Made available in DSpace on 2015-04-14T13:53:54Z (GMT). No. of bitstreams: 1
447317.pdf: 114787 bytes, checksum: 8e1f0f8c0990d63c2a83d55f53ceb084 (MD5)
Previous issue date: 2012-11-30 / Introduction: the Frailty syndrome (FS) increases the risk of institutionalization, disability and death in the elderly. The concept of fragility evolved into propositions that are no longer limited only to physical and functional aspects. Several authors have studied other dimensions such as psychological and social support structure. However, few studies focused on primary health care.Objective: Develop and validate a multidimensional instrument for frailty screening in elderly patients in primary care.Materials and methods: Cross-sectional, observational, descriptive and analytical, conducted in a random sample of 355 elderly participants Multidimensional Study of the Elderly in Porto Alegre (EMISUS), from 27 different Family Health Strategies of the municipality of Porto Alegre. The elderly were evaluated by an interdisciplinary team. The clinical criteria for determining the phenotype of FS was modified Fried (unintentional weight loss, decreased grip strength, exhaustion and slow walking time - individuals with 0 points were not considered fragile, with 1 point were considered prefrail and those with 2 or more frail).Results: For the development of the instrument, 10 dimensions were initially selected (social (living alone), age (≥80 years old), sensorial (vision, audition and speech), depressed mood, cognition (remembering three words mentioned), medication (5 or more), Daily Life Activities (DLA) / Instrumental activities of daily living (IADL), balance, urinary incontinence and nutrition) categorized as present or not. In the analysis of the degree of concordance between the instrument and the modified Fried phenotype showed low statistical power (degree of concordance = 0.267). It was then performed the multiple logistic regression method Forward Stepwise and five models were generated. The independent predictive variables with greater odds ratio, included in the model 5 where the dimensions were included nutrition (P = 0.019), polypharmacy ( P = 0.005), dependence in DAL / IADL (P = 0.052), urinary incontinence (P = 0.010) and balance (P <0.001). Additionally, it was performed a ROC curve and established a cutoff point of 1/2 to discriminate between individuals of pre-frail/frail not fragile. The instrument sensitivity was 0.759 and specificity was 0.563. The positive predictive value was 0.583 and the negative predictive value was 0.745. The agreement with the IMSIFI Fried phenotype was considered good . By the criteria of Fried, the phenotype was more common non frail (44.5%) following the pre-frail (32.4%). At IMSIFI, most elderly was considered prefrail/ frail (72.9%). It was observed an association between both instruments (Fried and IMSIFI) with functional capacity (DAL / IADL).Conclusion: The instrument developed is objective and of rapid implementation for the context of primary health care. However, longitudinal studies are needed to to compare the IMSIFI with the complete Fried phenotype and other multidimensional instruments, as well as longitudinal studies, are required to prove the role of the IMSIFI in the screening FS / Introdu??o: A S?ndrome da Fragilidade (SF) aumenta o risco de institucionaliza??o, incapacidade e morte em idosos. O conceito de fragilidade evoluiu para proposi??es de natureza que n?o se limitam mais somente aos aspectos f?sicos e funcionais. Diversos autores t?m estudado outras dimens?es como a psicol?gica e a estrutura de apoio social. Por?m poucos estudos s?o voltados para a aten??o b?sica de sa?de.Objetivo: Elaborar e validar um instrumento multidimensional de rastreio de S?ndrome da Fragilidade em idosos atendidos na aten??o b?sica.Materiais e m?todos: Trata-se de um estudo transversal, observacional, descritivo e anal?tico, realizado em uma amostra aleat?ria de 355 idosos participantes do Estudo Multidimensional dos Idosos de Porto Alegre (EMISUS), provenientes de 27 diferentes Estrat?gias Sa?de da Fam?lia. Os idosos foram avaliados por uma equipe interdisciplinar. O crit?rio cl?nico para determina??o da SF foi o fen?tipo de Fried modificado (diminui??o de peso involunt?ria, for?a de preens?o palmar diminu?da, exaust?o e lentid?o do tempo de caminhada indiv?duos com 0 pontos foram considerados n?o fr?geis, com 1 ponto foram considerados pr?fr?geis e os com 2 pontos ou mais, fr?geis).Resultados: Para elabora??o do instrumento, foram selecionados, inicialmente 10 dimens?es [social (vive sozinho), idade (≥80 anos), sensorial (vis?o, audi??o e fala), humor depressivo, cogni??o (lembrar as tr?s palavras ditas), medicamentos (uso de 5 ou mais medicamentos), depend?ncia (AVD/AIVD), equil?brio (quest?o espec?fica), contin?ncia urin?ria (quest?o espec?fica) e nutri??o (IMC)] categorizados como presente ou n?o. Na an?lise do grau de concord?ncia entre o instrumento e o fen?tipo de Fried modificado, observou-se um grau fraco (P=0,267). Foi, ent?o, realizada uma regress?o log?stica m?ltipla pelo m?todo Forward Stepwise e cinco modelos foram gerados, sendo o modelo com as vari?veis preditivas de SF independentes com maior raz?o de chance (OR), as do modelo 5 [desnutri??o (P=0,019; OR=2,661), polifarm?cia, (P=0,005; OR=1,921), depend?ncia AVD/AIVD (P=0,052; P=4,584), incontin?ncia urin?ria (P=0,010; OR=1,876) e desequil?brio, (P<0,001; OR=3,316)]. Adicionalmente, foi realizada uma curva ROC e estabelecido o ponto de corte de 1/2 para discriminar os indiv?duos n?o fr?geis dos pr?fr?geis/ fr?geis. A sensibilidade do instrumento foi de 0,759 e a especificidade foi de 0,563. O valor preditivo positivo foi de 0,583 e o valor preditivo negativo foi de 0,745. A concord?ncia do instrumento multidimensional de rastreio de S?ndrome da Fragilidade (IMSIFI) com o fen?tipo de Fried foi considerada de grau bom (?rea abaixo da curva=0,720). Pelos crit?rios de Fried, 44,5% dos idosos foram considerados n?o fr?geis, 32,4% pr?-fr?geis e 23,1% fr?geis. Pelo IMSIFI, 27,1% foram considerados n?o fr?geis e 72,9% pr?-fr?gil/fr?gil. Observou-se associa??o de ambos instrumentos (fen?tipo de Fried modificado e IMSIFI) com depend?ncia.Conclus?o: Elaborou-se um instrumento objetivo e de r?pida aplica??o para o contexto da aten??o b?sica. Contudo, estudos adicionais comparando o IMSIFI com o fen?tipo completo de Fried e outros instrumentos multidimensionais, al?m de estudos longitudinais, s?o necess?rios para comprovar o papel do IMSIFI no rastreio de SF.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/2693 |
| Date | 30 November 2012 |
| Creators | Lind?so, Zayanna Christine Lopes |
| Contributors | Schwanke, Carla Helena Augustin |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Gerontologia Biom?dica, PUCRS, BR, Instituto de Geriatria e Gerontologia |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 4438661476953179033, 500, 600, 2296420844541114010 |
Page generated in 0.0026 seconds