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Previous issue date: 2012-03-23 / Falls and fractures in the elderly represent a significant public health problem, facing the process of longevity of the Brazilian population. They are associated with higher rates of morbidity and mortality, reduction of functional capacity, increased frailty, institutionalization of elderly and early death. The influence of environmental factors on the risk of falls is related to the functional state and mobility of elderly people with gait and balance changes. Although there are scientific studies in Brazil that indicate that there is association of falls and fractures with clime in elderly, in the State of Rio Grande do Sul this problem is little studied. Against this reality, the present study aimed to investigate falls and fractures in the elderly (60 years and over) resident in municipalities of the metropolitan and Serra region in the State of Rio Grande do Sul, Brazil. This study is characterized as cross-sectional, retrospective, descriptive and analytical, quantitative of elderly patients in the year 2010. Data were collected from the 6633 charts of elderly patients presenting falls from four units of Urgency and Emergency (UAUEH) SUS, RS/Brazil. The final sample of 6,556 elderly assisted by falls after the inclusion and exclusion criteria established. Among them, 4,664 (71%) were women and 1,892 (29%) were men, with 26.8% of cases occurring in winter followed by autumn with 24.5%. More than half of the visits (57%) were performed up to 6 hours after the fall. The fall site was not reported in 83% of the charts. Among the bulletins reporting the location of the fall, 42% of them were at home and 58% outside of the home. Falls on stairs, bus and bed were the three most frequently reported risk locations. Only 30% of reports contain records on vital signs. Blood pressure as the most observed and recorded. The winter was the season with the highest average of systolic and diastolic blood pressure. The degree of consciousness was mentioned only in 20.4% of the charts. This percentage was higher in elderly patients with brain injure where almost 50% had the degree of consciousness recorded. 31% of falls had fractures confirmed by radiological investigation, 32% of the women and 28% of the men (p <0.0001). Average age of fractured people was significantly higher than people who do not fractured. Fractures of the upper limbs were the most frequently recorded with 978 fractures, followed by fractures of the lower limbs with 620 fractures. The season with the highest number of confirmed fractures was the winter where fractures were observed in 34% of falls (p = 0.0002). The season with the lowest percentage of fractures was the spring within 28% of falls. Age, sex, and winter were the significant risk factors for falls. A person one year older is 2.2% more likely to fracture when falling. The chances of women fracture after a fall are 15% higher than men the same age. All other seasons were protective factors when compared to winter. When compared with those who felt in winter, older people who fall in the spring are 27% less likely to fracture when falling (p <0.0001), and this chance to 22% in summer (p = 0.0011) and 8% in autumn (p = 0.2854). We conclude that falls in the winter months are more frequent and more severe. Female gender and older age are more vulnerable to falls and fractures. We face structures using emergency care routines inappropriate for the elderly. Little heed seems to have been given to the elderly who have fallen in order to diagnose the possible causes of the fall. The biggest challenges for the effectiveness of preventing falls and fractures in the elderly to be faced in practice are professional training of health services network, the creation of programs and activities of multifactorial intervention. The reorganization of services and continuous improvement actions and ongoing care by a multidisciplinary team, working in a coordinated and integrated in different multifactorial intervention programs more individualized, is an essential prerequisite for the prevention of falls and fractures. This reorganization is essential to obtain complete and reliable data about the care provided in the elderly. This survey results point to the need for further epidemiological and clinical studies that can clarify issues related to other approaches to risk factors for falls and fractures. These approaches include behavioral factors, extrinsic and intrinsic multifactorial interventions; particularly in the context of primary and secondary care by the Brazilian Unique Health System. / Quedas e fraturas em pessoas idosas representam um problema de sa?de p?blica relevante frente ao processo de longevidade da popula??o brasileira. Estas est?o associadas