workload, with the trend continuing to rise.
Dr. Atthasit said cases can become more frequent during hot periods, particularly around April. Some weeks have seen as many as three cases, showing that the problem is no longer an occasional occurrence but has become a regular part of forensic work.
Working-age people also dying alone
Those found dead range from about 20 to 80 years old and are not limited to elderly people. Among younger victims are working-age people and workers who live alone.
Dr. Atthasit said that if a working-age person falls ill and fails to report to work for two or three consecutive days, an employer may notice something is wrong and look for them. If the person lives in rented accommodation, a neighbour may notice an unusual smell and alert authorities.
A body may not have a strong smell on the first day after death, he said, but decomposition becomes more apparent after about three days, when people nearby may notice the smell and police may be called to inspect the room.
In cases involving elderly people, many still have children or relatives. However, their children may work in other areas, leaving their parents alone at home without regular visits or contact. Some families may speak once a week or once a month, meaning they may not discover that a parent has died until the body has decomposed.
From extended families to living alone
Dr. Atthasit said one factor behind the increase is the changing structure of Thai families.
Thailand traditionally had extended families in which parents, grandparents and children lived together. Today, families are more often nuclear, while some people remain unmarried or couples live separately.
When someone dies, there may therefore be no one nearby to notice.
The problem is not limited to elderly people but reflects an urban society in which people increasingly have less interaction with those around them. Even people living next door or in the same condominium may not know each other’s names, jobs or daily routines.
If someone becomes ill or dies inside their room, nobody may know until the body begins to decompose and a smell emerges.
‘Not deliberately abandoned’
Dr. Atthasit stressed that many of those who die alone still have children and families. The issue is that family members do not live together and do not communicate every day.
In some cases, a child’s last conversation with a parent may have been about a week earlier. The child may only learn of the death when rescuers or authorities call to say that the parent has died and the body has begun to decompose inside the home.
“Everyone is not deliberately abandoning their parents. Everyone has work and responsibilities to take care of their own families,” Dr. Atthasit said.
After learning of the death, some relatives feel guilty that they did not check on or return to see their parents sooner, he said.
Even a message can help
Regular contact is therefore important, Dr. Atthasit said. Even a simple greeting by message, or an elderly person sending a Line message about something as ordinary as a cartoon or other content, should not be dismissed as meaningless.
At the very least, such contact lets relatives know that someone living alone is still alive and reachable.
If regular contact suddenly stops, it can also signal that something is wrong and prompt someone to check on the person sooner.
Decomposed bodies require autopsies
From a forensic perspective, decomposed bodies must undergo autopsy because changes to the body can make it difficult to determine the cause of death from an external examination.
Dr. Atthasit said decomposition changes the colour of the skin and makes injuries difficult to examine. Doctors therefore need to conduct a detailed autopsy to determine whether the person suffered injuries before death, such as from a fall or assault, or whether another cause was involved.
This is necessary to avoid missing important evidence related to the death.
The increase also creates additional work for forensic doctors and costs for relatives and property owners. Homes or rooms where a decomposed body has been found often require specialist cleaning because of the smell, with costs ranging from several thousand baht to tens of thousands of baht depending on the condition of the property.
It can happen to anyone
Dr. Atthasit said people should not assume that those found dead in a decomposed state are necessarily poor or living in rented rooms.
Such cases occur across social and economic groups, he said.
Some people live alone in large homes and have pensions or other financial resources, while their children live in other provinces or overseas. If the person dies, nobody may know immediately.
The issue therefore reflects urban isolation rather than a problem affecting any particular social group, he said.
Thailand lacks a system for people living alone
Asked about support systems for people living alone, Dr. Atthasit said Thailand currently has no clear system for addressing the problem. Deaths in homes that go undiscovered until decomposition have received relatively little attention.
Some countries, particularly in Scandinavia, have systems to support elderly people and those living alone. One model involves a caregiver system in which people accumulate hours spent caring for others as credits. When they become elderly or can no longer care for themselves, they can use those accumulated hours to receive care.
Such approaches can reduce costs and allow elderly or sick people to remain at home rather than necessarily moving into care facilities, he said.
For Thailand, Dr. Atthasit said technology could help, including monitoring devices for elderly people or those living alone, alert systems that detect unusual activity, and cameras that allow families to check on people living alone.
‘Death is natural, but nobody should die unnoticed’
Dr. Atthasit said death is something nobody can prevent, but society should not allow someone to die inside their home without anyone knowing for several days until the body decomposes.
“It should not happen in an urban society. We should have a system to detect people before they decompose,” he said.
For example, if someone who normally goes to work every day suddenly stops showing up, or someone who is normally in regular contact suddenly disappears, there should be a mechanism for colleagues, landlords or people nearby to check on them.
If someone is found on the first day, they may still be able to receive help, rather than dying alone and remaining undiscovered until decomposition.
The issue is therefore not simply the absence of someone living with a person, but the declining level of interaction between people in urban society. People live increasingly separate lives, and when something happens, those nearby may not even know where someone who lives next door or whom they regularly see has gone.
Society needs systems to detect problems
Dr. Atthasit said that if the trend continues, such cases could become even more frequent, particularly in Bangkok and other large cities where populations are dense but people increasingly live separately.
“It is already happening in Bangkok,” he said, adding that based on the trend, the number of such cases could reach a point where decomposed bodies are found every day within the next two to three years.
Forensic doctors see more than just numbers in the autopsy room, Dr. Atthasit said. The cases reflect changes in family structures, working patterns, living arrangements and relationships between people.
People may choose to live alone, but society should not allow someone to die alone without anyone knowing. By the time they are discovered, it may be not simply a case of finding someone who has died, but of finding a body that has already decomposed — meaning that the window in which help could have been provided or something unusual could have been detected has already passed.
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