Traumatismos maxilofaciais em idosos vítimas de queda: análise comparativa entre os períodos pré-pandêmico e pandêmico de Covid-19 em um hospital público de Belo Horizonte - Brasil

Abstract

The increase in the active elderly population is a worldwide phenomenon, which has also been seen in Brazil. This change in demographic profile tends to lead to a change in morbidity and mortality to which the health system and the population in general must adapt in order to offer the best possible care. Research indicates a high occurrence of falls in the elderly and they are a risk factor for this population, especially for the oldest old due to intrinsic and extrinsic factors, which can lead to morbidity and mortality. To our knowledge, no comparative studies of falls in the elderly in the pre-pandemic and pandemic periods of Covid-19 have been found. The Covid-19 pandemic has changed the routine of the elderly due to movement restrictions and social distancing. The social distancing can lead to falls and consequent maxillofacial injuries, impacting victims and society. This study addresses maxillofacial injuries in elderly fall victims and evaluates the pre-pandemic and pandemic periods of Covid-19 in a public hospital in Belo Horizonte, Brazil. Its objectives are to analyze the epidemiological profile of the victims according to gender, age group and type of injury suffered; to comparatively analyze fall events in the pre-pandemic and pandemic periods of Covid-19; to analyze the prevalence of the different fall mechanisms, the type and location of the injury suffered; to analyze the period of the day and week in which the falls occurred; to analyze the proposed treatment modality; to present an algorithm and a protocol for decision-making in the care of elderly victims of maxillofacial injury. This cross-sectional study carried out from the collection of secondary data from the Oral and Maxillofacial Surgery and Traumatology service of the Hospital Metropolitano Odilon Behrens. Cases of elderly patients suffering from maxillofacial injury resulting from a fall treated at this hospital between January 1, 2017 and December 31, 2022 were included. The independent variables of interest were: time of day, day of week, types of fall, age of victims (60 to 74 years old and 75 years or older), types of maxillofacial injury suffered and type of proposed treatment. All events unrelated to the fall outcome were excluded. The analyzes involved descriptive statistics and bivariate analysis using SPSS version 20.1 software from databases collected and tabulated in the Excel program. This research was submitted to the Research Ethics Committees of the Federal University of Minas Gerais and the Hospital Metropolitano Odilon Behrens. The sample consisted of 835 elderly people (ages ranged from 60 to 101 years old). Approximately 59% of the sample was made up of non-long-lived elderly people aged (60-74 years) and 59.0% were female. The fall from one’s own height was reported by more than 85.0% of the elderly; the majority of falls (51.1%) occurred during the day and 72.8% of falls occurred during the week. In the pre-pandemic period (2017 to 2019), the frequency of falls was 51.3% and in the pandemic period (2020 to 2022), there was a slight decrease (48.7%). The types of injuries were as follows: soft tissue injuries (54.9%), followed by simple fractures (32.9%); dentoalveolar injuries (6.6%) and lastly, multiple fractures (5.6%). Conservative treatment was more than 90% in cases of falls. In the bivariate analysis, the frequency of falls during the pandemic was higher among elderly men (p=0.031). There was no association with the other variables. Women prevailed in falls, except during the pandemic when men suffered more falls. In most cases, the etiology was a fall from a height. There was a reduction in cases of falls during the pandemic period. Maxillofacial soft tissue injuries and simple fractures were the most prevalent. Conservative treatment was the most used. Falls in the elderly are multifactorial and complex to analyze, requiring more studies to understand the epidemiology of maxillofacial trauma and intervention on associated factors. With these results, three technical/scientific products were created: an article, a protocol, and an algorithm. The high prevalence, the considerable increase in this portion of the population in society and the scarcity of research related to the topic, requires a differentiated treatment and requires a more attentive look on the part of health system managers and the scientific community, not only due to the particularities of this population, but also to reinforce the means of preventing maxillofacial trauma, which in most cases could be avoided.

Keywords: falls; elderly; maxillofacial injuries; pandemic; coronavirus.