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Previous issue date: 2016-06-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O envelhecimento populacional ? um fen?meno mundial. No Brasil, o aumento da propor??o de idosos na popula??o vem sendo acompanhado por mudan?as no perfil epidemiol?gico, onde prevalecem as doen?as cr?nicas e agravos n?o transmiss?veis, sendo estas as principais causas de morbidade, incapacidade e mortalidade, especialmente nos idosos que residem em Institui??es de Longa Perman?ncia. A escassez de trabalhos envolvendo a situa??o de sa?de e de mortalidade dos idosos institucionalizados motivou a realiza??o desta pesquisa, que tem como objetivo determinar a mortalidade e seus fatores progn?sticos em idosos institucionalizados no munic?pio de Natal-RN. Trata-se de um estudo de progn?stico, com popula??o din?mica, iniciado em Outubro de 2013, com dura??o de 18 meses de acompanhamento a todos os idosos residentes (n=345) em institui??es de longa perman?ncia, com e sem fins lucrativos. Durante este per?odo, foram realizados sete ondas de avalia??o, onde foram mensuradas as seguintes vari?veis antropom?tricas: peso (kg), altura (cm), per?metros braquial (cm) e da panturrilha (cm). A triagem nutricional foi realizada utilizando a Mini Avalia??o Nutricional. As informa??es referentes ao consumo alimentar e a concentra??o de albumina s?rica foram obtidas a partir da an?lise de dados de uma outra pesquisa a qual esse estudo faz parte. J? as informa??es sobre as morbidades, hospitaliza??es, tipo de dieta e n?mero de medicamentos, foram obtidas por meio dos prontu?rios. Os dados socioecon?micos, sociodemogr?ficos e socioculturais foram coletados atrav?s de entrevistas estruturadas com aux?lio de question?rios. As informa??es sobre a mortalidade foram obtidas ap?s a an?lise do atestado de ?bito. Realizou-se a an?lise estat?stica mediante a an?lise de sobrevida pelo m?todo de Kaplan-Meier e, em seguida, regress?o de Cox na an?lise multivariada, com os respectivos hazards ratios (HR). Os 345 idosos avaliados apresentaram m?dia de idade igual a 81,2 (9,3) anos, com maior propor??o da popula??o ?75 anos (74,8%). A maioria dos institucionalizados ? do sexo feminino (76,5%), s?o solteiros (45,8%) e possuem algum grau de escolaridade (61,4%). Um total de 179 idosos (51,9%) possui restri??o de mobilidade, 89,0% foram diagnosticados com doen?as cr?nicas, 54% com desnutri??o e 45,2% utilizam mais de cinco medicamentos ao dia. As doen?as cr?nicas como a hipertens?o (45,5%) e o diabetes (25,0%), s?o as mais frequentes. Durante o seguimento, 70 idosos (20,3%, IC 95%=16,25% - 25,00%) foram a ?bito, nos quais as doen?as do aparelho respirat?rio (44,3%) e circulat?rio (30,0%) foram as suas principais causas. A probabilidade de sobrevida global dos idosos institucionalizados foi de 78,7% (IC, 0,74-0,83) ao final da coorte, onde os principais fatores progn?sticos identificados na an?lise de Cox foram a idade ? 75 anos (HR=3,85), per?metro da panturrilha inferior a 31cm (HR=2,58), alimenta??o por sonda (HR=2,59), alimenta??o pastosa (HR=2,23), com restri??o de mobilidade (HR= 1,76), sexo masculino (HR= 1,75) e polifarm?cia (HR=1,55). Dessa forma, melhorias nas condi??es de sa?de, com a??es voltadas a preven??o de doen?as respirat?rias e cardiovasculares, bem como a recupera??o do estado nutricional e adequa??o na prescri??o de alimentos e medicamentos podem resultar na redu??o do risco de mortalidade precoce. / Population aging is a global phenomenon. In Brazil, the increase in the proportion of elderly in the population has been accompanied by changes in the epidemiological profile, which are prevalent noncommunicable chronic diseases, which are the leading causes of morbidity, disability and mortality, especially in the elderly residing in nursing homes. The shortage of studies involving the situation of health and mortality in institutionalized elderly motivated this research, which aims to determine the mortality and its prognostic factors in institutionalized elderly in the city of Natal-RN. This is a prognostic study with dynamic population, started in October 2013 with duration of 18 months follow-up to all elderly residents (n = 345) in nursing homes, with and without profit. During this period, were realized seven assessment waves, where the following anthropometric variables were measured: weight (kg), height (cm), brachial perimeters (cm) and calf (cm). The nutritional screening was performed using the Mini Nutritional Assessment. Information about the food consumption and serum albumin concentration were obtained from the data analysis of a survey which this study is part. As for the information about morbidities, hospitalizations, diet type and number of medications they were obtained through medical records. Socioeconomic, demographic and sociocultural data were collected through structured interviews with questionnaires assistance. The information on mortality was obtained after analysis of death certificate. The statistical analysis was carried out through the analysis of survival by the Kaplan-Meier method, and then Cox regression at multivariate analysis, with the respective hazards ratios (HR). Thes 345 elderly evaluated presented mean age equal to 81.2 (9.3) years, with the largest proportion of the population ? 75 years (74,8%). Most institutionalized are female (76.5%), are single (45.8%) and have some degree of schooling (61.4%). A total of 179 elderly (51.9%) have mobility restriction, 89.0% were diagnosed with chronic diseases, 54% with malnutrition and 45.2% use more than five drugs a day. Chronic diseases such as hypertension (45.5%) and diabetes (25.0%) are the most frequent. During follow-up, 70 elderly (20.3%, CI 95%:16.25%- 25.00%) died, in which respiratory diseases (44.3%) and circulatory (30.0%) were the its main causes. The probability of overall survival of institutionalized elderly was 78.7% (CI: 0.74-0.83) at the end of the cohort, where the main prognostic factors identified in the Cox analysis were age ? 75 years (HR = 3 85), calf perimeter less than 31cm (HR = 2.58), tube feeding (HR = 2.59), doughy food (HR = 2.23), with mobility restrictions (HR = 1, 76), male (HR = 1.75) and polypharmacy (HR = 1.55). In this way, improvements in health, with actions directed to prevention of cardiovascular and respiratory diseases, as well as the recovery of nutritional status and fitness on prescription food and medications can result in reducing the risk of early mortality.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/22775 |
| Date | 29 June 2016 |
| Creators | Oliveira, Larissa Pra?a de |
| Contributors | 50337157472, Lyra, Clelia de Oliveira, 70406030472, Gomes, Igor Conterato, 33970223806, Ferreira, Maria Angela Fernandes, 39817270459, Veras, Renato Peixoto, 14963388715, Lima, Kenio Costa de |
| Publisher | PROGRAMA DE P?S-GRADUA??O EM SA?DE COLETIVA, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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