a elevados ?ndices de morbimortalidade, redu??o da capacidade funcional, aumento da fragiliza??o, de institucionaliza??o do idoso e ?bito precoce. A influ?ncia dos fatores ambientais no risco de quedas associa-se ao estado funcional e a mobilidade daquelas pessoas idosas com altera??es de equil?brio e marcha. Embora existam estudos cient?ficos no Brasil que indicam que h? associa??o das quedas e fraturas com o clima em idosos, no Rio Grande do Sul esta problem?tica ainda ? pouco estudada. Frente a esta realidade o presente estudo teve como objetivo geral investigar quedas e fraturas em pessoas idosas (60 anos e mais), residentes em munic?pios da regi?o metropolitana e da serra ga?cha do Estado do Rio Grande do Sul/Brasil. Caracterizou-se por ser um estudo transversal, retrospectivo, descritivo-anal?tico, quantitativo, de idosos atendidos por queda no ano de 2010. Os dados foram coletados a partir dos 6.633 boletins de atendimentos de idosos de quatro Unidades de Urg?ncia e Emerg?ncia (UAUEH) do SUS do RS/Brasil. A amostra final foi de 6.556 idosos atendidos por queda, respeitando os crit?rios de inclus?o e exclus?o estabelecidos. Entre os idosos atendidos 4.664 (71%) eram mulheres e 1.892 (29%) com 26,8% dos atendimentos ocorrendo no inverno seguido do outono com 24,5%. Mais da metade dos atendimentos (57%) foram realizados nas unidades at? 6 horas ap?s a queda. O local da queda n?o foi relatado em 83% dos boletins. Entre os boletins com local relatado 42% das quedas no domic?lio e 58% fora do mesmo. Quedas em escada, ?nibus e cama foram os tr?s locais de risco mais relatados. Apenas 30% dos boletins continham registro dos sinais vitais, sendo a press?o arterial o mais verificado e registrado. O inverno foi a esta??o com a maior m?dia das press?es arteriais sist?lica e diast?lica. O grau de consci?ncia foi mencionado somente em 20,4% dos boletins. Essa percentagem foi um pouco maior em idosos com traumatismo cranioencef?lico, onde menos de 50% teve esse registro realizado. 31% das quedas tiveram fratura confirmada pela investiga??o radiol?gica, sendo 32% em mulheres e 28% em homens (p<0,0001). Idade das pessoas fraturadas foi significativamente maior do que as pessoas que n?o fraturaram. Fraturas dos membros superiores foram as mais registradas com 978 fraturas, seguidas das fraturas dos membros inferiores com 620 fraturas. A esta??o do ano com maior n?mero de fraturas confirmadas foi a do inverno onde foram observadas fraturas em 34% dos atendidos (p=0,0002). A esta??o do ano com menor percentual de fraturas foi a primavera com 28% das quedas. Idade sexo e inverno foram os fatores de risco significativos para as quedas. Uma pessoa um ano mais velha tem 2,2% mais chance de fraturar ao cair. As chances das mulheres fraturarem ao cair s?o 15% maiores do que os homens na mesma idade. Todas as outras esta??es do ano foram fatores protetores quando comparadas ao inverno. Quando comparados com os que caem no inverno, idosos que caem na primavera t?m 27% menos chance de fraturar ao cair (p<0,0001), sendo essa chance de 22% no ver?o (p=0,0011) e 8% no outono (p=0,2854). Conclu?mos que as quedas nos meses de inverno s?o mais frequentes e com maior gravidade. Sexo feminino e faixa et?ria mais elevada s?o mais vulner?veis a quedas e fraturas. Deparamo-nos com estruturas emergenciais utilizando rotinas de atendimento inadequadas aos idosos. Pouca import?ncia parece ter sido dada aos idosos que ca?ram no sentido de diagnosticar as poss?veis causas da queda. Os maiores desafios para a efetiva??o da preven??o de quedas e fraturas em idosos a ser enfrentados na pr?tica s?o: a capacita??o dos profissionais da rede de servi?os do SUS; a cria??o de programas e a??es de interven??o multifatoriais; a reorganiza??o dos servi?os e o aperfei?oamento cont?nuo e permanente das a??es de atendimento pela equipe multiprofissional, atuando de forma articulada e integrada, nos diferentes programas de interven??o multifatorial mais individualizada, ? condi??o imprescind?vel na preven??o de quedas e fraturas. Essa reorganiza??o ? essencial para a obten??o de dados completos e seguros sobre os atendimentos realizados nos idosos. Os resultados da pesquisa apontam para a necessidade de novos estudos epidemiol?gicos e cl?nicos que possam esclarecer outras quest?es relacionadas ?s abordagens sobre os fatores de risco de quedas e fraturas. Essas abordagens incluiriam fatores comportamentais, extr?nsecos e intr?nsecos, interven??es multifatoriais, principalmente em ?mbito de aten??o b?sica e secund?ria do SUS.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/2675 |
| Date | 23 March 2012 |
| Creators | Caberlon, Iride Cristofoli |
| Contributors | B?s, ?ngelo Jos? Gon?alves |
| 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 |
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