Dissertations / Theses on the topic 'Accidental falls'
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Xu, Tianma. "Development of Stepping On After Stroke fall prevention program in Singapore." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18918.
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The aim of the work was to develop a group-based fall prevention program for community-living stroke survivors by adapting an evidence-based fall prevention program, Stepping On. This thesis comprises of five studies using mixed methodologies. The first study, a systematic review and meta-analysis confirmed that fall risk factors in this studied group are multifactorial and suggested that interventions should be multi-dimensional. In the second study, semi-structured interviews with community-living stroke survivors and caregivers conducted in Singapore identified the common self-perceived fall risk factors post-stroke, main challenges and common safety and coping strategies after a fall post-stroke. The third study, focus groups with therapists trained in Stepping On reported a lack of structured fall prevention programs and suggested adapting the Stepping On with some changes and additional key elements to suit the target population. In the fourth study, building on the earlier work, the key elements of Stepping On After Stroke (SOAS) program were reviewed by international and Singapore experts using a modified Delphi method. The program was further refined based on the review findings. In the final study, the adapted SOAS program was piloted with two groups of stroke survivors and their caregivers in two community centres. The results suggest that it is acceptable and feasible to implement this group-based SOAS program with the target population in Singapore. In summary, the findings from this research have made novel contributions to fall prevention in community-living stroke survivors in Singapore and other countries. The research suggests the need for a structured fall prevention program targeting both stroke survivors and caregivers and focusing on the modifiable fall risk factors with its aim to reduce fall risk and increase community participation. However, further fine-tuning of the program is needed before moving to a larger scale study.
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Bea, Jennifer W., Cynthia A. Thomson, Robert B. Wallace, Chunyuan Wu, Rebecca A. Seguin, Scott B. Going, Andrea LaCroix, et al. "Changes in physical activity, sedentary time, and risk of falling: The Women's Health Initiative Observational Study." ACADEMIC PRESS INC ELSEVIER SCIENCE, 2017. http://hdl.handle.net/10150/623524.
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Falling significantly affects quality of life, morbidity, and mortality among older adults. We sought to evaluate the prospective association between sedentary time, physical activity, and falling among post-menopausal women aged 50-79 years recruited to the Women's Health Initiative Observational Study between 1993 and 1998 from 40 clinical centers across the United States. Baseline (B) and change in each of the following were evaluated at year 3 (Y3) and year 6 (Y6; baseline n= 93,676; Y3 n= 76,598; Y6 n= 75,428): recreational physical activity (MET-h/wk), sitting, sleeping (min/day), and lean body mass by dual energy X-ray absorptiometry (subset N= 6475). Falls per year (0, 1, 2, >= 3) were assessed annually by self-report questionnaire and then dichotomized as = 1 and = 2 falls/year. Logistic regression models were adjusted for demographics, body mass index, fall history, tobacco and alcohol use, medical conditions, and medications. Higher baseline activity was associated with greater risk of falling at Y6 (18%; p for trend <0.0001). Increasing sedentary time minimally decreased falling (1% Y3; 2% Y6; p < 0.05). Increasing activity up to >= 9 MET-h/wk. (OR: 1.12, 95% CI: 1.03-1.22) or maintaining >= 9 MET-h/wk. (OR: 1.20, 95% CI: 1.13-1.29) increased falling at Y3 and Y6 (p for trend <0.001). Adding lean body mass to the models attenuated these relationships. Physically active lifestyles increased falling among post-menopausal women. Additional fall prevention strategies, such as balance and resistance training, should be evaluated to assist post-menopausal women in reaching or maintaining levels of aerobic activity known to prevent and manage several chronic diseases.
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Gunn, Hilary. "An investigation of accidental falls in people with multiple sclerosis." Thesis, University of Plymouth, 2015. http://hdl.handle.net/10026.1/3315.
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More than 50% of people with MS fall in any six-month period. The importance of developing a suitable falls management programme has been identified by people with MS and professionals. This thesis aimed to develop a model for an MS falls intervention. The studies employed a systematic approach to evaluate the risk factors for falls and to identify the optimal programme content, format and structure. Methods The thesis comprises two sections; the first involving a systematic review and an observational study of falls risk factors (n=148). Part two included a second systematic review to inform programme content, and a nominal group study (n=36) to explore approach, format and structure from the perspective of key stakeholders. Results Part one identified the potential target group (people at key mobility transition stages and those with progressive MS), and mechanisms by which the intervention could act (the identification of specific risk factors associated with falls in MS). These include non-modifiable disease and demographic characteristics (e.g. MS classification and gender), and potentially modifiable clinical characteristics (including balance, mobility, continence issues and medication usage). Part two identified that an MS specific falls programme should address falls and participation-related outcomes, incorporating educational activities and a programme of individually tailored gait, balance and functional training. The programme should use a collaborative approach; supporting participants to achieve sufficient intensity and duration of exercise and to integrate falls prevention strategies into their daily lives. The programme should enable participants to engage flexibly according to individual needs and preferences. Conclusions This thesis has identified specific risk factors associated with accidental falls in MS. The evaluation indicates that the success and sustainability of an MS falls programme requires that it is MS specific, employs a collaborative approach and moves away from the group-based, weekly format common to many generic falls programmes.
