Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-08-03T17:50:38Z No. of bitstreams: 1 RaimundoSousaNeto.pdf: 1546457 bytes, checksum: 8ca2b0801082558761dd5b57e6169ad6 (MD5) / Made available in DSpace on 2017-08-03T17:50:38Z (GMT). No. of bitstreams: 1 RaimundoSousaNeto.pdf: 1546457 bytes, checksum: 8ca2b0801082558761dd5b57e6169ad6 (MD5) Previous issue date: 2017-01-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The general objective of the research was to verify the association of the risk of falling to the fear of falling in the elderly served in the Family Health Strategy of São Luís, Maranhão. The specific objectives were: To characterize the sociodemographic and health profile of elderly people more susceptible to falls; To verify the factors influencing the risk of falls in the elderly served in the Family Health Strategy; To verify the influencing factors in the fear of falling from the elderly served in the Family Health Strategy. This was a cross-sectional, analytical study with a quantitative approach carried out at the Basic Health Units of the city of São Luís, between September and November 2015, with elderly individuals aged 60 years or older, reaching a total of 203 researched. A sociodemographic and health identification card, Downton risk scale and fall efficacy scale were used as instruments of the research. Initially, the descriptive analysis was performed by means of absolute and relative frequencies. The chi-square association test was then used to evaluate the relationship between the risk of falling and fear of falling, and their relationship with sociodemographic characteristics. For significant associations, logistic regressions were calculated. The collected data was stored in a specific database created on the Microsoft Excel version 2016 spreadsheet. After that, the statistical analysis of the data was performed in the IBM SPSS program. The research is part of the project "Chronic Conditions in the Elderly Served in the Family Health Strategy in São Luís-MA", meets the aspects recommended in resolution 466/12, and was approved with the opinion number 949.100. The sample studied is mostly composed of women, aged 60-69 years, married, with at least complete primary education, who do not live alone, do not have a diagnosis of osteoporosis, have already received guidance on falls prevention, which Do not practice physical activity and when they do it, they do it in the same age group, until they are 89 years old and they have already diagnosed basic diseases. From the Chi-Square test a highly significant p-value was obtained, demonstrating that the risk of falling depends on the fear of falling. The characteristics of age, schooling, diagnosis of osteoporosis, not practicing physical activity and presenting underlying disease influence the risk of falling and fear of falling, since they present p-value with high significance, just as the fact of living alone also influences the Fear of falling. It is concluded that the risk of falling is associated with the fear of falling, that they are influenced by age, schooling, diagnoses of underlying diseases or osteoporosis, and sedentary lifestyle. It is assumed a high risk of falling into it. / O objetivo geral da pesquisa foi verificar a associação do risco de queda ao medo de cair nos idosos atendidos na Estratégia Saúde da Família de São Luís, Maranhão. Os objetivos específicos foram: Caracterizar o perfil sóciodemográfico e de saúde dos idosos mais suscetíveis à quedas; Verificar os fatores influenciadores no risco de queda em idosos atendidos na Estratégia Saúde da Família; Verificar os fatores influenciadores no medo de cair de idosos atendidos na Estratégia Saúde da Família. Tratou-se de um estudo do tipo analítico, transversal, com abordagem quantitativa, realizado em Unidades Básicas de Saúde da cidade de São Luís, entre os meses Setembro e Novembro de 2015, com idosos de 60 anos ou mais, chegando a um total de 203 pesquisados. Foram utilizados como instrumentos da pesquisa uma ficha de identificação sociodemográfica e de saúde, a escala do risco de quedas de Downton e a escala de eficácia de quedas. Inicialmente, foi realizada a análise descritiva por meio de frequências absolutas e relativas. Em seguida, utilizou-se o teste de Qui-Quadrado de associação para avaliar a relação entre as variáveis risco de queda e medo de cair, e a relação destas, com características sociodemográficas. Para associações significativas, foram calculadas regressões logísticas. Os dados coletados foram armazenados em um banco de dados específico criado na planilha Microsoft Excel versão 2016. Após ocorrido, a análise estatística dos dados foi realizada no programa IBM SPSS. A pesquisa faz parte do projeto “Condições Crônicas em Idosos Atendidos na Estratégia Saúde da Família em São Luís- MA”, atende aos aspectos recomendados na resolução 466/12, sendo aprovada com o parecer de número 949.100. A amostra estudada é composta em sua maioria por mulheres, com idade entre 60 e 69 anos, casadas, com pelo menos o ensino fundamental completo, que não moram sozinhas, não tem o diagnóstico de osteoporose, já receberam orientação sobre prevenção de quedas, que não praticam atividade física e quando a realizam, fazem na mesma faixa etária perdurando até os 89 anos de idade e apresentam doenças de base já diagnosticadas. A partir do teste de Qui-Quadrado alcançou-se como resultado um p-valor altamente significativo, demonstrando que o risco de queda depende do medo de cair. As características idade, escolaridade, ter diagnóstico de osteoporose, não praticar atividade física e apresentar doença de base influenciam no risco de queda e no medo de cair, pois apresentam p-valor com alta significância, assim como o fato de morar sozinho também influencia no medo de cair. Conclui-se que o risco de queda esta associado ao medo de cair, que os mesmos são influenciados por idade, escolaridade, diagnósticos de doenças de base ou de osteoporose, sedentarismo e por isso, ao determinar presença de medo de cair em um idoso deve-se presumir alto risco de queda no mesmo.

