Fragilidade, quedas e medo de cair: um estudo de base populacional

Abstract

Frailty, falls and fear of falling are geriatric syndromes that characterize significant issues of public health. Those conditions are frequent, preventable, responsible for the reduction of functional capacity and life quality, and predictors of institutionalization, morbidity and mortality. The purpose was to verify the frailty prevalence and analyze the associated aspects. Moreover, the comprehension of the events fall, recurrent fall and fear of falling are also issues to be analyzed in this study. Household survey realized between October 2014 and March 2015, with 400 elderly (60 years old and over), both sex, not institutionalized, north zone of Juiz de Fora City. It was considered demographic and socioeconomic characteristics, health profile, use of health services, frailty (Edmonton Frail Scale), falls, fear of falling (Falls Efficacy Scale – International – Brazil) and functional capability (Lawton and Brody Scale). The data was processed in a database on the software Statistical Package for Social Sciences, complex analyze module, 15.0 version. The software Strata 9.2 was used to increment the results. Several methods of statistical analysis were adopted to achieve the goals. The significance level was 5%. For frail associated aspects, a theoretical model of determination with three hierarchical blocks, adjusted by Poisson regression, was built. The fragility prevalence was 34.5% and was associated to walking difficulties, need of auxiliary device for mobility, a caregiver assistance and functional dependency for instrumental activities accomplishment. The falling prevalence was 35.3%. The majority of the events happened at home, during the mornings. For estimation and variable adjustments, a hierarchic theoretical approach, ranked in 3 levels, was adopted. After all the adjustments, age and reports of walking difficulties kept associated to falling. For the investigation of recurrent falls, an observational follow-up study was carried out using two cross-sectional waves. For this, data from the first Health Survey conducted in 2010 was also applied. Multinomial logistic regression was used to estimate the association of independent variables with the outcomes follow-up fall and recurrent fall. 44.5% of the elderly do not report falls, 39% suffered falling events in, at least, one of the surveys, and 16.5% reported falling events in both surveys. None association was found for the outcome recurrent fall. Follow-up fall was related to female and age segment from 71 to 80 years old. The prevalence of fear of falling was 95.2%. The Spearman correlation revealed correspondence of fear of falling with age, self-perception of health, walking difficulties, use of auxiliary device for mobility, falls and functional capacity. The results reveal high prevalence of frailty, falls and fear of falling, and evidenced the multifactorial and complexity of the interactions of several factors in the health condition of the elderly. The need for development of public policies and health actions aimed to this population, emphasizing educational, preventive and health promotion actions of an interdisciplinary nature, is eminent, based on the identification of groups in risk and associated factors.