Fatores associados à quedas em idosos moradores em cidades com diferentes índices de desenvolvimento humano

Abstract

Falls among the elderly is one of the biggest concerns regarding public health. It characterizes as a multi-factor event related to physiological, environmental and behavioral elements. Such accidents harm the individual physically, psychologically and socially and generate elevated costs for the country. One of the most relevant aspects regarding the prevention of the falls is identifying the risk factors. For that, it is necessary to understand the aging process among diverse populations, considering demographic, social, economic and regional contexts. Therefore, the objectives of this study were: (1) to evaluate the factors associated with the occurrence of falls in community-dwelling elderly in Belo Horizonte (BH) and Diamantina (DM); (2) to characterize e compare fallers and non-fallers elderly in these two cities. It is transversal, multicenter study of non-probalistic samples. Individuals with ages equal or superior to 60 years, who are independent walkers, and reside in the mentioned cities, were included in the study. Those who have disabling pain on their lower limbs or cognitive decline (Mini-Mental Status Examination) according to their schooling levels were excluded. Clinical conditions, social demographics factors (self-report), depressive symptoms (geriatric depression scale), fear of falling Falls Efficacy Scale-International),level of physical activity (Minnesota Leisure Time Activities Questionnaire), muscular strength (hand dynamometer), functional capacity (4.6 meters in marching speed) and body mass index (BMI), mobility/balance (Timed Up and Go-TUG) were analyzed. The outcome variable were the self-reports regarding falls that had happened in the past months. The falling elderly were characterized by their self-reports of one or more falls and the non-falling elderly, were those with no reports of falls. For the association of the variables with its closing on falls the correlation Spearman test was used, considering p<0.10 in order to include in this analyses of binomial regression using the forward stepwise likelihood ratio method. In the final logistics model, the level of significance p<0.05, expressed by odds ratio (OR), with a confidence interval of 95% was taken into consideration. For the comparisons, used the analyses of variance two factors (Anova two-way), the Bonferroni with post hoc, and the level of significance p<0.05. 173 community residing elderly participated in this study, being 100 of those residents of Belo Horizonte (70.94 ± 6.28 years of age), and 73 residents of Diamantina (72.97 ± 5.84 years of age). There was a correlation between the variables age (p= 0.05), schooling (p= 0.07), muscular strength (p= 0.01), and mobility (p= 0.08). These were included in a multivariate analyses (regression logistics), although, only the muscular strength variable remained as factor truly associated to the occurrence of falls (p= 0.02; OR: 0.93; IC95%: 0.87- 0.98). In the comparing between cities, there was a difference between the numbers of medication taken (p= 0.03), fear of falling (p= 0.03), functional capacity (p= 0.01) and mobility/balance (p= 0.03). In the comparing between fallers elderly and the non-fallers ones there was a difference in age (p= 0.03), schooling (p= 0.01) and muscular strength (p= 0.02). In the comparing between fallers elderly and the non-fallers ones and their residency location, a difference in schooling (p= 0.01) and medications in use (p= 0.03) were observed. Therefore concluding that muscular strength was the only factor that could be associated to the occurrence of falls in both elderly populations, in BH and DM. The elderly who reside in Belo Horizonte consumed more medication. On the other hand, the elderly population residing in Diamantina presented lower schooling levels, a bigger fear of falling despite better functional capacity and mobility. This information can support new strategies on dealing with these falls, on a specific manner, for the elderly population of the analyzed cities.