National Analysis of Socioeconomic and Demographic Predictors of Physical Abuse Among Geriatric Individuals With Facial Fractures.

Introduction: Elder abuse significantly increases the risk of life-threatening injuries, leading to loss of functional independence and diminishing quality of life. Identifying patterns of facial fractures resulting from abuse can inform initial assessments and public policy initiatives.

Objectives: To investigate which socioeconomic, demographic, and fracture characteristics indicate likely physical abuse among geriatric patients presenting with facial fractures.

Methods: Data were obtained from the 2019 to 2020 Nationwide Emergency Department (ED) Sample, representing 20% of annual encounters at hospital-owned EDs in the United States. ICD-10 codes were used to identify geriatric patients presenting with facial fractures. Patient demographics, causes of injury, concomitant injuries, comorbidities, and socioeconomic data were summarized. A multivariable logistic regression was performed to determine predictors of physical assault-related fractures.

Results: There were 46,829 geriatric facial fractures, 876 (1.9%) of which were assault related. Assaulted patients were younger (mean age: 71 versus 78 years, P<0.001) and predominantly male (84% versus 16% female, P<0.001). Patients living in zip codes with the lowest income quartile accounted for 45% of fractures caused by elder abuse. Black patients had the highest risk of assault (OR: 4.27, 95% CI: 3.50-5.18) and assault-related fractures were more likely on weekends (OR: 1.24, 95% CI: 1.07-1.44). Patients with orbital (OR: 1.54, 95% CI: 1.29-1.84), nasal (OR: 1.28, 95% CI: 1.08-1.51), maxillary (OR: 1.25, 95% CI: 1.03-1.52), zygoma (OR: 1.57, 95% CI: 1.26-1.95), or mandibular fractures (OR: 2.57, 95% CI: 2.00-3.28) were significantly more likely to have been assaulted. Tooth fractures (OR: 0.58, 95% CI: 0.38-0.86) and skull base fractures (OR: 0.60, 95% CI: 0.44-0.81) were associated with a decreased likelihood of assault.

Conclusions: Elder abuse has a distinct indefinable pattern of injury among geriatric patients with facial fractures. These were more prevalent among patients who were younger, male, of lower socioeconomic status, from racial minority groups, and with fractures in specific anatomic regions. Understanding these findings can improve prevention strategies and effective support for geriatric patients with facial fractures from assault.