Detection of Elder Abuse Among Orthopedic Patients

Approximately 10% of US adults experience elder abuse, which often manifests as musculoskeletal and soft tissue injuries. The goal of our study was to deter-mine the rate of elder abuse among orthopedic surgery patients and characterize which patients may be at an increased risk. National Inpatient Sample Health-care Cost and Utilization Project data from 2001 to 2015 were parsed with the Clinical Classifications Software tool. Patients 60 years and older were identified by International Classification of Diseases, Ninth Revision (ICD-9), code for elder abuse. Primary orthopedic procedures and subsequent inpatient diagnoses and comorbidities were used to develop a binary logistic regression model to predict an elder's risk of abuse. Of a total of 20,532,211 admissions for an orthopedic procedure, 0.010% (2084) were classified as elder abuse. Patients with a clas-sification of abuse more commonly were women (74.8% vs 60.6%) and from the lowest socioeconomic quartile by income (28.5% vs 21.7%). In addition, these patients had hospital stays that were twice as long (10.2 vs 5.3 days) and had higher admission mortality rates (4.4% vs 1.2%). No primary orthopedic proce-dures were associated with a higher risk of elder abuse. Nonorthopedic diagno-ses made during admission that were associated with increased risk of abuse in-cluded superficial injury or contusion (odds ratio [OR], 3.252), chronic skin ulcer (OR, 3.119), nutritional deficiency (OR, 3.418), fluid and electrolyte disturbances (OR, 1.729), and delirium or dementia (OR, 2.210). The incidence of elder abuse among orthopedic surgery patients is significantly lower than national estimates. This finding warrants further investigation to determine whether it is a function of underreporting or differences in patient populations, given the 4-fold increase in mortality risk.