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Elder Abuse: The Role of the Orthopaedic Surgeon in Diagnosis and Management

Dr. Chen is Resident, Department of Orthopaedic Surgery, New York University–Hospital for Joint Diseases Orthopaedic Institute, New York, NY. Dr. Koval is Associate Professor and Chief, Fracture Service, Department of Orthopaedic Surgery, New York University–Hospital for Joint Diseases Orthopaedic Institute.

Reprint requests: Dr. Koval, Hospital for Joint Diseases Orthopaedic Institute, 301 East 17th Street, New York, NY 10003.

Increased awareness of elder abuse has led to the recognition that mistreatment of individuals over the age of 65 years is a widespread public health problem. It is estimated that the prevalence of elder abuse is 32 cases per 1,000 persons and is increasing with the growing elderly population. Elder abuse is suspected to be a major source of morbidity and mortality, representing a high economic burden to society. The diagnosis of elder abuse is seldom straightforward due to social issues, cognitive impairment, and comorbid conditions, and requires careful correlation of historical and clinical findings. Comprehensive evaluation, including a detailed history, systematic physical examination, and appropriate laboratory and radiographic assessment, is essential. The orthopaedic surgeon consulted to evaluate an elderly individual with musculoskeletal injuries must be cognizant of the potential for elder abuse, especially when circumstances are suspect. The role of the orthopaedic surgeon is often fundamental to establishing whether musculoskeletal injuries are consistent with the stated mechanism of injury. Due to the variety of presentations, there are no fracture patterns considered pathognomonic of elder abuse. Rather, the nature and pattern of injury must be viewed in the context of the general health and psychosocial environment of the patient to determine whether abuse has occurred. Once the diagnosis of elder abuse has been made, a comprehensive, multidisciplinary long-term care plan must be formulated to ensure patient safety while respecting the autonomy of a competent individual. Physicians have an ethical and legal responsibility to protect patients from suspected abuse, and most states mandate reporting by health-care personnel.