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Nilsagård, Ylva. "Walking ability, balance and accidental falls in persons with Multiple Sclerosis." Doctoral thesis, Örebro universitet, Hälsoakademin, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2518.
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By using a pragmatic paradigm, different research methodologies were employed in this thesis. MS-related symptoms may be exaggerated due to heatsensitivity and it is supposed that cooling garments relieve the symptoms. The effects of wearing a Rehband® vest were evaluated in a sample of 42 persons with MS in a randomised controlled crossover study. Both objective and subjective statistically significant improvements were found when a cooled Rehband® vest was worn compared to the wearing of a room-tempered vest. Using a repeated-measures design, 10m and 30m timed walks and Timed Up and Go were studied in 42 persons with MS. Reproducibility was investigated within and between test points. High reproducibility was found both within (r=0.97–0.98) and between measure points (r=0.91–0.93). The correlation between the three tests was high (r=0.85). Differences at –23% to +40% were established as being needed to detect genuine changes. Severity of MS infl uenced the size of the differences, especially for the 30m timed walk test. The 12-item MS Walking Scale was translated and used in a cross-sectional study. Out of 81 persons with MS, 89–96% perceived limitations in standing or walking. The internal consistency of the scale was acceptable for nine items (0.69–0.84). The concurrent validity between the 12-item MS Walking Scale and the investigated objective tests was low: Berg Balance Scale (r=–0.368**), Four Square Step Test (r=0.338**) and Timed Up and Gocognitive (r=0.319*). A prevalence of falling was found at 63% in a longitudinal cohort study with prospectively registered falls including 76 persons with MS. The odds of falling were fi ve fold when there was a reported need of using a walking aid indoors and outdoors and by 2.5 to 15.6 times while there was disturbed proprioception, depending on severity. The highest sensitivity was found for the Berg Balance Scale (94%) and the highest specifi city was found for the 12-item MS Walking Scale (82%). Positive predictive values at 70–83% were found for the Berg Balance Scale, Timed Up and Gocognitive, the Four Square Step Test and the 12-item MS Walking Scale. Finally, we explored and described factors that persons with MS perceive as related to accidental falls. A content analysis with a deductive approach was chosen. By conducting interviews, we found previously untargeted factors: divided attention, reduced muscular endurance, fatigue and heat-sensitivity. The content of the interviews also gave support to previously reported risk factors such as changes in gait pattern, walking disability, impaired proprioception and vision, and spasticity.
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Beavis, Anne-Marie, Lynette Mackenzie, Lindy Clemson, and Amy Tan. "Systematic review (and meta-analysis) of interventions studies with GP involvement in falls prevention for community dwelling older people." Thesis, Discipline of Occupational Therapy, 2018. http://hdl.handle.net/2123/18337.
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Falls are a significant health problem for the ageing population as health outcomes decline as 30% of people over the age of 65 experience at least one fall annually. Prevention interventions are well established in the literature but falls continue in high numbers in Australia, in line with global trends. General practitioners are well situated to reduce falls for community dwelling older people but research is unclear which interventions are effective in the general practice context. Using a systematic review methodology with meta-analysis this review has addressed the question of which interventions are applicable in the general practice context. This study has identified falls risk screening, medication screening and management, and general practitioner training and education to be effective interventions to reduce falls in older people.
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Eriksson, Staffan. "Falls in people with dementia." Doctoral thesis, Umeå : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1449.
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Matinolli, M. (Maarit). "Balance, mobility and falls in Parkinson’s disease." Doctoral thesis, University of Oulu, 2009. http://urn.fi/urn:isbn:9789514292330.
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Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease which is characterized by resting tremor, rigidity, bradykinesia and postural instability. Advanced PD is often complicated by falls, immobilisation and progressive deterioration of overall physical capability that may jointly contribute to a reduced quality of life and even to increased mortality.
The purpose of this study was to identify risk factors for falls and mortality in PD, to assess the clinical correlates of balance and mobility, and to evaluate the association between orthostatic hypotension (OH), balance and mobility. From a total population of approximately 205 000 inhabitants, 125 patients with idiopathic PD were included in the study. Baseline medical data including occurrence of recent falls were collected, and patients were clinically tested for balance, mobility and orthostatic blood pressure reactions. Falls were thereafter prospectively recorded for two years using fall diaries and follow-up calls. Mortality was documented by reviewing the hospital charts four years after the baseline examination.