Yeung, Pui Yee. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 131-145). / Abstract and some appendixes also in Chinese. / ABSTRACT --- p.i / ABSTRACT (in Chinese) --- p.iii / DECLARATION OF ORIGINALITY --- p.iv / ACKNOWLEDGEMENTS --- p.v / RESEARCH-RELATED PRESENTATIONS AND AWARD --- p.vi / TABLE OF CONTENTS --- p.vii / LIST OF ABBREVIATIONS --- p.xi / LIST OF FIGURES --- p.xii / LIST OF TABLES --- p.xiii / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.3 / Chapter 2.1 --- Incidence and prevalence of falls in older people --- p.4 / Chapter 2.1.1 --- Incidence and prevalence in western countries --- p.4 / Chapter 2.1.2 --- Incidence and prevalence in Hong Kong --- p.4 / Chapter 2.2 --- Causes and risk factors for falls --- p.5 / Chapter 2.2.1 --- Causes for falls --- p.5 / Chapter 2.2.2 --- Risk factors for falls --- p.6 / Chapter 2.3 --- Consequences of falls --- p.7 / Chapter 2.3.1 --- Individual perspective --- p.7 / Chapter 2.3.2 --- Impact on health service and society --- p.9 / Chapter 2.4 --- Intervention and prevention strategies --- p.10 / Chapter 2.4.1 --- Effective interventions and preventive approaches --- p.10 / Chapter 2.4.2 --- Areas of uncertainty for interventions and prevention approaches --- p.19 / Chapter 2.5 --- Existing efforts in intervention and prevention --- p.20 / Chapter 2.5.1 --- Worldwide levels and collaborations among various countries --- p.20 / Chapter 2.5.2 --- Current services for falls prevention in Hong Kong --- p.23 / Chapter 2.6 --- Criteria contributing to successful intervention and risks modification --- p.27 / Chapter 2.6.1 --- Identification of elderly fallers at Accident & Emergency Department --- p.28 / Chapter 2.6.2 --- Selection of the proved effective programme to those likely to benefit --- p.29 / Chapter 2.6.3 --- Uptake and adherence of the target fallers to the selected programmes --- p.30 / Chapter 2.7 --- Current gaps in study of services for elderly fallers in Hong Kong --- p.31 / Chapter CHAPTER 3 --- METHODOLOGY --- p.32 / Chapter 3.1 --- Research objectives --- p.33 / Chapter 3.2 --- Operational definition of falls --- p.33 / Chapter 3.3 --- Study design --- p.34 / Chapter 3.3.1 --- Diagrammatic illustration of the study design --- p.35 / Chapter 3.3.2 --- "Subjects, assessors and setting" --- p.37 / Chapter 3.3.3 --- Sources of data collection --- p.38 / Chapter 3.3.4 --- Questionnaire and assessment instruments --- p.39 / Chapter 3.3.5 --- Referrals and interventions --- p.49 / Chapter 3.4 --- Plan of data analysis --- p.52 / Chapter CHAPTER 4 --- RESULT --- p.55 / Chapter 4.1 --- Progression of elderly fallers --- p.56 / Chapter 4.2 --- Characteristics of all elderly fallers presented to A&E --- p.58 / Chapter 4.2.1 --- Demographics --- p.58 / Chapter 4.2.2 --- Rate of hip fracture --- p.58 / Chapter 4.2.3 --- Seasonal variation for occurrence of falls --- p.58 / Chapter 4.2.4 --- Subsequent one-year mortality --- p.59 / Chapter 4.2.5 --- Subsequent one-year occurrence of falls with presentation to A&E --- p.59 / Chapter 4.2.6 --- Subsequent one-year hospitalization and length of stay --- p.59 / Chapter 4.3 --- Profile of elderly fallers who received comprehensive falls assessment --- p.63 / Chapter 4.3.1 --- Demographics --- p.63 / Chapter 4.3.2 --- "Circumstances, consequences and past history of falls" --- p.67 / Chapter 4.3.3 --- Health and functional profile --- p.75 / Chapter 4.4 --- Uptake of interventions or referrals by elderly fallers --- p.89 / Chapter 4.4.1 --- Uptake rate of various interventions or referrals --- p.89 / Chapter 4.4.2 --- Reasons for refusing interventions or referrals --- p.89 / Chapter 4.5 --- Comparison between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.5.1 --- Co-morbidity between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.5.2 --- Functional profile between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.6 --- Comparison between injurious falls and non-injurious falls --- p.93 / Chapter 4.6.1 --- Co-morbidity between fallers with resultant injury and fallers without injury --- p.93 / Chapter 4.6.2 --- Functional profile between fallers with resultant injury and fallers without injury --- p.93 / Chapter 4.7 --- Comparison of the profiles between the elderly fallers and the general older population in Hong Kong --- p.95 / Chapter 4.7.1 --- Comparison in demographics --- p.95 / Chapter 4.7.2 --- Comparison in self-perceived health --- p.95 / Chapter 4.7.3 --- Comparison in lifestyle factors --- p.95 / Chapter 4.7.4 --- Comparison in BMI --- p.96 / Chapter 4.7.5 --- Comparison in morbidity --- p.96 / Chapter 4.7.6 --- Comparison in number of disease --- p.97 / Chapter 4.7.7 --- Comparison in medication use --- p.97 / Chapter 4.8 --- Comparison between fallers attended and those who did not attend the falls assessment clinic in terms of the subsequent one-year results --- p.102 / Chapter 4.8.1 --- Comparison in subsequent one-year mortality --- p.102 / Chapter 4.8.2 --- Comparison in subsequent one-year recurrent falls with presentation to A&E --- p.102 / Chapter 4.8.3 --- Comparison in subsequent one-year hospitalization and LOS --- p.103 / Chapter 4.9 --- Validation of a simple screening tool adopted from the Mr. Os (Hong Kong) study by the result of this study --- p.106 / Chapter CHAPTER --- 5 DISCUSSION --- p.108 / Chapter 5.1 --- Profile of elderly fallers presenting to A&E and its implications to health care planning for the elderly --- p.110 / Chapter 5.1.1 --- Profile of fallers in terms of subsequent one-year results --- p.110 / Chapter 5.1.2 --- Profile of fallers compared with general older population --- p.111 / Chapter 5.1.3 --- Implications on health care planning for the elderly --- p.113 / Chapter 5.2 --- Acceptability of various interventions and referrals by fallers and its implications to health care planning for the elderly --- p.116 / Chapter 5.2.1 --- Uptake rates for various interventions and referrals --- p.116 / Chapter 5.2.2 --- Views towards various interventions and referrals by fallers --- p.117 / Chapter 5.2.3 --- Implications on health care planning for the elderly --- p.117 / Chapter 5.3 --- Discussion of other findings --- p.120 / Chapter 5.3.1 --- Seasonal variation in occurrence of falls --- p.120 / Chapter 5.3.2 --- "Circumstances, consequences and past