Incidência e fatores de risco relacionados a quedas em uma coorte de idosos institucionalizados

Abstract

Falls are a common geriatric syndrome and are related to high morbidity and mortality among this age group. The risk of falls among institutionalized elderly persons is higher due to their poor health, impaired mobility, increased frailty and functional dependence. This study aims to determine the incidence and risk factors related to falls among institutionalized elderly. To this purpose, a one-year longitudinal cohort study was carried out. Residents of ten Homes for the Aged (HA) in the city of Natal, Rio Grande do Norte, who has both the ability to walking (with or without assistance) and preserved cognitive function were assessed. Following the application of the inclusion and exclusion criteria, 130 of a total of 364 elderly residents of the HA were included in this study. The occurrence of falls over the last twelve months was asked to the elderly residents, caregivers and a research strategy was performed through the nursing records. Variables regarding to the institutions, socio-demographic conditions, use of daily medications, chronic diseases, hospitalization and fractures were collected from medical records The elderly residents were asked regarding to depression, fatigue, cognition status, dizziness and somnolence while caregivers were asked about the functional capacity of the elderly residents. Environmental, anthropometric and functional capacity data was obtained from secondary sources. Statistical analysis was performed using the Chi-squared or Fisher's exact tests and stepwise forward Logistic Regression, considering a statistical significance level of 5%. The environmental analysis results found that no institution met all the necessary Health Surveillance guidelines. Physical and functional assessment revealed implications for the risk of falls. A total of 62 elderly persons had fallen at the end of the twelve-month evaluation, with an incidence of 47.7% (CI 95% = 39.59 to 55.81) and a rate of falls per person/year of 1.65 (+ 8.43). The incidence of recurrent falls was 26.92% (CI95% = 22.38 to 31.46), equivalent to 56.45% of the elderly individuals who had fallen. Most falls occurred in the rooms of the elderly individuals. The use of antiepileptic drugs and fatigue, were found to be risk factors, while reduced mobility and use of antithrombotic drugs were identified as protective factors, adjusted by thyroid therapy, functionality and sex. It was concluded that falls are a high incident events in HA and fatigue and antiepileptic drugs were identified as risk factor for falling. Therefore the physical condition of the elderly should be assessed as well drugs with nervous central system action should be discontinued or replaced whenever possible.