Fractures in Elderly Americans Associated With Walking Leashed Dogs

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.

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.

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.

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.

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.