history of falls" --- p.122 / Chapter 5.3.3 --- Comparison between recurrent fallers and non-recurrent fallers in terms of co-morbidity and functional profile --- p.123 / Chapter 5.3.4 --- Comparison between fallers with resultant injury and fallers without injury in terms of co-morbidity and functional profile --- p.123 / Chapter 5.3.5 --- Comparison between fallers attended and those who did not attend the falls assessment clinicin terms of subsequent one-year results --- p.124 / Chapter 5.3.6 --- Usefulness of the risk profile of recurrent falling adopted from Mr. Os (Hong Kong) Studyin screening the fallers with high risk of falling --- p.125 / Chapter 5.4 --- Limitations --- p.126 / Chapter 5.5 --- Recommendations for further research --- p.128 / Chapter CHAPTER 6 --- CONCLUSION --- p.129 / REFERENCES --- p.131 / APPENDICES / Appendix 1 Assessment Form used in Falls Assessment Clinic --- p.146 / Appendix 2a Scale for Subjective Socioeconomic Status -English version --- p.151 / Appendix 2b Scale for Subjective Socioeconomic Status -Chinese version --- p.152 / Appendix 3a Simple Physical Activity Questionnaire -English version --- p.153 / Appendix 3b Simple Physical Activity Questionnaire -Chinese version --- p.155 / Appendix 4 Modified Barthel Index --- p.157 / Appendix 5 Rating Form for Impairment in IADL --- p.159 / Appendix 6 Mini-Mental State Examination -Cantonese version (CMMSE) --- p.160 / Appendix 7 Geriatric Depression Scale - Four-item short form (GDS-4) --- p.162 / Appendix 8 Berg Balance Scale - short form (BBS short form) --- p.163

Falls and their consequences are a major health problem in the older population, increasing their immobility, morbidity and mortality. This thesis focuses on older people living in geriatric care settings, frail older people who are most prone to suffer falls. The aim was to study predisposing and precipitating factors associated with falls in older people with or without cognitive impairment. In a cross-sectional study with a one-year prospective follow-up for falls 63% of the 83 residents suffered 163 falls and 65% of the fallers fell more than once. The antidepressants selective serotonine reuptake inhibitors (SSRIs), impaired vision and being unable to use stairs independently were the factors most strongly associated with sustaining falls. Acute diseases were judged to have precipitated 32 % of the falls and drug side effects 9%. In another cross-sectional study with a one-year follow-up for falls, including 199 residents, previous falls and treatment with antidepressants (mainly SSRIs) were found to be the most important predisposing factor for falls. Acute disease was judged to be the precipitating factor alone or in combination, in 39% of the falls, medical drugs in 8%, external factors such as obstacles in 8% and other conditions both related to the individual and the environment, such as misinterpretation, misuse of roller walkers or mistakes made by the staff were judged to have precipitated 17% of the falls. In a population-based cross-sectional study including 3604 residents in geriatric care settings more than 8% sustained a fall at least once during the preceding week. A history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, use of neuroleptics and use of antidepressants were all associated with falls in multivariate analyses. In the subgroup of people with cognitive impairment (2008 residents) more than 9% had sustained a fall at least once during the preceding week. As for the whole population, being able to get up from a chair, previous falls, needing a helper when walking with the addition of hyperactive symptoms were the factors independently associated with falls. In a study with a one-year prospective follow up for falls, including 439 residents in residential care facilities, 63% sustained 1354 falls, corresponding to an incidence rate of 3.5 falls / person year. Thirty-three percent of the falls and 37% of the injurious falls occurred during the night (9pm-6am). There were significantly higher fall rates in the evening and in January, April, May, November and December. There were no associations between fall rates and any of the weather parameters studied. In conclusion falls and fall-related injuries in older people in geriatric care settings are common. Both predisposing and precipitating factors contribute to the risk of falling. Addressing precipitating factors for falls seems to be important in an individualised preventive strategy among older people in geriatric care settings.

The overall goal of my research was to advance our understanding of the potential for novel compliant flooring systems to reduce the risk for fall-related injuries in older adults, including fall-related traumatic brain injury (TBI). This entailed an assessment of how these floors affect the competing demands of fall-related TBI – impact severity attenuation in concert with minimal concomitant impairments to balance control and postural stability. Two studies are included as part of this thesis. The first study used a mechanical drop tower to assess the effects of four traditional flooring systems and six novel compliant flooring conditions on the impact dynamics of a surrogate headform during the impact phase of simulated ‘worst- case’ head impacts. The second study entailed an assessment of the effect of two traditional and three novel compliant floors on the initial phase of the compensatory balance reactions of older adult men and women living in a residential-care facility environment following an externally induced perturbation using a tether-release paradigm. Overall, this thesis demonstrates that novel compliant floors substantially attenuate the forces and accelerations applied to the head during simulated worst- case impacts when compared to traditional flooring surfaces such as vinyl and carpet with underpadding. These benefits are achieved without compromising indices of balance control, supported by the finding that parameters characterizing early compensatory balance reactions were unaffected by the novel compliant floors tested. This work supports the introduction of pilot installations of novel compliant flooring systems into environments with high incidences of falls to test their effectiveness at reducing fall-related injuries in clinical settings.

