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      Quedas de idosos institucionalizados: ocorrência e fatores associados Translated title: Falls of institutionalized elderly: occurrence and associated factors

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          Abstract

          Quedas entre pessoas idosas constituem importante problema de saúde pública, devido à sua incidência, às complicações para a saúde e aos altos custos assistenciais. Estudos realizados no Brasil e em outros países referem que as quedas são mais frequentes em idosos institucionalizados e apresentam causa multifatorial. Com o objetivo de verificar a ocorrência de quedas em idosos institucionalizados e identificar seus fatores associados, foi realizado um levantamento de dados de 105 indivíduos com idade igual ou superior a 60 anos, residentes em quatro instituições asilares do município de Catanduva, São Paulo. O método utilizado para a coleta dos dados foi entrevista. Foram utilizados os instrumentos: Escala de Depressão Geriátrica e Mini-Exame do Estado Mental, instrumentos estes destinados à avaliação dos estados de humor e cognitivo, respectivamente. Os achados mostraram que 40% dos idosos relataram quedas nos últimos seis meses, e os fatores de risco considerados significativos foram: sexo feminino (p=0,035), uso de medicamentos (p=0,047), visão deficiente (p=0,029), ausência de atividade física (p=0,035), presença de osteoartrose (p=0,000), depressão (p=0,034), déficit de força de preensão palmar (p=0,0165) e distúrbios no equilíbrio e marcha (p=0,038). Os resultados apontam para a necessidade da implementação de programas de prevenções de quedas em instituições asilares, através de intervenção multidisciplinar buscando, portanto, uma melhoria na qualidade de vida dessa população.

          Translated abstract

          Falls among the elderly are an important public health problem due to their incidence, to health complications, and to the high assistance cost. Research conducted in Brazil and other countries refer that falls are more frequent among institutionalized elderly people and have multifactorial causes. Aiming at verifying the occurrence of falls among institutionalized elderly people and at identifying their associated factors, data collection of 105 individuals - aged 60 years or over - was carried out. The subjects are all residents of four home institutions in the city of Catanduva, São Paulo. The method used in data collection was a semi-structured interview. The following instruments were used: Geriatric Depression Scale and Mental Status Mini Exam. These instruments are destined to the evaluation of mood, cognitive status respectively. The finds show that 40% of the elderly reported falls over the last six months, and the risk factors considered to be significant were: female sex (p=0.035), medicine use (p=0.047), visual disability (p=0.029), lack of physical activity (p=0.035), presence of osteoarthritis (p=0.000), depression (p=0.034), palm prehension strength deficit (p=0.0165), and balance and march disorder (p=0.038). The results point at the necessity of implementing fall prevention programs in home institutions, through multidisciplinary intervention, therefore aiming at improving this population’s quality of life.

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          A multifactorial intervention to reduce the risk of falling among elderly people living in the community.

          Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors. We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling: postural hypotension; use of sedatives; use of at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet (transfer skills), or gait. These subjects were given either a combination of adjustment in their medications, behavioral instructions, and exercise programs aimed at modifying their risk factors (intervention group, 153 subjects) or usual health care plus social visits (control group, 148 subjects). During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subjects who had a particular risk factor at base line, a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of reassessment, as follows: at least four prescription medications, 63 percent versus 86 percent, P = 0.009; balance impairment, 21 percent versus 46 percent, P = 0.001; impairment in toilet-transfer skills, 49 percent versus 65 percent, P = 0.05; and gait impairment, 45 percent versus 62 percent, P = 0.07. The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group, as compared with the control group. Thus, risk-factor modification may partially explain the reduction in the risk of falling.
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            Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes.

            The aim of this prospective cohort study was to identify the risk factors involved in falls in 190 elderly residents of two geriatric centres in Granada (Andalusia, Spain). Because different types of falls may be associated with different factors, falls were classified according to the precipitating cause, either extrinsic or intrinsic. The incidence density and the ratios for crude and adjusted density were calculated. Cox proportional risk analysis was used to calculate adjusted incidence density ratios. Of the 121 falls identified, 63 (52.1%) had a extrinsic precipitating cause, 43 (35.5%) had an intrinsic precipitating cause, and no precipitating cause was determined in 15 falls. The rate of falls with an extrinsic precipitating cause was 0.39 per person per year, while falls with an intrinsic precipitating cause showed a frequency of 0.27 per person per year. For falls with an extrinsic precipitating cause, the most significant risk factors were: age, diabetes mellitus, a history of falling, and treatment with neuroleptics or oral bronchodilators. The number of illnesses acted as a protective factor. For falls with an intrinsic precipitating cause, the independent risk factors were: age, diabetes, dementia, alterations of gait and balance, previous falls, and treatment with digitalins, neuroleptics or antidepressants. These results suggest that the susceptibility to a fall with an intrinsic precipitating cause is easier to identify and has a greater potential for being controlled.
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              Influência das características sociodemográficas e epidemiológicas na capacidade funcional de idosos residentes em Ubá, Minas Gerais

              OBJETIVO: O objetivo deste trabalho foi conhecer a capacidade funcional de idosos e seus determinantes. MÉTODOS: Foi realizado um estudo transversal de base populacional com amostra de 397 idosos residentes na zona urbana da cidade de Ubá, Minas Gerais. Foi aplicado um questionário semiestruturado e pré-testado em forma de entrevista para avaliar as características sociodemográficas, econômicas e de saúde dos idosos. A capacidade funcional foi avaliada por meio da escala de atividades de vida diária básica e instrumental. Investigou-se a associação entre a capacidade funcional e as características socioeconômicas, demográficas e epidemiológicas. Os dados foram analisados nos programas Epi info, Versão 6.0 e Sigma. Considerou-se o nível de significância de 0,05. Para análise estatística, realizou-se a distribuição de frequência, medidas de associação (Odds Ratio) entre a capacidade funcional e as variáveis socioeconômicas, demográficas e epidemiológicas e análise de regressão logística múltipla. RESULTADOS: O comprometimento da capacidade funcional está relacionado a piores condições de saúde autorreferidas, às quedas, ao sexo feminino, à viúvez, a idosos mais velhos, à baixa escolaridade e à baixa renda e a não estar ativo no mercado de trabalho. CONCLUSÃO: Ações de atenção integral à saúde do idoso precisam ser efetivadas, aliando o incentivo à pesquisa às ações planejadas e direcionadas para melhorar as condições de saúde e qualidade de vida deste grupo.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbgg
                Revista Brasileira de Geriatria e Gerontologia
                Rev. bras. geriatr. gerontol.
                Universidade do Estado do Rio Janeiro (Rio de Janeiro )
                1981-2256
                December 2010
                : 13
                : 3
                : 403-412
                Affiliations
                [1 ] Instituto Municipal de Ensino Superior Brazil
                [2 ] Universidade de São Paulo Brazil
                [3 ] Universidade de São Paulo Brazil
                Article
                S1809-98232010000300007
                10.1590/S1809-98232010000300007
                26bd1f82-8f81-45e6-bfb6-fc0dc281ce8f

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1809-9823&lng=en
                Categories
                GERIATRICS & GERONTOLOGY

                Geriatric medicine
                Accidental Falls,Aged,Risk Factors,Acidentes por Quedas,Idoso,Fatores de Risco
                Geriatric medicine
                Accidental Falls, Aged, Risk Factors, Acidentes por Quedas, Idoso, Fatores de Risco

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