Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-10-18T19:26:56Z No. of bitstreams: 1 KarlaVanessaRodriguesSoaresMenezes_TESE.pdf: 2355811 bytes, checksum: c138086bdc743e599474c6cfedf3b042 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-10-18T22:33:57Z (GMT) No. of bitstreams: 1 KarlaVanessaRodriguesSoaresMenezes_TESE.pdf: 2355811 bytes, checksum: c138086bdc743e599474c6cfedf3b042 (MD5) / Made available in DSpace on 2017-10-18T22:33:57Z (GMT). No. of bitstreams: 1 KarlaVanessaRodriguesSoaresMenezes_TESE.pdf: 2355811 bytes, checksum: c138086bdc743e599474c6cfedf3b042 (MD5) Previous issue date: 2017-07-13 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / Introduction: As people get older, it remains a challenge maintaining functional capacity. Functioning consists of the ability to perform self-care activities (i.e. activities of daily living - ADLs) classified inside the level of ?activity and participation? of the International Classification of Functioning, Disability and Health (ICF). Previous studies have identified different risk factors for worsening functional capacity during hospitalization, including older age, sociodemographic characteristics, pre-existing impairment, cognitive loss, delirium, and comorbidity. In-hospital mobility has received particular attention due to its important association to loss of functional capacity. Few studies about hospitalization effects on older adults have been done in Brazil. Identifying older adults at risk for loss in functional capacity during hospitalization will help researchers and clinicians in order to make informed decisions. Objectives: This study contemplates three objectives: first, to provide an updated review to identify and appraise relevant instruments for measuring older adults? mobility based on the ICF conceptual framework in the context of an acute care or intensive geriatric rehabilitation unit, and to appraise and compare their measurement properties; second, to evaluate if in-hospital mobility assessed at admission is predictive of loss in functional capacity during hospitalization of older adults and to verify if other variables combined with in-hospital mobility can better predict loss in functional capacity; third, to assess functional changes of hospitalized older adults from pre-admission (baseline) until discharge and identify predictors of loss in functional capacity. Methods: This cohort prospective study was conducted at the Onofre Lopes University Hospital (HUOL), Natal/RN, Brazil, between January 1, 2014 and April 30, 2015. The study enrolled all consecutive patients aged 60 years and older who were acutely admitted and met the following inclusion criteria: 1) ability to provide informed consent; 2) admitted directly from the community; 3) screening for study eligibility performed in the first 24 hours of admission. Independent variables included personal characteristics, domestic living activities (i.e. instrumental activities of daily living ? IADL) evaluated by Lawton and Brody?s scale, cognition evaluated by Legan?s cognitive test, depression assessed by Geriatric Depression Scale (GDS-15), and in-hospital mobility evaluated by the Short Physical Performance Battery (SPPB). The dependent variable of functional capacity was assessed by the Katz scale. These instruments were applied at two different times: at admission (first 24 hours) and at discharge (12-24 hours before). Analysis included descriptive statistics, bivariate and multivariate analysis by means of frequencies, means ? standard error, receiver-operating characteristic (ROC), logistic binary regression and Generalized Estimating Equation (GEE). Data were entered into the Statistical Package for Social Sciences (SPSS) version 18.0 for Windows. Results: From the 1256 included at discharge, 65 (5.1%) died during hospitalization, thus the final sample consisted of 1191 older adults. The mean age was 70.02 (?7.34) and mean length of hospital stay was 7.65 days (?9.94). Our sample had a high prevalence of surgery (70.1%). Regarding the best instruments to assess mobility, the De Morton Mobility Index (DEMMI) and SPPB presented the best balance between mobility coverage, measurement properties and applicability to acute care and intensive geriatric rehabilitation units. A SPPB cutoff point of 6.5 (62% sensitivity, 54% specificity) identified 593 (49.8%) patients at risk for loss in functional capacity. In logistic regression, SPPB alone presented a statistically significant prediction loss of functional capacity between admission and discharge. Finally, regarding changes in functional capacity, 52.5% of the older adults were discharged with worse functional capacity than baseline. Being dependent for domestic life activities, presence of depression symptons, low levels of cognition and in-hospital mobility were risk factors for greater loss in functional capacity after a hospitalization event. Conclusion: We conclude that DEMMI and SPPB were the best instruments to assess mobility in hospitalized older adults. Regarding functional capacity, half the sample presented loss in functioning between baseline and discharge, while in-hospital mobility evaluated by SPPB can predict loss