The overall goal of my research was to advance our understanding of the potential for novel compliant flooring systems to reduce the risk for fall-related injuries in older adults, including fall-related traumatic brain injury (TBI). This entailed an assessment of how these floors affect the competing demands of fall-related TBI – impact severity attenuation in concert with minimal concomitant impairments to balance control and postural stability. Two studies are included as part of this thesis. The first study used a mechanical drop tower to assess the effects of four traditional flooring systems and six novel compliant flooring conditions on the impact dynamics of a surrogate headform during the impact phase of simulated ‘worst- case’ head impacts. The second study entailed an assessment of the effect of two traditional and three novel compliant floors on the initial phase of the compensatory balance reactions of older adult men and women living in a residential-care facility environment following an externally induced perturbation using a tether-release paradigm. Overall, this thesis demonstrates that novel compliant floors substantially attenuate the forces and accelerations applied to the head during simulated worst- case impacts when compared to traditional flooring surfaces such as vinyl and carpet with underpadding. These benefits are achieved without compromising indices of balance control, supported by the finding that parameters characterizing early compensatory balance reactions were unaffected by the novel compliant floors tested. This work supports the introduction of pilot installations of novel compliant flooring systems into environments with high incidences of falls to test their effectiveness at reducing fall-related injuries in clinical settings.

Made available in DSpace on 2015-07-22T20:49:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-27 / Este estudo observacional do tipo seccional teve por objetivos: investigar a prevalência de quedas acidentais em idosos freqüentadores de centro de convivência para idosos (CCI) e a influência de variáveis a ela associadas (faixa etária, sexo, estado civil, escolaridade, renda familiar/pessoa, aposentadoria, inserção no mercado de trabalho, estado cognitivo, tempo de registro e atividades praticadas no CCI e, nível de atividade física); estimar o nível de atividade física (NAF) desses idosos analisando as mesmas variáveis anteriores bem como a possível associação com quedas acidentais; e analisar as possíveis associações entre NAF e os fatores e/ou conseqüências relacionados à mais recente queda (número, período e local das quedas, ocorrência de fratura ou ferimento, procura por atendimento médico e medo de cair). Uma amostra de 350 idosos de três CCI da cidade de Cuiabá (Estado de Mato Grosso, Brasil) responderam ao Mini-Exame do Estado Mental – MEEM, e ao Questionário Internacional de Atividades Físicas - IPAQ versão curta. O Questionário de Caracterização de Quedas somente foi respondido pelos idosos que sofreram queda. Foram utilizadas para a análise de dados estatística descritiva, regressão logística binária e regressão logística ordinal pelo Modelo de Odds Proporcional (MOP), considerando o valor de p<0,05, em uma sub-amostra de 291 idosos. Cerca de 40% dos idosos disseram ter caído nos últimos 12 meses anteriores ao inquérito; dos que sofreram queda, 45,3% afirmaram ter sofrido duas ou mais quedas. O modelo preditivo de quedas foi composto das variáveis: sexo feminino (OR= 5,12; IC= 2,48–10,56), faixa etária de 75 a 79 anos (OR=3,0; IC= 1,20–7,47), estado civil separado (OR=4,09; IC= 1,27–13,22), e ser pensionista (OR=2,82; IC= 1,20–6,64). Quanto ao NAF, 38,1% dos voluntários foram classificados no nível “alto”, 49,8% no nível “moderado” e 12,1% no nível “baixo”. Os resultados do MOP para NAF indicaram que idosos mais velhos têm menos chance de estar no NAF alto (OR=0,78: IC=0,96-2,92) do que idosos nas faixas etárias mais jovens. Da mesma forma, idosos que não trabalham (OR=0,38: IC=0,22–0,67) e aqueles com baixo índice cognitivo (OR=0,31; IC=0,31-0,38) têm menos chance de estar no NAF alto em oposição aos outros níveis. Quanto à última queda relatada, verificou-se que 46,2% dos idosos caíram à tarde, 9,4% das quedas ocasionaram fratura, 70,9% dos casos resultaram em algum tipo de ferimento e não houve conseqüências em 23,9% das quedas. Foi verificado que 54,7% dos idosos caíram fora de casa, 61,5% não procuraram atendimento médico e 43,6% relataram muito medo de cair. Em relação às variáveis referentes à última queda, o resultado do MOP pelo NAF revelou que idosos que não sofreram ferimentos têm mais chances de se encontrar no NAF alto (OR=8,19: IC= 1,00–66,74). Os resultados indicam que a condição civil, o recebimento de benefício previdenciário, o sexo e a idade foram preditores de quedas. Além disso, o nível de atividade física dos idosos não mostrou qualquer associação com a ocorrência de quedas acidentais. / The aims of this observational, cross-sectional study were: i) investigate the prevalence of accidental falls in Senior Citizen Centers (SCC) users and the influence of factors associated with these falls such as age group, sex, civil status, level of education, family/person income, retirement, labor market participation, cognitive status, registration period and activities carried out at SCC, and level of physical activity; ii) estimate the level of physical activity in this elderly population relating to the variables described above as well as the possible association with accidental falls; and iii) analyze the association among level of physical activity and related-factors and/or consequences on the most recent fall (number, daytime and fall location, fracture or injury occurrence, search for medical services and fear of falling). The sample included 350 Senior Citizens from three different SCC from Cuiabá City (Mato Grosso State, Brazil) that answered the Mini-mental State Examination–MMSE and the International Physical Activity Questionnaire-IPAQ short version. The Characterization of Falls Questionnaire was answered only by those elderly who had fallen. Descriptive Statistic, Binary Logistic Regression and Ordinal