Radiological appearance of physical elder abuse

The aim of the study was to determine the radiologic imaging characteristics of the trauma-related lesions of elderly patients determined to be abused, and to raise awareness among all types of physicians, foremost radiologists, about elder abuse.

Clinical records and radiological images of 92 patients with the diagnosis of elder abuse were retrospectively evaluated in terms of age, gender, the reason for admission to the hospital, the presence or absence of comorbid disease(s), bone fracture location and number, characteristics of the fracture(s), the presence or absence of soft-tissue damage or old fracture(s), and the mortality.

Of the patients, 85.9% were brought to the hospital because of a fall. Upper extremity was the most common body segment subjected to trauma (37%), followed by head and neck (30.4%) and chest (30.4%). The most commonly fractured bones were costae, and they were mostly multiple and located in the posterior segment. In long bone fractures, the lesions were located in the distal end of the bone and diaphyseal segment in 56.9% and 53.8% of the cases, respectively. The rates of concurrent joint dislocation, soft-tissue lesion(s) and old fracture(s) were 12%, 54.3% and 19.6%, respectively. The mortality rate was 9.8%.

Specific fracture features and certain accompanying findings can be identified in abused elderly patients. We recommend that radiologists increase their skills in interpreting radiographs from potential victims of abuse, prioritise this work over more routine reporting and collaborate with clinicians in a multidisciplinary approach to the detection and secondary prevention of violence and neglect of older people.