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Previous issue date: 2016-08-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O presente trabalho teve como objetivos principais: verificar a preval?ncia de incapacidade funcional (IF) para as atividades b?sicas da vida di?ria (ABVD) e os fatores associados (Estudo 1), assim como verificar a incid?ncia de decl?nio funcional e os fatores progn?sticos de decl?nio funcional (Estudo 2) em idosos institucionalizados. A amostra do trabalho foi formada por indiv?duos de 60 anos ou mais pertencentes a 10 institui??es de longa perman?ncia para idosos (ILPI) da cidade do Natal/RN, sendo exclu?dos os hospitalizados ou em processo de cuidados paliativos. O Estudo 1 ? de tipo transversal (Outubro e Dezembro de 2013) e foi avaliada a IF mediante a escala de Katz e caracterizada quando houve limita??o em uma ou mais ABVD (alimenta??o, controle de esf?ncteres, transfer?ncias posturais, higiene pessoal, capacidade para se vestir e tomar banho). Como vari?veis independentes foram consideradas as sociodemogr?ficas, as relacionadas ? institui??o e ?s condi??es de sa?de. Usaram-se o teste qui-quadrado, teste de Fisher ou teste qui-quadrado de tend?ncia linear para a an?lise bivariada, assim como a regress?o log?stica para a multivariada. A amostra foi de 321 idosos e a preval?ncia de IF de 72,9% (IC 95%: 67,8-77,5%). A tarefa mais afetada foi o ?banho?, seguido por ?vestir-se? e ?ir ao banheiro?. O modelo final constatou associa??o com a institui??o de tipo privado (RP=1,33, p<0,001), idade igual ou superior a 83 anos (RP=1,26, p=0,003), ser institucionalizado por n?o ter cuidador (RP=1,17, p=0,033) e osteoporose (OR=1,23, p=0,045), ajustado por sexo. O Estudo 2 ? longitudinal de 24 meses de acompanhamento com intervalos de follow-up de 6 meses (5 ondas). Al?m dos crit?rios aplicados no Estudo 1, foram exclu?dos aqueles que apresentavam IF para todas as ABVD (banho, higiene pessoal, vestir-se, ir ao banheiro, caminhar, transfer?ncias posturais e comer) no in?cio do estudo. Foi considerada a presen?a de decl?nio funcional quando houve redu??o na pontua??o total das ABVD, as quais foram avaliadas mediante uma escala tipo Likert de 5 pontos. Foram analisadas todas as vari?veis independentes do Estudo 1, mais o estado de mobilidade, cognitivo (teste de Pfeiffer), h?bitos t?xicos e atividade f?sica, al?m de vari?veis dependentes do tempo. Para a an?lise estat?stica, foi utilizado o m?todo atuarial, o teste log-rank, a an?lise univariada de Cox e a regress?o de Cox. A coorte esteve composta por 280 idosos: 140, 50,0% (IC 95%: 44,2-55,8%), sofreram decl?nio funcional, 94, 33,6% (IC 95%: 28,3-39,3%) mantiveram a capacidade funcional, e 40, 14,3% (IC 95%: 10,7-18,9%), apresentaram melhora funcional em uma ou mais avalia??es. A probabilidade acumulada de manuten??o funcional foi de 44,0% (IC 95%: 37,7-50,2%) aos 24 meses. A capacidade de se alimentar foi a que apresentou maior decl?nio durante o per?odo (-0,54 pontos), seguido por deambula??o (-0,43), vestir-se (-0,35), transfer?ncias posturais (-0,31), banho (-0,29), higiene pessoal (-0,24) e ir ao banheiro (-0,22). O modelo multivariado mostrou que os fatores predictores de decl?nio funcional foram a incapacidade cognitiva grave (HR=1,98; p=0,003), decl?nio da contin?ncia (HR=1,70; p=0,013) e incid?ncia de hospitaliza??es (HR=1,65; p=0,023). / The main objectives of this work were: to verify the prevalence of functionaldisability (FD) inthe basic activities of daily living (BADL) and its associated factors (Study 1) and verify the incidence of functional decline and predictor factors of functional decline (Study 2) in institutionalized older people. The sample of the study was formed by individuals aged 60 years and over belonging to 10 nursing homes (NH) in Natal/RN, being excluded hospitalized or palliative care residents. The Study 1 is a cross-sectional study (October-December 2013) and FD was evaluated by Katz scale and characterized when there was limitation in one or more BADL (eating, sphincter control, transferring, personal hygiene, dressing and bathing). As independent variables sociodemographic, instituition-related health-related variables were considered. The Chi-square test, Fisher's exact test or the linear Chi-square test for the bivariate analysis and logistic regression for multivariate analysis were applied. The sample consisted of 321 individuals and the prevalence of FD was 72.9% (95% CI: 67.8-77.5%). The most affected task was 'bathing', followed by 'dressing' and 'toileting.' The final model found association with private NH (PR=1.33, p<0.001), age 83 and over (RP=1.26, p=0.003), reason for institutionalization ?lack of caregiver? (RP=1.17, p=0.033) and osteoporosis (RP=1.23, p=0.045), adjusted by sex. The Study 2 is a 24-months longitudinal study with follow-up every 6 months (5 waves). Apart from the criteria considered in the Study 1, residents with FD for all BADL (bathing, personal hygiene, dressing, toileting, walking, transferring and eating) at baseline were excluded. The presence of functional decline was defined when there was a reduction the total score of BADL, which were assessed by a 5-point Likert scale. All independent variables of the Study 1 were considered, as well asthe mobility status, cognitive status (Pfeiffer test), toxic habits, physical activity and time-dependent variables. Statistical analysis was performed using the actuarial method, log-rank test, Cox univariate analysis and Cox regression. The cohort was composed of 280 individuals: 140, 50.0% (95% CI: 44.2-55.8%) experienced functional decline; 94, 33.6% (95% CI: 28.3-39.3%), maintained their functional capacity, and; 40, 14.3% (95% CI: 10.7-18.9%), showed functional improvement at one or more waves. The cumulative probability of functional maintenance was 44.0% (95% CI: 37.7-50.2%) at 24 months. The ability to eat showed the largest decline during the period (-0.54 points), followed by walking (-0.43), dressing (-0.35), transferring (-0.31), bathing (-0.29), personal hygiene (-0.24) and toileting (-0.22). The final model showed that the predictors factors of functional decline were severe cognitive impairment (HR=1.96, p=0.001), continence decline (HR=1.85, p=0.002) and incidence of hospitalizations (HR=1.62, p=0.020).
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/21961 |
| Date | 23 August 2016 |
| Creators | Roig, Javier Jerez |
| Contributors | 50337157472, Pernambuco, Leandro de Ara?jo, 02862922463, Ferreira, Maria Angela Fernandes, 39817270459, Zunzunegui, Maria Victoria, 00000000000, Guerra, Ricardo Oliveira, 39643069400, 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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