Logistic Regression by Proportional Odds Model (POM) were used for data analyses (p<0.05) from a 291 elderly sub-sample. About 40% of the elderly suffered falls in the last year. From this group, 45.3% declared to have fallen two or more times in the same period. The predictive model of falls was comprised by the following variables: female gender (OR= 5.12; IC= 2.48–10.56), 75-79 years old age group (OR=3.0; IC= 1.20–7.47), divorced marital status (OR=4.09; IC= 1.27–13.22), and to be pensioner (OR=2.82; IC= 1.20–6.64). Analyzing the level of physical activity (LPA), 38.1% of voluntaries were classified as high level, 49.8% as moderate level and 12.1% as low level. The results of POM indicated that the oldest group showed lower chance to be classified as high LPA (OR=0.78: IC=0.96-2.92) than elderly younger groups. Seniors that do not have a job (OR=0.38: IC=0.22–0.67) and those with low cognitive status (OR=0.31; IC=0.31-0.38) had little possibility to be in high LPA in opposition to the other levels. Regarding to the last fall reported, it was verified that 46.2% occurred in the afternoon, 9.4% resulted in fractures, 70.9% resulted in some sort of injury and 23.9% did not result in any impairments. It was also verified that 54.7% of the elderly suffered outdoor falls, 61.5% did not seek any medical attention and 43.6% related being very afraid of falling. In relation to the variables concerning to the last fall reported, results from MOP by NAF revealed that elderly that did not suffered injuries were more likely to be in high LPA (OR=8.19: IC= 1.00–66.74). Our results indicate that civil status, social security benefit receiving, sex and age were predictors to falls. Moreover, level of physical activity did not show any association with accidental falls occurrence. / TEDE / BV UNIFESP: Teses e dissertações

Submitted by MAIRA PELOGGIA CURSINO null (maira_cursino@hotmail.com) on 2016-05-02T20:29:20Z No. of bitstreams: 1 dissertacao Maira Cursino.pdf: 2521886 bytes, checksum: 862681ed4fd4899b3eae13a3cd63d24c (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-05-04T19:52:20Z (GMT) No. of bitstreams: 1 cursino_mp_me_rcla.pdf: 2521886 bytes, checksum: 862681ed4fd4899b3eae13a3cd63d24c (MD5) / Made available in DSpace on 2016-05-04T19:52:20Z (GMT). No. of bitstreams: 1 cursino_mp_me_rcla.pdf: 2521886 bytes, checksum: 862681ed4fd4899b3eae13a3cd63d24c (MD5) Previous issue date: 2016-04-08 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A doença de Parkinson (DP) é uma das doenças que mais acarreta distúrbios do movimento. Objetivo: analisar os efeitos do treino de marcha em esteira com Suporte Parcial de Peso (SPP) e do treino com Estímulo Auditivo (EA) sobre variáveis cinemáticas da marcha, comprimento de passo (CP), variabilidade do comprimento de passo (VCP), largura de passo (LP), variabilidade da largura de passo (VLP) e velocidade de marcha (VM) de pacientes com DP, e sobre os testes de mobilidade, a qualidade de vida (QV) e a preocupação com quedas. Método: Participaram 21 voluntários diagnosticados com DP, com marcha independente, divididos igualmente em: grupo com SPP (GSPP), grupo com EA (GEA), e grupo controle (GC), o qual treinou somente com esteira. Foram avaliadas a mobilidade pelo Short Physical Performance Battery (SPPB) e pelo Timed up and go (TUG), a QV pelo Parkinson Disease Questionnary – 39 (PDQ-39), a preocupação com quedas pelo Falls Efficacy Scale – International (FES-I) e a avaliação biomecânica da marcha em solo pelo programa Peak Motus Motion Measurement System 9.0. O treinamento foi realizado durante seis semanas, com três sessões semanais de 30 minutos. Foi realizado o teste ANOVA Medidas Repetidas Two Way com post Hoc de Bonferroni no software PASW statistics 18.0® (SPSS), adotado nível de significância p<0,05 e a magnitude de efeito das variáveis. Resultados: Os grupos eram homogêneos (p>0,05) para idade, massa corpórea, altura, IMC, tempo de diagnóstico da DP, classificação da escala de Hoehn & Yahr, função cognitiva e quedas. Considerando a magnitude de efeito, tem-se uma diferença clínica inicial e final no GC, GSPP e GEA respectivamente (1,44; 1,46 e 1,86 para o SPPB, 0,96; 0,88 e 2,59 para o TUG, 1,15; 0,92 e 0,25 para o FES-I e 2,17; 1,09 e 2,88 para o PDQ-39); o GEA apresentou melhora significativa inicial e final no SPPB (p=0,018), TUG (p=0,07) e no PDQ-39 (p=0,006) e o GC só no PDQ-39 (p=0,005). Houve grande efeito clínico para as variáveis CP do GC, VCP do GSPP e GEA, LP dos três grupos, VLP do GSPP, VM do GC e GEA, comparando o período inicial e final intragrupo, e, independente dos grupos, houve melhora significativa para velocidade de marcha (p=0,048), no medo de cair (p=0,044) e na QV (p=0,002). Conclusão: treinar em esteira com ou sem estímulos é vantajoso para a melhora da mobilidade, da preocupação com quedas, da marcha e da QV, entretanto, quando o objetivo é melhorar a mobilidade, a preocupação com quedas e a velocidade de marcha, a associação com EA é mais indicada. / Introduction: Parkinson's disease (PD) is one of the diseases that causes movement disorders. Objective: To analyze the effects of gait training on a treadmill with weight Partial body weight support (PBWS) and training with Auditory Stimulus (AS) on kinematic variables of gait, stride length (SL), stride length variability (SLV) step width (SW), step width variability (SWV) and gait speed (GP) in PD patients, and on the mobility tests, quality of life (QOL) and concern about falls. Method: 21 volunteers diagnosed with PD, with independent walking, equally divided into: group with PBWS (GPBWS), a group with AS (GAS) and control group (CG), which only trained with treadmill. Were evaluated mobility by Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG), QOL by Parkinson Disease Questionnary - 39 (PDQ-39), the concern about falls at Falls Efficacy Scale - International (FES-I ) and the biomechanics of gait evaluation on the soil in Peak Motus Motion Measurement System 9.0. The training was conducted over six weeks, with three weekly sessions of 30 minutes. Statistical analysis ANOVA Two Way Repeated Measures with Bonferroni post hoc in PASW Statistics software 18.0® (SPSS), adopted significance