Medo de quedas em indivíduos idosos hospitalizados com doença pulmonar obstrutiva crônica

Abstract

Chronic obstructive pulmonary disease (COPD) leads to frequent hospitalizations, associated with exacerbations and comorbidities. Individuals are more likely to fall, which can lead to fear of falls and decreased physical activity. The relationship between fear of falls and physical activity in hospitalized elderly people with COPD is not well understood. Objectives: To verify the behavior of fear of falling in hospitalized elderly individuals with COPD and its association with the level of physical activity, activities of daily living (ADL), quality of life and symptoms of anxiety and depression. Materials and Methods: Cross-sectional observational study with hospitalized elderly individuals with COPD. Demographic and characterization data were collected, followed by study evaluation. The Activities-specific Balance Confidence (ABC), Falls Efficacy Scale – International (FES-I) and Short Falls Efficacy Scale – International (Short FES-I) questionnaires were used to assess fear of falls. Physical activity level was assessed by accelerometry using a triaxial accelerometer (Actigraph wGT3X®). ADL was assessed by the London Chest Activity of Daily Living (LCADL), while quality of life and symptoms of anxiety and depression were assessed by the EuroQuol five dimensions (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) questionnaires, respectively. Lower limb strength and functionality were assessed by the 60-second Sit-to-Stand Test (SST 60s) and postural balance by the Mini Balance Evaluation Systems Test (MiniBESTest). Univariate and multiple regression analyses were performed to identify associations and predictors of fear of falling. P < 0.05 was considered significant. Results: Twenty-three individuals were included (mean ± SD; age 71.6 ± 7.2 years, FEV1 ± 52.5 ± 22.1% pred). The mean ABC score was 69.2 ± 27.8, with a moderate fear of falling in the FES-I and Short FESI (27.2 ± 10.4 and 11 ± 4.84 points respectively). Fear of falling in the Short FES-I was associated with greater sedentary behavior (R²= 0.924; p= 0.039). In the ABC, fear of falling was associated with the "sensory orientation" domain of the Mini BESTest, after adjustment for length of hospital stay (R²= 0.502; p= 0.037). In the FES-I, the degree of dyspnea (R²= 0.620; p= 0.010) and the "total" (R²= 0.552; p= 0.006), "domestic activities" (R²= 0.408; p= 0.014) and "leisure activities" (R²= 0.484; p= 0.013) domains of ADL remained significant after adjustment for comorbidities. In the Short FES-I, the degree of dyspnea and the "total" and "leisure activities" domains of ADL remained significant after adjustment for comorbidities. The predictors for fear of falls were dyspnea, ADL, lower limb strength and functionality, and postural balance. Conclusion: Hospitalized elderly individuals with COPD have a moderate fear of falls, associated with greater sedentary behavior, worse postural balance, greater dyspnea, and negative impact on ADL. Dyspnea, ADL, lower limb strength and functionality, and postural balance may be predictors for fear of falls, with comorbidities and length of hospital stay influencing these relationships.