[Skip to Navigation]
Sign In
Table 1.  Weighted National Estimates of Patients 65 Years or Older Presenting to Emergency Departments With Fractures Associated With Walking Leashed Dogs, 2004-2017
Weighted National Estimates of Patients 65 Years or Older Presenting to Emergency Departments With Fractures Associated With Walking Leashed Dogs, 2004-2017
Table 2.  Overall Demographics and Injury Characteristics of Patients Age 65 Years and Older Presenting to US Emergency Departments With Fractures Associated With Walking Leashed Dogs, 2004-2017
Overall Demographics and Injury Characteristics of Patients Age 65 Years and Older Presenting to US Emergency Departments With Fractures Associated With Walking Leashed Dogs, 2004-2017
1.
Dall  PM, Ellis  SLH, Ellis  BM,  et al.  The influence of dog ownership on objective measures of free-living physical activity and sedentary behaviour in community-dwelling older adults: a longitudinal case-controlled study.  BMC Public Health. 2017;17(1):496. doi:10.1186/s12889-017-4422-5PubMedGoogle ScholarCrossref
2.
Cotton  DW, Whitehead  CL, Vyas  S, Cooper  C, Patterson  EA.  Are hip fractures caused by falling and breaking or breaking and falling? Photoelastic stress analysis.  Forensic Sci Int. 1994;65(2):105-112.PubMedGoogle ScholarCrossref
3.
Schroeder  T, Ault  K.  The NEISS sample: Design and implementation. Washington, DC: US Consumer Product Safety Commission; 2001, https://www.cpsc.gov/Research--Statistics/NEISS-Injury-Data. Accessed February 1, 2019.
4.
StataCorp LP. Stata/IC 15.1 for Windows. https://www.stata.com/company/. Accessed June 16, 2018.
5.
Ricci  G, Longaray  MP, Gonçalves  RZ, Neto  AdaS, Manente  M, Barbosa  LB.  Evaluation of the mortality rate one year after hip fracture and factors relating to diminished survival among elderly people.  Rev Bras Ortop. 2015;47(3):304-309. doi:10.1590/S0102-36162012000300005PubMedGoogle ScholarCrossref
6.
Kutsumi  A, Nagasawa  M, Ohta  M, Ohtani  N.  Importance of puppy training for future behavior of the dog.  J Vet Med Sci. 2013;75(2):141-149.PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Research Letter
    March 6, 2019

    Fractures in Elderly Americans Associated With Walking Leashed Dogs

    Author Affiliations
    • 1Perelman School of Medicine, University of Pennsylvania, Philadelphia
    • 2Hatboro-Horsham High School, Horsham, Pennsylvania
    • 3Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
    JAMA Surg. 2019;154(5):458-459. doi:10.1001/jamasurg.2019.0061

    Dog walking is often suggested as an effective modality for improving physical health in elderly Americans.1 Nonetheless, injury risks associated with dog walking remain obscure. Considering that older patients are more vulnerable to fractures owing to falls or axial muscle compression forces inherent to walking motions, a risk-benefit analysis with respect to dog walking as an exercise alternative is essential to minimizing injury risk.2 This study represents a comprehensive, up-to-date investigation into fracture risk in older adults who use leashes when walking dogs.

    Methods

    A retrospective, cross-sectional analysis was performed using the publicly available deidentified National Electronic Injury Surveillance System database of the US Consumer Product Safety Commission, which records product- or activity-related injuries in patients presenting to approximately 100 US hospital emergency departments stratified by size and location. This nationally representative, statistically validated probability sample can be used to derive reliable weighted national estimates and sampling errors for queried injuries.3 Data were acquired from a deidentified, publicly available database. According to the University of Pennsylvania IRB Standard Operating Procedures, institutional review board approval is waived in cases where data are redacted and openly publicly available.

    We individually reviewed 1033 free-text narratives in the database of fractures between 2004 and 2017 associated with pet supplies (product code 1715) in patients 65 years or older. We identified 697 total entries, representing 32 624 cases of fall-related fractures in elderly Americans associated with walking leashed dogs. National estimates and 95% CIs were derived using Stata/IC, version 15.1.4 Significance of trends was determined using adjusted Wald tests. Two-sided P values <.05 were considered significant.