level of p <0.05 and the magnitude of the variable effect was made. Results: The groups were homogeneous (p> 0.05) for age, body mass, height, BMI, PD diagnostic time scale rating Hoehn & Yahr of, cognitive function and falls. Considering the magnitude of effect, it has an initial clinical difference and end the CG, GPBWS and GAS respectively (1.44, 1.46 and 1.86 for SPPB, 0.96, 0.88 and 2.59 for TUG, 1.15, 0.92 and 0.25 for FES-I and 2.17, 1.09 and 2.88 for the PDQ-39); GAS had initial and final significant improvement in SPPB (p = 0.018), TUG (p = 0.07) and the PDQ-39 (p = 0.006) and CG only in the PDQ-39 (p = 0.005). There was great clinical effect in variables SL in CG, SLV in GPBWS and GAS, SW in the three groups, SWV in GPBWS, GP in CG and GAS, comparing the initial and end period intragroup, and independent groups, there was significant improvement to WS (p = 0.048), fear of falling (p = 0.044) and QOL (p = 0.002). Conclusion: training on a treadmill with or without stimuli is advantageous for the improvement of mobility, concern about falls, gait and QOL, however, when the objective is to improve mobility, concern about falls and gait speed, the association with AS is most appropriate.

The fall of hospitalized patients is a world reality and the most frequent adverse events in this environment. This study aims to evaluate the risk of falls among adult patients in clinical and surgical unit of a university hospital. It is a cohort study with follow up of patients admitted in the Surgical Clinic and Medical I and II Clinic of the Hospital Universitário de Santa Maria (HUSM) between March to June 2013 (122 days). For data collection was utilized semi-structured form with demographic and clinical questions of patients and the Brazilian version of the Morse Fall Scale (SPS) was used. The data were organized in Excel ® with double entered independently. After the correction of errors and inconsistencies the analysis was realized in PASW ® Statistics (Predictive Analytics Software, Chicago - USA) version 18.0 for Windows, using the descriptive and inferential statistics. The study included 831 patients. Of these patients 60.2 % were male, the mean age was 58.1 (± 16.1) years , were on average 7.7 days (± 9.2) and were hospitalized on average 5.4 days (± 5.2) for evaluation. During the period 19 patients fell the floor / ground representing an average of 4.7 falls / month, a percentage of 2.28 % (95% CI: 1.66 to 2.91) falls in the period and a fee incidence of 1.68 % (95% CI: 1.51 to 1.72 % ). The MFS score had averaged 39.37 points (± 19.4). In the first evaluation and in the average final evaluation higher percentage of patients were classified as high risk for falls (36.6 %, 37.7 % and 41.2 %, respectively), with strong positive correlation between the first and final evaluation (r = 0.810, p = 0.000). The falls occurred between the 1st and 10th day of evaluation (85.7 %) during the morning (52.4 %), in the ward (at the bedside), bathroom and during the displacement, resulting in psychological harm (58.8 %) and physical (29.4%). Among the contributing factors highlight overestimate of the ability of patient, dizziness, agitation, gloom, high bed and inadequate and / or difficult of handle bars. It is concluded that MFS is an important tool for evaluation of risk of falls and recommended the deploying of the same as a quality indicator of health care in the research institution. It is hoped that this study will serve as subsidy for health professionals, particularly the nursing staff to implement of strategies that prevent the occurrence of falls during the hospitalization. / A queda de pacientes hospitalizados é uma realidade mundial e um dos eventos adversos mais frequentes neste ambiente. Este estudo tem por objetivo avaliar o risco de quedas de pacientes adultos internados em unidades clínica e cirúrgica de um hospital universitário. Trata-se de um estudo de coorte, com acompanhamento de pacientes internados nas Unidades de Clínica Cirúrgica e Clínica Médica I e II do Hospital Universitário de Santa Maria (HUSM), no período de março a julho de 2013 (122 dias). Para a coleta dos dados foram utilizados um formulário semiestruturado, com questões demográficas e clínicas dos pacientes, e a versão brasileira da Morse Fall Scale (MSF). Os dados foram organizados no programa Excel®, com dupla digitação independente. Após a correção de erros e inconsistências a análise foi realizada no PASW Statistics® (Predictive Analytics Software, Chicago - USA) versão 18.0 for Windows, utilizando-se da estatística descritiva e inferencial. Participaram do estudo 831 pacientes. Destes, 60,2% eram do sexo masculino, a média de idade foi de 58,1 (±16,1) anos, permaneceram em média 7,7 dias (±9,2) internados e tiveram em média 5,4 dias (±5,2) de avaliação. Durante o período, 19 pacientes tiveram queda ao solo/chão, representando uma média de 4,7 quedas/mês, um percentual de 2,28% (IC95%: 1,66 2,91) de quedas no período e uma taxa de incidência de 1,68% (IC95%; 1,51 1,72%). O escore da MFS teve uma média de 39,37 pontos (±19,4). Tanto na primeira avaliação quanto na média das avaliações e na última avaliação, maior percentual de pacientes foi classificado na categoria de risco elevado para quedas (36,6%, 37,7% e 41,2%, respectivamente), com correlação positiva forte entre a primeira e a última avaliação (r=0,810; p=0,000). As quedas ocorreram entre o 1º e o 10º dia de avaliação (85,7%), no turno da manhã (52,4%), na enfermaria (à beira do leito), no banheiro e durante o deslocamento, resultando em dano psicológico (58,8%) e físico (29,4%). Dentre os fatores contribuintes destacaram-se a superestima da capacidade por parte do paciente, vertigem, agitação, penumbra, cama alta e grades inadequadas e/ou de difícil manuseio. Conclui-se que a MFS é um importante instrumento para avaliação do risco de quedas e recomenda-se a implantação da mesma como um indicador de qualidade da assistência à saúde na instituição pesquisada. Espera-se que este estudo sirva de subsídio para os profissionais de saúde, em especial a equipe de enfermagem, para a implementação de estratégias que previnam a ocorrência de quedas de pacientes durante a internação.

