Department of Anthropology, University of South Carolina, Columbia, South Carolina, United States of America.
Department of Anthropology, University of Toronto Mississauga, Mississauga, Ontario, Canada.
PLoS One. 2023 Aug 30;18(8):e0290014. doi: 10.1371/journal.pone.0290014. eCollection 2023.
Past and present institutions (e.g., state and public hospitals, assisted living facilities, public nursing homes) have struggled with structural issues tied to patient care and neglect, which often manifests in the form of fracture trauma, and may explain why institutionalized individuals are at higher risk for this injury. Six hundred individuals from the Robert J. Terry Anatomical Collection born between 1822-1877 were examined to investigate hip fracture prevalence. Analysis of associated records and documentary data, including death, morgue, and census records, revealed that 36.3% (n = 218) of these individuals died in institutions such as the St. Louis State Hospital, City Infirmary, and Missouri State Hospital No. 4. Of the institutionalized individuals, 4.3% had evidence of hip fracture, significantly higher than the non-institutionalized (2.3%). Records revealed that many hip fractures were suffered around the time of death in state hospitals and were preventable, resulting from structural issues tied to understaffing and underfunding. Forensic and clinical literature, as well as current news media, indicate that structural violence in the forms of underfunding and understaffing continues to manifest as hip fractures harming institutionalized individuals today. This paper demonstrates how an anthropological perspective using paleopathological analysis sheds light on the chronicity and time depth of this issue, with the aim of driving public policy to entrench the equitable care of institutionalized people as a human right.
过去和现在的机构（例如，州立和公立医院、辅助生活设施、公立养老院）都在努力解决与患者护理和忽视相关的结构问题，这些问题常常表现为骨折创伤的形式，这也许可以解释为什么机构化的个体更容易受到这种伤害。从罗伯特·J·特里解剖学收藏中选取了 1822 年至 1877 年间出生的 600 个人进行研究，以调查髋部骨折的患病率。对相关记录和文献数据（包括死亡、太平间和人口普查记录）的分析表明，这些人中的 36.3%（n=218）在圣路易斯州立医院、城市医务室和密苏里州立医院第 4 号等机构去世。在这些机构化的个体中，有 4.3%的人有髋部骨折的证据，明显高于非机构化个体（2.3%）。记录显示，许多髋部骨折发生在州立医院的死亡时间前后，是可以预防的，这是由于人员配备不足和资金不足等结构问题导致的。法医和临床文献以及当前的新闻媒体都表明，资金不足和人员配备不足等形式的结构性暴力今天仍然表现为髋部骨折，伤害机构化的个体。本文展示了使用骨骼病理学分析的人类学视角如何揭示这个问题的长期性和时间深度，旨在推动公共政策，将为机构化人群提供公平护理作为一项人权。
