Summary

Orthopedic injuries resulting from popular sports played by older adults were evaluated, and contrary to popular belief, non-contact and limited contact sports resulted in severe injuries and poor outcomes for older adults.

Abstract

OBJECTIVES: Sports participation among older adults is increasing, yet comprehensive studies on sports with a low injury risk for this population are lacking. This study aimed to quantify and characterize orthopedic injuries in older adults across various popular sports. We hypothesized that non-contact and limited-contact sports would be safer for older adults and associated with lower odds of hospitalization.

Methods

The National Electronic Injury Surveillance System (NEISS) database was queried for orthopedic injuries in adults aged >55 years from 12 popular sports between 2014 and 2023. Demographics, injury characteristics, and dispositions were analyzed. Weighted national estimates were calculated. Incidence rates per 100,000 individuals were computed using US Census data. Multivariable logistic regression models, adjusted for age, sex, body part and sport type were used to calculate odds ratios (OR) for hospitalization, fracture, sprain/strain, and dislocation.

Results

A total of 5,561 cases (national estimate: 287,255) were identified. Golf (22.8%), pickleball (17.0%), tennis (13.4%), and weightlifting (12.9%) accounted for the majority of injuries. Sprain/strain was most common overall (56.9%), but fractures predominated in baseball, pickleball, soccer, and tennis. Fracture risk increased with age (OR 2.6, 95% CI 2.52-2.77 for 85+ vs. 55-59), while sprain/strain risk decreased. Females had higher fracture odds (OR 2.7, 95% CI 2.64-2.73). Basketball (OR 1.76, 95% CI 1.62-1.93), tennis (OR 1.59, 95% CI 1.46-1.72), and pickleball (OR 1.44, 95% CI 1.33-1.56) had the highest hospitalization odds. The upper extremity (40%) and lower extremity (30%) were the most frequently injured body regions, with trunk injuries notable in golf, swimming, and weightlifting (24% of all injuries).

The odds of hospitalization increased significantly with age, with those 85+ having 5.1 times higher odds compared to those aged 55-59. Among injury types, fractures had the highest odds of hospitalization.

Contrary to expectations, non-contact and limited-contact sports such as basketball, tennis, and pickleball were associated with the worst dispositions and most severe orthopedic injuries. Soccer showed the highest odds of fracture, followed by baseball and softball. Weightlifting had the highest odds of sprain/strain (OR 5.80, 95% CI 5.54-6.07), followed by golf (OR 4.89, 95% CI 4.69-5.11) and swimming (OR 4.76, 95% CI 4.49-5.05). Swimming demonstrated the highest odds of dislocation (OR 1.41, 95% CI 1.28-1.56), followed by baseball and volleyball.

The incidence of orthopedic injuries remained relatively stable for most sports, with a slight decrease during the COVID-19 pandemic, except for basketball and softball.

Conclusion

Contrary to our hypothesis, non-contact and limited-contact sports resulted in severe injuries and poor outcomes for older adults. Age-related changes in injury patterns, particularly increased fracture risk and hospitalization rates with age, suggest a need for specialized orthopedic care and prevention strategies for this growing demographic of athletes. The high fracture risk in elderly, especially women, underscores the importance of integrating bone health assessments and strengthening programs into pre-participation evaluations for older athletes. Our findings highlight the need for age-specific approaches to sports medicine and injury prevention, as well as the importance of educating patients about ways to strengthen bones and muscles through nutrition, exercise, and prevention strategies.