In the cross-sectional part of the study, one-third of the patients reported recent falling. Disease duration and severity, recent falling and use of a walking aid were predictors of increased postural sway in PD. Advanced age and severity of the disease were related to impaired balance and mobility in PD patients. Severity of the disease and increased postural sway were independent risk factors for recent falling in PD, whereas measures of mobility were less important in this manner.
Fifty-three percent of the patients had OH in the orthostatic test. Patients with OH had significantly increased postural sway in standing compared to patients without OH. On the contrary, OH was not associated with mobility and walking speed. In the present data, OH was not associated with the risk of falling in PD.
Sixty-three percent of the study patients experienced falls and almost half of the subjects fell recurrently during the two-year follow-up. History of falling and disease severity indicated increased risk of recurrent falls in PD, while patients with slow walking speed had an increased risk of mortality. The results show that balance impairment and falls are common features in PD. Slow walking speed may be associated with increased mortality in PD.
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Boyle, Nichola Mary. "Falls in older people: Examining risk factors in specific subgroups and the effectiveness of a specialist-led falls prevention intervention." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17976.
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Accidental falls remain an important healthcare issue for older people. We report on three studies examining risk predictors for further falls, falls-related hospital attendances and mortality, and then test the effectiveness of a hospital-based falls prevention intervention. A prospective study of 498 older people who attended an Emergency Department (E.D.) with a fall showed that age 80 years and older was the greatest predictor of further falls, with a 2-fold increased adjusted risk by 5 years (HR 2.00; 95% C.I. 1.42 – 2.82). Mortality following an E.D. presentation with a fall was 19% at 1 year, increasing to 52% by 5 years. Increasing age and assistance with ADLs predicted both ED re-presentation and mortality. Being female and falls due to syncope were protective. The Concord Health and Ageing in Men (CHAMP), is a longitudinal study of 1705 men. Previous history of falls was the most significant predictor of future falls (IRR 3.12; 95% C.I. 2.49 – 3.91) and falls injury hospitalisations at 10 years (HR 1.48; 95% C.I. 1.09 – 1.99) in this cohort. Risk factors for falls included increasing age, disability in ADLs, being single, dementia, having 3 or more comorbidities, polypharmacy and reduced visual acuity. Dementia was associated with 2-fold increased risk of falls injury hospitalisation at 10 years (HR 2.67; 95% C.I. 1.69 – 4.22). Men born in a non-English-speaking country and men who were still working were less likely to be hospitalised die to a fall injury. A randomised controlled trial (n = 81) of a specialist-led CONFABs clinic versus enhanced G.P. coordinated care, showed an increased rate of falls (IRR 2.39; 95% C.I. 1.09 – 5.27) and risk of falls (RR 1.79; 95% C.I. 1.10 – 2.96) at 1 year with the CONFABS clinic intervention. There was no significant difference in the rate of injurious falls or in the number of fractures between the interventions. Compliance with recommendations was similar in both groups, although more falls prevention strategies were recommended to the falls clinic participants. There are shared risk factors for falls, fall hospitalisations and mortality, with increasing age, functional disability and dementia the most important to consider. Falls prevention strategies may be successfully provided in General Practice, supported by specialist risk assessment and recommendations.
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Pedemont, Karen. "Predicting falls risk in a non-English speaking older population." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/12681.
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Background To determine if the QuickScreen© clinical falls risk assessment tool, can accurately predict the risk of falling in non-English speaking, community-dwelling older people. To date, the QuickScreen© has not been validated for use with this population. Method A letter/matching board was designed for use with the QuickScreen’s© low contrast acuity chart, to assist the non-English speaking participants in providing a vision response. A pilot study was conducted (n=30) to assess the validity and feasibility of this board, to be used to obtain accurate acuity regardless of language skill. The QuickScreen© tool was conducted with a sample of 34 non-English speaking participants (mean age 77 years ± 6.61) and their falls were monitored for a 12 month period. Finally, these participants were investigated more thoroughly in individual case studies and their activity determined during the study period. Results The designed letter/matching board did not impact on performance by adding complexity, or enabling guessing (one-way ANOVA P = 0.66). This board was found to be easy to use and not time exhaustive. The correlation between the number of falls and the QuickScreen© falls risk score was not statistically significant (spearman correlation rs = 0.062, P = 0.73). The qualitative study provided additional information about two of the participants, suggesting the possibility of culture influencing falls risk and the need to re-consider high contrast visual acuity as a predictor of falls in older people. Conclusion The researcher successfully adapted the QuickScreen© for use in a non-English speaking population in a clinical setting. The evidence suggests that the QuickScreen© is not suitable for use with non-English speaking older people and needs revisiting in a larger community based sample; that the relative importance of falls risk factors may vary between cultural groups, suggesting that falls risk screening tools may need to be tailored to particular cultural groups.
