Elder abuse: an update on prevalence, identification, and reporting for the orthopaedic surgeon.

Elder abuse is an underestimated mechanism of musculoskeletal injury and is of significant concern in geriatric and rapidly aging populations of the United States. Abuse can occur in a home or institutional setting and may include physical, sexual, emotional, or financial abuse as well as neglect or abandonment. Elderly persons with shared living arrangements, those with a history of domestic violence, and those with cognitive impairment are at high risk of abuse. Prevalence studies in the United States estimate that more than 1 million elderly persons are victims of abuse annually, and up to 25% have been physically abused. Multiple fractures, inconsistent histories, bruising, dehydration, and malnutrition are indications of abuse that can be identified by the orthopaedic surgeon. Elder abuse is often overlooked and is severely underreported. Because physicians are required to report abuse to agencies such as Adult Protective Services, awareness of its prevalence is essential, and the orthopaedic surgeon must know how best to identify, treat, and report elder abuse.