Quedas e fatores multidimensionais associados: estudo longitudinal de idosos residentes em instituições de longa permanência em Goiânia(GO)
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2009-04-27
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Universidade Federal de Goiás
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Abstract xvii
ABSTRACT
Falling is a geriatric syndrome with multifactorial causes. Several
studies confirm that fallings are frequent among institutionalized elders. The
main objective of this study was to analyze the multidimensional factors
associated with the falling episodes among elderly living at long-term care
institutions in Goiania (GO) during the time of 2005-2007. A prospective
longitudinal clinical trial was carried out at five philanthropic long-term care
institutions for the elderly (LTCEI) in the city of Goiânia. The sample of the
investigation included 59 elderly that met the inclusion and exclusion criteria. It
was used a questionnaire containing socio-demographic data; information about
falling episodes in the previous twelve months before the study and during
may/august 2005 and may/august 2007 and the context of their occurrence;
clinical data related to health/disease conditions; psycho-emotional data
depression; assessment of the ability to perform Basic Activities of Daily Living
(BADL) and the assessment of balance and gait. Simple frequencies of all the
variables of the study were used for the data analysis. The comparisons among
the variables were carried out using the McNemar test, the test of Marginal
Homogeneity and the Chi-square test. Multi and univariate logistic regression
analysis were performed in order to estimate the relative weight of each factor
on the occurrence of fallings. The level of significance used for the statistic tests
was 5%. The findings showed that there was a statistically significant increase of
stroke (p=0,031) and other diseases (p=0,031) among the study population.
There was an unfavorable evolution of the health for both groups (falling and
non-falling elderly). The variable number of chronic diseases referred
presented statistically significant difference among falling elderly, evidencing the
unfavorable evolution (p=0,048). The variable other diseases presented
statistically significant unfavorable evolution (p=0,021) for the non-falling elderly.
Considering the study population, 54,2% of the elderly referred falling episodes,
22 (68,8%) elderly referred one episode, 06 (18,8%) referred two episodes and
04 (12,5%) referred three episodes. The context of occurrence of the falling
episodes demonstrates that theses incidents took place mainly during day time,
out of the indoor institution environment, during walking, on concrete floors, on
dry surfaces, when they stumbled on something and when they were wearing
flip-flops. The falls related for the study population were statistically associated
to the female sex (p=0,015); cataract (p=0,007); lower score on the POMABrazil
(p=0,038); altered performance of POMA-Balance on the following
maneuvers 5th maneuver balance with eyes closed (p=0,024) and 10th
maneuver perform spine extension (p=0,026); abnormal performance of
POMA-Gait on the following maneuvers 15th maneuver step height
Abstract xviii
(p=0,047) and the 21st maneuver base of support during gait (p=0,047). The
following variables were indicated as protection factors for falls by means of the
univariate logistic regression analysis: male sex (OR 0,26), having cataract (OR
0,22), higher total score on POMA-Brazil (OR 0,04), normal performance on the
5th maneuver POMA-Brazil balance with closed eyes (OR 0,11), normal
performance on the 6th maneuver POMA-Brazil balance when turning 360°
(OR 0,29) and normal performance on the 10th maneuver POMA-Brazil spine
extension (OR 0,19). By means of the multivariate logistic regression analysis,
the following factors associated to falls were identified: protection variables
associated to falls - male sex (OR 0,028) and the presence of cataract (OR
0,158); variable associated to risk of falls worse self-perception of health when
compared to other people (OR 23,25). Because of this study it was possible to
verify the decline of the elderly health during the two years investigated,
characterizing the situation of functional vulnerability. Fallings cannot be
underestimated and through this study it was possible to verify that the incident
is present at the LTCEI of the city of Goiânia. With the dada obtained, we are
able to point out the need of interventions directed to the health of the elderly,
starting with a multidimensional approach that is only possible with the existence
of an interdisciplinary health professional team, focusing on health promotion
and health maintenance.
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MENEZES, Ruth Losada de. Falls and multidimensional factors involved: a longitudinal study of elderly residents in long-stay institutions in Goiânia (GO). 2009. 256 f. Tese (Doutorado em Ciencias da Saude) - Universidade Federal de Goiás, Goiânia, 2009.