Preditores associados à Fragilidade no Idoso em um Serviço de Atenção Secundária em Saúde do Idoso

Abstract

Decreasing in population fertility and mortality rates, linked to increasing in life expectancy, have determined new challenges related to the expansion of the elderly population, which encouraged the search for a better understanding of the aging process in its particularities - of a multidimensional nature. One of the factors that is most related to the heterogeneity of the health determinants of the older adults is frailty. The term frailty is used to measure the degree of vulnerability of an individual to adverse outcomes, such as falls, functional disabilities, institutionalization and mortality. However, operationalization of frailty concept and of multiple variables involved in it becomes a dilemma in face of different definitions in this construct. In the meantime, the present work aims to analyze the health predictors associated with frailty in an elderly population, assisted by the service of secondary care in geriatrics. To this end, we carried out a cross-sectional observational study based on outpatient data that included a sample of 4,323 instruments for the clinical-functional assessment of the elderly, applied to patients aged 60 years and over and treated at the Reference Center for the Elderly, between November from 2016 to March 2020. Data collection and data processing took place through software, REDCap and SPSS 20.0., respectively. Quantitative variables were presented in median format due to the nonnormal distribution of the sample. Clinical-functional variables were presented in percentages of frequency in the population studied, as well as univariate logistic regressions were performed in order to obtain associations between the response variable and each of the independent variables individually. In view of this, using odds ratio (OR), 95% confidence interval (CI) and p-value, the selected independent variables were analyzed in comparison to the dependent variable of the study: functional stratum treated using the Visual Frailty Scale dichotomized into frail and nonfrail. Furthermore, we performed multivariate regression using the stepwise and forward methods of selecting variables in the equation. Thus, through physical characteristics and cognitive aspects, seven variables were related to the frailty of older adults. Age (OR 1.016; 95% CI 1.001 – 1.028; p< 0.001), dementia (OR 5.179; 95% CI 3.839 – 5.961; p< 0.001), depressive symptoms (OR 1.268; CI 951.090 – 1.475; p: 0.002), urinary incontinence (OR 1.330; 95% CI: 1.153 – 1.535; p< 0.001), changes in gait pattern (OR 1.483; 95% CI: 1.287 – 1.709; p< 0.001), calf circumference (OR 0.956; CI 95%: 0.932 – 0.982; p=0.001), body mass index (OR 1.026; 95% CI: 1.008 – 1.044; p=0.005). The present study analyzed main predictors of frailty in older adults treated at an outpatient secondary health service. Our results corroborate with multidimensionality of the frailty syndrome