Prevenção de quedas e fraturas na atenção à saúde do idoso no Rio Grande do Sul, Brasil

• Autor(a) principal: Caberlon, Iride Cristofoli
• Data de Publicação: 2012
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
• Texto Completo: http://tede2.pucrs.br/tede2/handle/tede/2675
• topic: MEDICINA; GERONTOLOGIA; ACIDENTES - PREVENÇÃO; FRATURAS ÓSSEAS; IDOSOS; GERIATRIA; SAÚDE DO IDOSO; CNPQ::CIENCIAS DA SAUDE::MEDICINA

Falls and fractures in the elderly represent a significant public health problem, facing the process of longevity of the Brazilian population. They are associated with higher rates of morbidity and mortality, reduction of functional capacity, increased frailty, institutionalization of elderly and early death. The influence of environmental factors on the risk of falls is related to the functional state and mobility of elderly people with gait and balance changes. Although there are scientific studies in Brazil that indicate that there is association of falls and fractures with clime in elderly, in the State of Rio Grande do Sul this problem is little studied. Against this reality, the present study aimed to investigate falls and fractures in the elderly (60 years and over) resident in municipalities of the metropolitan and Serra region in the State of Rio Grande do Sul, Brazil. This study is characterized as cross-sectional, retrospective, descriptive and analytical, quantitative of elderly patients in the year 2010. Data were collected from the 6633 charts of elderly patients presenting falls from four units of Urgency and Emergency (UAUEH) SUS, RS/Brazil. The final sample of 6,556 elderly assisted by falls after the inclusion and exclusion criteria established. Among them, 4,664 (71%) were women and 1,892 (29%) were men, with 26.8% of cases occurring in winter followed by autumn with 24.5%. More than half of the visits (57%) were performed up to 6 hours after the fall. The fall site was not reported in 83% of the charts. Among the bulletins reporting the location of the fall, 42% of them were at home and 58% outside of the home. Falls on stairs, bus and bed were the three most frequently reported risk locations. Only 30% of reports contain records on vital signs. Blood pressure as the most observed and recorded. The winter was the season with the highest average of systolic and diastolic blood pressure. The degree of consciousness was mentioned only in 20.4% of the charts. This percentage was higher in elderly patients with brain injure where almost 50% had the degree of consciousness recorded. 31% of falls had fractures confirmed by radiological investigation, 32% of the women and 28% of the men (p <0.0001). Average age of fractured people was significantly higher than people who do not fractured. Fractures of the upper limbs were the most frequently recorded with 978 fractures, followed by fractures of the lower limbs with 620 fractures. The season with the highest number of confirmed fractures was the winter where fractures were observed in 34% of falls (p = 0.0002). The season with the lowest percentage of fractures was the spring within 28% of falls. Age, sex, and winter were the significant risk factors for falls. A person one year older is 2.2% more likely to fracture when falling. The chances of women fracture after a fall are 15% higher than men the same age. All other seasons were protective factors when compared to winter. When compared with those who felt in winter, older people who fall in the spring are 27% less likely to fracture when falling (p <0.0001), and this chance to 22% in summer (p = 0.0011) and 8% in autumn (p = 0.2854). We conclude that falls in the winter months are more frequent and more severe. Female gender and older age are more vulnerable to falls and fractures. We face structures using emergency care routines inappropriate for the elderly. Little heed seems to have been given to the elderly who have fallen in order to diagnose the possible causes of the fall. The biggest challenges for the effectiveness of preventing falls and fractures in the elderly to be faced in practice are professional training of health services network, the creation of programs and activities of multifactorial intervention. The reorganization of services and continuous improvement actions and ongoing care by a multidisciplinary team, working in a coordinated and integrated in different multifactorial intervention programs more individualized, is an essential prerequisite for the prevention of falls and fractures. This reorganization is essential to obtain complete and reliable data about the care provided in the elderly. This survey results point to the need for further epidemiological and clinical studies that can clarify issues related to other approaches to risk factors for falls and fractures. These approaches include behavioral factors, extrinsic and intrinsic multifactorial interventions; particularly in the context of primary and secondary care by the Brazilian Unique Health System.