Fatores associados ao risco de quedas e medo de cair em idosos ambulatoriais

Abstract

Falls in the elderly are very prevalent. One in every three older adults experience falls at least one fall per year, resulting in physical, functional, psychological and social repercussions. Among the psychological consequences of falls, fear of falling and restriction of activities play an important role in worsening functionality and quality of life. Despite the large number of studies evaluating the factors associated with falls and fear of falling, there are still few that have comprehensively investigated all the dimensions that can lead to falls in this age group, given their complex multifactorial etiology. To investigate in a comprehensive way factors associated with falls, recurrent falls, and fear of falling among outpatient older individuals, a cross-sectional study was carried out with older adults outpatients treated at specialized services in the city of Juiz de Fora, specifically the Elderly Health Care Service (SASI) of the Juiz de Fora City Hall and the Geriatrics and Gerontology Service of the University Hospital-UFJF(HU UFJF/ EBSERH). A broad approach to risk factors for falls in the elderly was developed, based on the main guidelines, including the following dimensions: sociodemographics, lifestyle habits, physical activity, sensory, environment, physical examination, cognition, mental health, frailty, sleep, functionality, diseases, medication and mobility. Among the main instruments used were the Timed up and go (TUG), gait speed test (VM) and Tinetti balance and gait scale to assess mobility, the international falls self-efficacy scale (FES-I) to assess fear of falling, the Mini sleep questionnaire (MQS) to investigate sleep disturbances, the geriatric depression scale (EDG) to screen for depressive symptoms and the mini-mental state examination (Minimental) to assess cognition. The environmental falls risk scale was used to determine environmental risk and risk behaviors, such as wearing inappropriate footwear, were questioned. Logistic regression models (falls in the last year and recurrent falls) and linear regression models (fear of falling using the Falls Efficacy Scale-International) were carried out to assess the main risk factors for falls in this population. A total of 335 older outpatients were included in this study. Among them, 4 of 10 had fallen in the previous year, most often accidentally and outdoors. Over half of the falls resulted in physical injuries, and nearly a one-third required hospital care. The main risk factors associated with falls were anxiety, visual impairment, number of medications and environmental risk, while being married and walking faster were protective factors. As for recurrent falls, anticonvulsant use and increased depressive symptoms were identified as risk factors. At least 6 out of 10 older outpatients included in this study feared falling, and the risk factors were depressive symptoms, difficulties in climbing stairs, visual impairment, sleep problems, sedentarism behavior, hypothyroidism, and hypertension. Conversely, a higher Tinetti score was found to be protective against fear of falling. Falls and fear of falling are highly prevalent among the older adults, with many of the identified risk factors being modifiable. Predisposing factors to this multifactorial event must be identified and included in a broader approach, focused on biological, behavioral, environmental and socioeconomic dimensions and centered on older persons.