of function in hospitalized older adults. In addition to in-hospital mobility, dependence for domestic living activities, low levels of cognition and depression improve the detection of cases for being at risk of loss in functional capacity. / Introdu??o A medida que as pessoas envelhecem manter sua funcionalidade permanece um desafio. A funcionalidade consiste da habilidade do indiv?duo de realizar atividades de auto-cuidado (e.g. atividades de vida di?ria ? AVD?s) classificados dentro do n?vel de atividade e participa??o da Classifica??o Internacional de Funcionalidade, Incapacidade e Sa?de (CIF). Estudos anteriores identificaram fatores de risco para a diminui??o da capacidade funcional durante a hospitaliza??o que inclu?am idade avan?ada, caracter?sticas socioecon?micas, incapacidade preexistente, perda cognitiva, del?rio, co-morbidade. Mobilidade dentro do hospital tem recebido aten??o especial devido a sua importante rela??o com a perda da capacidade funcional. Poucos estudos foram realizados tendo como foco a avalia??o dos efeitos da hospitaliza??o em idosos brasileiros. Identificar idosos em risco para a perda funcional durante a hospitaliza??o poder? auxiliar pesquisadores e cl?nicos a tomar decis?es baseadas em evid?ncia. Objetivos Esse estudo contempla tr?s objetivos. Primeiro: promover uma atualiza??o a cerca dos instrumentos relevantes utilizados para avaliar a mobilidade de idosos baseado no conceito da CIF no contexto de hospitaliza??o ou unidades de reabilita??o geri?trica intensiva. Segundo: avaliar se a mobilidade avaliada dentro do hospital na admiss?o ? preditiva de perda funcional durante a hospitaliza??o em idosos e identificar fatores preditores de perda funcional. Terceiro: avaliar mudan?as funcionais desde antes da interna??o (medida de base) at? a alta hospitalar e identificar preditores de perda funcional. M?todos Esse estudo do tipo coorte prospectivo foi realizado no Hospital Universit?rio Onofre Lopes (HUOL), localizado em Natal/RN, Brasil entre primeiro de Janeiro de 2014 a 30 de Abril de 2015. Participaram do estudo pacientes com 60 anos ou mais de idade admitidos no hospital e que preencheram os crit?rios de inclus?o: 1) fornecer o termo de consentimento assinado; 2) advindo da comunidade; 3) ser abordado para participar do estudo dentro das primeiras 24 horas de interna??o. As vari?veis independentes incluem caracter?sticas pessoais, atividades de vida dom?stica (e.g. atividades instrumentais de vida di?ria ? AIVDs) avaliada pela escala de Lawton e Brody?s, a cogni??o foi avaliada pelo teste cognitivo de Legan?s, a depress?o foi investigada atrav?s da escala de depress?o geri?trica (GDS-15), a mobilidade dentro do hospital foi avaliada pela Short Physical Performance Battery (SPPB). A vari?vel dependente capacidade funcional foi avaliada pela escala de Katz. Esses instrumentos foram avaliados em dois momentos distintos: na admiss?o (primeiras 24 horas) e na alta hospitalar (12-24 horas antes). A an?lise estat?stica inclui an?lise descritiva, bivariada e multivariada, atrav?s de frequ?ncias, m?dias ? erro padr?o, receiver-operating characteristic (ROC), regress?o log?stica bin?ria e Equa??o de Estimativa Generalizada (EEG). Os dados foram inseridos atrav?s do SPSS vers?o 18.0 para Windows. Resultados Na alta hospitalar dos 1256 idosos inclu?dos na pesquisa 65 (5,1%) foram a ?bito durante a hospitaliza??o o que culminou em uma amostra final de 1191 idosos. A idade m?dia foi de 70,02 (?7,34), 684 (57,4%) dos participantes s?o homens e 790 eram casados (66,3%). A m?dia de dias de interna??o foi de 7,65 dias (?9,94). Nossa amostra apresentou uma frequ?ncia alta para abordagem cir?rgica (>70%). Em rela??o aos melhores instrumentos para avaliar mobilidade o De Morton Mobility Index (DEMMI) e o SPPB apresentaram o melhor equil?brio entre a cobertura do conceito de mobilidade, propriedades psicom?tricas e aplicabilidade em ambiente hospitalar e unidades de reabilita??o geri?trica. O ponto de corte do SPPB de 6.5 (62% sensibilidade, 54% especificidade) identificou 593 (49.8%) pacientes em risco para perda da capacidade funcional. Na regress?o log?stica o SPPB sozinho apresentou predi??o estatisticamente significante para perda funcional entre admiss?o e alta hospitalar. Finalmente em rela??o ?s mudan?as funcionais 52,5% dos idosos receberam alta hospitalar com uma capacidade funcional pior do que antes da interna??o. Ser dependente para as atividades instrumentais de vida di?ria, presen?a de sintomas depressivos, baixos n?veis de cogni??o e mobilidade dentro do hospital foram fatores de risco para perda funcional ap?s um evento de hospitaliza??o. Conclus?o Conclu?mos que DEMMI e SPPB foram os melhores instrumentos para avaliar mobilidade em idosos hospitalizados. Com rela??o a capacidade funcional metade da amostra apresentou perda da funcionalidade entre linha de base e alta hospitalar e a mobilidade dentro do hospital avaliada pelo SPPB pode predizer perda da capacidade funcional em idosos hospitalizados. Somando ? mobilidade dentro do hospital, depend?ncia para atividades dom?sticas, baixos n?veis de cogni??o e depress?o melhora a detec??o de casos de idosos em risco para perda da capacidade funcional