Predictors of Physical Abuse in Elder Patients With Fracture

Abstract

Introduction:Elder abuse is a public health issue requiring attention. Unlike abuse in the pediatric population, predictors of elder abuse in patients with fracture have not been well defined.Methods:Elderly patients with physical abuse and fracture were abstracted using the 2007 to 2017 National Emergency Department Sample database. Univariate comparisons, multivariate regression, and adjusted odds ratios were used to determine independent predictors of elder abuse compared with nonabuse fracture controls.Results:Thirteen percent of elder physical abuse patients presenting to the emergency department had fracture. Of all patients with fracture, elder abuse patients tended to be younger; be female; belong to lower income quartiles; and have codiagnoses of volume depletion, mental disorders, dementia, and intellectual disability. Presentation with other forms of elder abuse, such as psychological abuse, neglect, and sexual abuse, and multiple fractures were also associated with elder physical abuse. Multivariate regression found elder abuse to be more likely in the setting of skull and rib fractures and less likely in the setting of femur and foot and ankle fractures.Discussion:This study identified predictors of elder physical abuse in fracture patients older than 60 years. As with pediatric abuse, heightened awareness of potential physical abuse should be considered, especially in higher risk patients.

Injury patterns and demographics in older adult abuse and falls: A comparative study in emergency department settings

“…Of the head/neck injuries, cervical spine fractures were rare in OAA and more common in the fall group (Figure 1), which aligns with previous guidance that older adults with a history of acute falls be evaluated for a cervical spine fracture to be ruled out 40 . Lower trunk (e.g., pelvis, hip) fractures were also more common in the fall group 41 . Patients in the fall group who presented with these injuries were more likely to be admitted to the hospital, whereas patients in OAA presenting with interpersonal violence‐related injuries (e.g., upper extremity fractures, facial fractures, contusions/abrasions) were more likely to be discharged from the ED.…”

“…40 Lower trunk (e.g., pelvis, hip) fractures were also more common in the fall group. 41 Patients in the fall group who presented with these injuries were more likely to be admitted to the hospital, whereas patients in OAA presenting with interpersonal violence-related injuries (e.g., upper extremity fractures, facial fractures, contusions/abrasions) were more likely to be discharged from the ED. Retrospective studies have shown similar trends with shorter average lengths of stay for interpersonal violence-related injuries-3 days for facial injuries 42 and no admission for upper extremity fractures.…”

DORIS study: domestic violence in orthopaedics, a prospective cohort study at a Swedish hospital on the annual prevalence of domestic violence in orthopaedic emergency care

“…Despite the difficulties of capturing cases in this group, it is important to acknowledge their vulnerability and that both dementia and female sex are predictive of abuse. 25 Furthermore, the authors acknowledge that DV affects both female and male patients. Screening of females was chosen as female DV patients have a greater fracture risk, 83% of ED visits due to DV are female and 50% of female homicides are due to DV.…”