    Results

    The annual number of patients 65 years or older presenting to US emergency departments with fractures associated with walking leashed dogs increased significantly between 2004 (n = 1671; 95% CI, 1111-2232) and 2017 (n = 4396; 95% CI, 3202-5590) (Table 1).

    Patient demographic and injury characteristics are detailed in Table 2. Most fractures occurred in women (78.6%; 95% CI, 74.9%-82.2%). Most patients sustained hip fractures (17.3%; 95% CI, 13.8%-20.7%), although the upper extremity was the most frequently fractured region overall (52.1%; 95% CI, 48.1%-56.1%); 28.7% of patients (95% CI, 23.7%-33.8%) required hospital admission.

    Discussion

    To our knowledge, this study is the first to identify and characterize leash-dependent dog walking as an activity that imparts a significant and rising injury risk in older adults.

    The gravity of this burden is exemplified by the hip being most frequently fractured, because this injury is associated with long-term decreases in quality of life and functional capabilities, as well as mortality rates approaching 30%.5 Combined with the sex disparity in injury burden, older women considering dog ownership must be made aware of this risk.

    Clinicians may play a role in identifying at-risk patients and minimizing fracture risk by advocating for preventive actions, such as obedience training to ensure dogs do not lunge while leashed, or suggesting smaller dog breeds for individuals contemplating ownership.6

    The study has limitations. Despite the validated nature of the source database, our findings likely underestimate the morbidity associated with elderly Americans walking leashed dogs: only emergency department cases are contained within the National Electronic Injury Surveillance System, and our analysis excluded less severe, nonfracture injuries. Moreover, the database does not include comparative dog sizes, cases requiring operative intervention, or disposition after discharge; future research may clarify the consequences of these variables.

    This study draws attention to an activity that can result in significant injury. For older adults—especially those living alone and with decreased bone mineral density—the risks associated with walking leashed dogs merit consideration. Even one such injury could result in a potentially lethal hip fracture, lifelong complications, or loss of independence.

    Back to top
    Article Information

    Accepted for Publication: December 9, 2018.

    Corresponding Author: Jaimo Ahn, MD, PhD, Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market St, Philadelphia, PA 19104 (ahnj@upenn.edu).

    Published Online: March 6, 2019. doi:10.1001/jamasurg.2019.0061

    Author Contributions: Dr Ahn had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Pirruccio, Ahn.

    Acquisition, analysis, or interpretation of data: Pirruccio, Yoon.

    Drafting of the manuscript: Pirruccio, Yoon.

    Critical revision of the manuscript for important intellectual content: Ahn.

    Statistical analysis: All authors.

    Administrative, technical, or material support: Ahn.

    Supervision: Pirruccio, Ahn.

    Conflict of Interest Disclosures: None reported.

    References
    1.
    Dall  PM, Ellis  SLH, Ellis  BM,  et al.  The influence of dog ownership on objective measures of free-living physical activity and sedentary behaviour in community-dwelling older adults: a longitudinal case-controlled study.  BMC Public Health. 2017;17(1):496. doi:10.1186/s12889-017-4422-5PubMedGoogle ScholarCrossref
    2.
    Cotton  DW, Whitehead  CL, Vyas  S, Cooper  C, Patterson  EA.  Are hip fractures caused by falling and breaking or breaking and falling? Photoelastic stress analysis.  Forensic Sci Int. 1994;65(2):105-112.PubMedGoogle ScholarCrossref
    3.
    Schroeder  T, Ault  K.  The NEISS sample: Design and implementation. Washington, DC: US Consumer Product Safety Commission; 2001, https://www.cpsc.gov/Research--Statistics/NEISS-Injury-Data. Accessed February 1, 2019.
    4.
    StataCorp LP. Stata/IC 15.1 for Windows. https://www.stata.com/company/. Accessed June 16, 2018.
    5.
    Ricci  G, Longaray  MP, Gonçalves  RZ, Neto  AdaS, Manente  M, Barbosa  LB.  Evaluation of the mortality rate one year after hip fracture and factors relating to diminished survival among elderly people.  Rev Bras Ortop. 2015;47(3):304-309. doi:10.1590/S0102-36162012000300005PubMedGoogle ScholarCrossref
    6.
    Kutsumi  A, Nagasawa  M, Ohta  M, Ohtani  N.  Importance of puppy training for future behavior of the dog.  J Vet Med Sci. 2013;75(2):141-149.PubMedGoogle ScholarCrossref
    ×