Introdução: Recorrência de quedas está presente em 50% dos casos de idosos caidores, fato que sinaliza piores desfechos na saúde dessa população. Daí a relevância dos fatores associados aos eventos recorrentes: se bem entendidos, eles podem conferir maior objetividade às avaliações de riscos e, consequentemente, produzir uma melhor correspondência entre as intervenções propostas e as reais necessidades dessa população. Objetivo: Investigar se a posturografia - uma das propostas de avaliação de risco de quedas -- adiciona à avaliação clínica a capacidade de discriminar a recorrência de quedas em idosos. Método: Estudo transversal, realizado no período de agosto de 2011 a novembro de 2012, com 124 idosos do Programa de Prevenção de Quedas em um hospital terciário na cidade de São Paulo. Foram avaliados dados sociodemográficos, clínicos e testes de performance como Timed Up and Go Test (TUGT), Velocidade de Marcha, Escala de Equilíbrio de Berg (Berg Balance Scale, BBS), teste do sentar e levantar, medo de cair (Falls Efficacy Scale International, FES-I) e sintomas depressivos (Escala de Depressão Geriátrica, EDG). A posturografia estática foi realizada por meio de plataforma de força em três diferentes situações: olhos abertos (OA), olhos fechados (OF) e OA com dupla tarefa. Resultados: Foram avaliados 124 sujeitos com idade entre 60 e 88 anos, sendo 35 caidores únicos e 89 caidores recorrentes. Houve diferença entre os grupos quanto ao relato de medo de cair (P= 0,01), sintomas depressivos (EDG) (P= 0,007), escala de eficácia em quedas - Internacional (FES-I) (P=0,01), consequência grave, como traumatismo cranioencefálico e fratura (P=0,002) e necessidade de ajuda para se levantar (P=0,007), sendo que essas duas últimas características são mais prevalentes no caidor único. A variável de amplitude média de deslocamento do centro de pressão (COP) no plano médio lateral (XSD) na condição de OF apresentou diferença entre grupos (P=0,011), assim como a velocidade média calculada pelo deslocamento total do COP em todas as direções (VAvg) na condição OA (P=0,014). Após regressão logística de forma hierárquica e adicionada à avaliação clínica, nenhuma variável da posturografia mostrou-se capaz de incrementar de forma significante o poder de diferenciação entre quedas recorrentes e únicas. No modelo final ajustado, sintomas depressivos (EDG) (P < 0,05), TUGT com distrator (P < 0,05) e BBS (P < 0,01) apresentaram poder preditivo significativo de forma independente. Conclusão: No que tange a discriminação da recorrência de quedas em idosos da comunidade, a posturografia realizada em diferentes situações (olhos abertos, olhos fechados e dupla tarefa) não agregou valor à avaliação clínica composta por dados sociodemográficos, variáveis clínicas e testes de performance / Introduction: The recurrence of falls has been present in 50% of cases of elderly fallers, which predicts bad health outcomes for this population. Thus, it is important to understand the factors associated with these recurrent events so that the risk assessments are objective and allow the proposed interventions to meet the real needs of this population. Objective: To investigate whether the posturography test adds to the clinical evaluation in the ability to discriminate the recurrence of falls in the elderly. Method: This cross sectional study was conducted from August 2011 to November 2012, with 124 elderly from a Falls Prevention Program at a tertiary level hospital in the city of São Paulo. Sociodemographic, clinical and functional testing such as the Timed Up and Go Test (TUGT), Speed Gait, Berg Balance Scale (BBS), five times sit-to-stand test, fear of falling (Falls Efficacy Scale - International, FES-I) and depressive symptoms (Geriatric Depressive Scale, GDS) were evaluated. The static postGDurography was performed by means of a force platform in three different situations: eyes open (EO), eyes closed (EC) and EO dual task. Results: 124 subjects aged 60 to 88 years were evaluated, consisting of 35 single fallers and 89 recurrent fallers. Differences were found among the groups in terms of the reported fear of falling (p= 0.010), depressive symptoms (GDS) (p=0.007), Falls Efficacy Scale - International, (FES-I) (p=0.010), serious consequences such as traumatic brain injury and fracture (p=0.002) and the need for help to stand up (p= 0.007); the two last characteristics were more prevalent in single fallers. The variable of mean amplitude of center of pressure displacement (COP) in the median lateral plane (XSD) in the EC condition was different among groups (p =0.011), as was the average speed calculated through the total displacement of the COP in all directions (VAvg) in the EO condition (p= 0.014). After hierarchical logistic regression added to clinical evaluation, no posturography variable was capable of significantly increase the power of differentiation between recurrent and single falls. In the final adjusted model, depressive symptoms (EDG) (P < 0.05), the TUGT with a distractor (P < 0.05) and the BBS (P < 0.01) presented significant independent predictive power. Conclusion: Posturography performed in different situations (eyes open, eyes closed and dual task) did not add value to clinical evaluation - consisting of sociodemographic data, clinical variables and functional tests - in discriminating the recurrence of falls in elderly individuals living in the community

