Vulnerabilidade clínico-funcional e autopercepção vocal e auditiva de idosos com histórico de hanseníase

Abstract

INTRODUCTION: Leprosy is a bacterial infectious disease. When not treated early, it has a high incapacitating potential because it causes lesions on the skin, peripheral nerves and cranial nerves. In Brazil, between the 30´s and 80´s, leprosy´s approach as prophylaxis and treatment occurred in colonies to leprosy disease in a compulsory and isolationist form. From the 80´s, leprosy colonies changed their perspective by offering treatment to the new cases of leprosy and maintaining the health care of those who lived there since compulsory intervention´s period. Santa Izabel Home Health is an old leprosy colony and nowadays its mission is to provide humanized and quality assistance to users of the Unified Health System, prioritizing people who was affected by leprosy, the elderly and those who need rehabilitation. Elders with leprosy history present clinical and functional impairment at several levels. The most vulnerable groups may be related with a bigger impairment in voice and hearing, causing physical, emotional and social damage in elderly's life. OBJECTIVE: To describe and verify the association between clinical and functional vulnerability classification and vocal and self-perception auditory in elders with leprosy history. METHODS: This was an observational cross-sectional study, developed at Santa Izabel Home Health in Betim-MG. A total of 117 elderly, men and women, with leprosy history participated in the study. We excluded elders with cognitive loss or suspected cognitive impairment loss that was measured by the Mini Mental State Examination. The elderly had sociodemographic and response data to the Clinical-Functional Vulnerability Index 20 (CFVI-20), collected in medical records and answered to the protocols of Screening for Vocal Alteration in the Elderly (SVAE), Voice Handicap Index (VHI-10) and Hearing Handicap Inventory for the Elderly - Screening Version (HHIE-S). The CFVI-20 is composed of 20 questions that are distributed in eight sections: age, health self-perception, functional disabilities, cognition, mood, mobility, communication and multiple comorbidities. The protocol classifies the elderly as robust (total score between 0-6); elderly in risk of becoming fragile (scores between 7-14); fragile elderly (score between 15 and 40). The vocal self-perception was evaluated through SVAE and VHI-10 protocols. SVAE is a screening instrument that identifies the prevalence of vocal alterations in elderly. It is composed of 10 questions that are associated with sensations and perceptions of vocal symptoms, as well as the frequency that they appear, the SVAE score can range from 0 to 20. The score total with more than three points defines the presence of vocal changes. The VHI-10 is composed of 10 questions that refers to the damag vocal handicap in the person´s life, the responses can range between 0 and 20. A score above 7,5 shows the presence of vocal handicapes. The HHIE-S was used to evaluate the restriction on auditory participation. It is a protocol that is composed of ten questions, which is divided in two sessions (social / situational scale and emotional scale). Score above 8 shows restriction on auditory participation. The sociodemographic and CFVI-20 information collected in the medical record, as well as the results of the protocols of vocal self-perception (SVAE and VHI-10) and auditory (HHIE-S) answered by the participants were describe in the study. To analyze the association between clinical-functional vulnerability and explanatory variables, the logistic proportional odds logistic regression model was used. RESULTS: From the elderly evaluated, 37.6% were classified as robust, 35.0% as risk of becoming fragile and 27.4% and as fragile. Vocal alteration, vocal handicap and restriction on auditory participation were observed in 65.8%, 24.8% and 48.7% of the elderly, respectively. In the multivariate analysis, elders (OR = 1.11, CI: 1.05-1.16) and individuals with vocal handicap (OR = 4.11, 95% CI: 1.77-9.56 ) were more likely to be in frailty risk and fragile categories. There was no statistically significant association between clinical-functional vulnerability and gender, institutionalization, restriction on auditory participation and vocal alteration. When combining the frequency distribution of the vocal handicap variables and restriction on auditory participation, it was verified that the simultaneous presence of both conditions (46.9%) was higher among the elderly that are considered fragile. CONCLUSION: Elderly patients with leprosy history present a high fragility risk and clinical-functional fragility. The results show that the increase in the age of the elderly with leprosy history and vocal handicap self-perception is associated with the presence of clinical-functional vulnerability. Vocal handicap and restriction on auditory participation are more frequent in the fragile elderly.