title: Is This Broken Bone Because of Abuse? Characteristics and Comorbid Diagnoses in Older Adults with Fractures.
abstract: To examine the relationship between individual characteristics and potential correlates of elder abuse in older adults who present with fractures.
  
  
  
  Cross-sectional analysis of deidentified data extracted from medical records.
  
  
  
  Academic medical center.
  
  
  
  Individuals aged 65 and with a primary diagnosis of any fracture admitted to an outpatient department or emergency department (ED) in a single southern California medical center over a 36-month period (N = 652).
  
  
  
  Participant characteristics included demographic characteristics, number of medical visits, and point of service. Corresponding International Classification of Diseases, Ninth Revision (ICD-9) codes, E-codes, and V-codes were extracted to identify cause, location, and type of fracture. The presence of 13 potential correlates of abuse as captured by ICD-9 codes were extracted and summed. Descriptive statistics and regression models were used for analyses.
  
  
  
  Mean age of participants was 77.2, 58% were female (58%), 60% were white (60%), and 46% had one or more potential correlates of abuse. In bivariate analyses, older age (≥80), dementia, seeking care in the ED (vs inpatient or outpatient clinics), only one visit to a medical facility (vs multiple visits) in the 36-month study period, cause of fracture as something other than a fall, and fractures of the head or face were more likely to have at least one correlate of abuse. In logistic regression, dementia (B = 0.794, standard error (SE) = 0.280); seeking care in the ED (vs outpatient or outpatient clinics) (B = 1.86, SE = 0.302); at least two visits to a medical facility (vs multiple visits) (B = -0.585, SE = 0.343); and fracture of the back (B = 0.730, SE = 0.289), head (B = 1.22, SE = 0.333), and face (B = 1.28, SE = 0.474) were associated with the presence of at least one correlate of abuse.
  
  
  
  Certain characteristics in older adults with fracture are associated with potential correlates of abuse. Medical practitioners should have a heightened awareness when these signs are present.
authors.affiliation: Department of Family Medicine, Keck School of Medicine, University of Southern California, Alhambra, California.
authors.forename: Melanie W
authors.initials: MW
authors.lastname: Gironda
authors.affiliation: Department of Family Medicine, Keck School of Medicine, University of Southern California, Alhambra, California.
authors.forename: Annie L
authors.initials: AL
authors.lastname: Nguyen
authors.affiliation: Department of Family Medicine, Keck School of Medicine, University of Southern California, Alhambra, California.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Mosqueda
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004552:Elder Abuse / Q000175:diagnosis / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D018570:Risk Assessment / Q000706:statistics & numerical data; D013223:Statistics as Topic
keywords: elder abuse; elder mistreatment; fractures; neglect