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2011. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2013-01-10T12:59:40Z No. of bitstreams: 1 mariliasilva.pdf: 482712 bytes, checksum: 9f9f81371db911f8600f3787acd71661 (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2013-01-10T16:54:00Z (GMT) No. of bitstreams: 1 mariliasilva.pdf: 482712 bytes, checksum: 9f9f81371db911f8600f3787acd71661 (MD5) / Made available in DSpace on 2013-01-10T16:54:00Z (GMT). No. of bitstreams: 1 mariliasilva.pdf: 482712 bytes, checksum: 9f9f81371db911f8600f3787acd71661 (MD5) Previous issue date: 2011 / As quedas entre os idosos representam importante problema de saúde pública. Dessa forma, a presente pesquisa, procedente de um projeto oriundo do Projeto Universal 2008, teve como objetivo: analisar a produção científica brasileira e estrangeira dos últimos cinco anos, a partir do diagnóstico de enfermagem da NANDA “risco de quedas”, acerca dos fatores de risco para população idosa. A metodologia utilizada foi a revisão integrativa, realizada em cinco fases: formulação do problema; coleta dos dados; avaliação dos dados; análise e interpretação dos dados; e apresentação dos dados. Para a coleta de dados utilizou-se os descritores: acidente por quedas e idoso, nas bases de dados da CINAHL e LILACS, tendo sido encontrados seiscentos e trinta e sete estudos, e sendo selecionados trinta e dois para análise de conteúdo. Os resultados foram apresentados considerando-se: informações relacionadas aos artigos e informações de relevância à pesquisa- fatores de riscos indicados na NANDA-I. Assim, após a análise dos dados, emergiram como categorias de fatores de risco: ambientais: ambiente com móveis e objetos/tapetes espalhados pelo chão, pouca iluminação e condições climáticas- piso escorregadio; cognitivos: estado mental rebaixado; em adultos: história de queda, idade acima de 65 anos, uso de dispositivos auxiliares; fisiológicos: dificuldades na marcha, dificuldades visuais, equilíbrio prejudicado, incontinência, neoplasia; medicamentos. Parece evidente que, da identificação dos fatores de risco para quedas nos idosos, emerge a necessidade do desenvolvimento de alternativas e estratégias que possibilitem modificações nos ambientes e componentes intrínsecos, passíveis de alterações. Assim, espera-se que essa pesquisa e as possíveis propostas de intervenção que surjam a partir dela sirvam como interconexão entre os serviços de saúde e a Academia, a fim de promover melhorias no cuidado ao idoso. / Falls among the elderly pose a major problem in public health. Thus, the following study, founded in a project of Universal Project 2008, aimed: to analyze the scientific production regarding the risk factors for falls, in the elderly population, both in Brazilian and foreign scientific literature within the last five years. The methodology applied was the integrative review, carried out in five stages: problem formulation; data collection; data assessment; data analysis and interpretation; and data presentation. For data collection, the following descriptors were used: fall accident and elderly, in the database of CINAHL and LILACS, where six hundred and thirty- seven studies were retrieved, from which thirty-two were selected for analysis of content. The results were presented taking into account: data related to the articles and relevant data to the research- risk factors indicated in NANDA-I. After data analysis, the following categories for risk factors emerged: environmental: environment with furniture and objects/rugs scattered around the floor, poor lighting, climatic conditions-slippery floor; cognitive: lowered mental state; In adults: history of falls, over 65 years of age, use of aid devices; physiological: marching difficulties, impaired vision, loss of balance, incontinence, neoplasia; medications. Understandably, by identifying the risk factors for falls among elderly there is a growing need for the development of alternatives and strategies to enable improvement in the environment as well as intrinsic components, open to alterations. Therefore, it is expected that this research and the following proposals of intervention which come up from it, may be an interconnection between the health services and the Academy, in order to promote improvements in the care of the elderly. / Las caídas entre los ancianos representan un importante problema de salud pública. Por lo tanto, la presente investigación, que se originó en un proyecto derivado del proyecto Universal 2008, tubo por objetivo: revisión de la literatura científica sobre los factores de riesgo de caídas en la población anciana, en la literatura nacional y extranjera, en los últimos cinco años. La metodología utilizada fue la revisión integradora, llevada a cabo en cinco fases: formulación del problema; recopilación de datos; evaluación de los datos; análisis e interpretación de los datos; y presentación de datos. Para la selección de datos se utilizaó los siguientes descriptores: accidente por la caída y anciano, en las bases de datos de la CINAHL y la LILACS, se ha encontrado seiscientos treinta y siete estudios, y se seleccionaron treinta y dos para el análisis de contenido. Los resultados fueron presentados teniendo en cuenta: informaciones relacionadas con los artículos e informaciones de interés para la investigación - factores de riesgo listados en NANDA-I. Así, después del análisis de los datos, surgió como categorías de factores de riesgo: ambientales: ambiente con muebles y objetos/alfombras en el suelo, con poca luz, condiciones del clima – piso resbaladizo; cognitivos: el estado mental degradado; en los adultos: historia de caída, edad superior a 65 años, uso de dispositivos de asistencia; fisiológicos: dificultad para caminar, dificultades visuales, equilibrio dañado, incontinencia, neoplasia; medicamentos. Parece claro que, de la identificación de factores de riesgo de caídas entre los ancianos, surge la necesidad de elaborar alternativas y estrategias que permitan cambios en los ambientes y los componentes intrínsecos, sujetos a cambios. Por lo tanto, se espera que esta investigación y las posibles propuestas de acción que surjan de ella sirvan como la interconexión entre los servicios de salud y de la Academia, para promover mejora de la atención para los ancianos.