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Skanebo, Emil. "Antihypertensive treatmentin elderly and risk of falls : a systematic review." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-77061.
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Introduction The consequences of falling can be fatal to elderly. The mortality, morbidity and the risk ofanxiety and depression increases following a fall. Drug prescription is a preventable fall risk,making the association between antihypertensive medications and risk of falling an importantarea of investigation. Aim Compile the results from studies which have examined the effect of initiating or changing theantihypertensive medication on fall risk in people aged 60 years or older. Methods Data sources: MEDLINE and Cochrane databases. Study selection: Original articles ofcohort-, case control-, case crossover-, cross-sectional- and randomized controlled trial type,published between January 2000 and May 2019 and written in English were included. Dataassessment: 6 studies met the criteria and were included. Study quality was assessed for eachstudy. Results Three studies found significant short-term increase in fall risk, regardless of drug type. Onestudy discovered an 18% increase in fall risk for every 5-day gap in treatment. Two studiesevaluated antihypertensive drug types separately and found contradictive results of thiazidediuretics on short-term fall risk. Calcium channel blockers showed a protective effect andbeta blockers an increased risk during the first 3 weeks after initiating treatment. Conclusions No consistent consensus was seen regarding the short-term fall risk in separateantihypertensive drug types, though most studies agree in a short-term risk increase aftergeneral antihypertensive treatment initiation or change.
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Costa, Alice Gabrielle de Sousa. "Queda e identificaÃÃo de fatores de risco em idosos: estudo caso- controle em face de acidente vascular encefÃlico." Universidade Federal do CearÃ, 2010. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=5450.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorA ocorrÃncia de quedas constitui sÃrio problema de saÃde em idade mais avanÃada. Dessa forma, os fatores envolvidos devem ser continuamente avaliados com vistas à melhoria da qualidade de vida do idoso. Teve-se como objetivo investigar as circunstÃncias de ocorrÃncia das quedas nos Ãltimos seis meses em idosos com e sem AVE, assim como os fatores intrÃnsecos e extrÃnsecos a eles relacionados. Estudo do tipo caso-controle, realizado em trÃs AssociaÃÃes Beneficentes Cearenses de ReabilitaÃÃo e um Centro de ReferÃncia da AssistÃncia Social na cidade de Fortaleza no perÃodo de janeiro a abril de 2010. Estabeleceram-se um grupo caso e trÃs grupos controles, cada um com quinze idosos, pareados por idade e sexo, com base na ocorrÃncia ou nÃo de quedas nos Ãltimos seis meses e de acidente vascular encefÃlico. Utilizou-se um formulÃrio organizado em quatro partes para a caracterizaÃÃo do paciente, condiÃÃes intrÃnsecas e extrÃnsecas atuais, ocorrÃncia de quedas e fatores ambientais envolvidos. Com a aprovaÃÃo por Comità de Ãtica em Pesquisa, a coleta de dados ocorreu no dia em que o idoso se encontrava na unidade, apÃs esclarecimento dos objetivos e assinatura do Termo de Consentimento Livre e Esclarecido. Os dados obtidos foram analisados pelo Predictive Analysis Software 18.0. Em sua maioria, os grupos foram formados por mulheres, aposentados, com companheiro, baixa renda per capita e escolaridade. Os idosos tiveram uma mÃdia de 1,4 AVE, em um tempo mÃdio de 5,6 anos e hemiparesia como principal sequela. Quanto Ãs variÃveis com associaÃÃo estatÃstica, destacaram-se: Uso de anti-hipertensivos entre os grupos que sofreram quedas independente de ocorrÃncia de AVE; Uso de inibidores da ECA no caso de idosos com AVE com ou sem quedas; AlteraÃÃes nos pÃs entre o grupo caso e indivÃduos sem queda e sem AVE. Com relaÃÃo Ãs variÃveis ForÃa diminuÃda em membros inferiores, Excesso de mÃveis em casa, Dificuldade na marcha e Mobilidade fÃsica prejudicada, encontrou-se associaÃÃo em todos os casos entre o grupo de indivÃduos com AVE e quedas e aqueles sem AVE e sem quedas. Dificuldade na marcha e Mobilidade fÃsica prejudicada tambÃm estiveram estatisticamente associadas entre o grupo caso e indivÃduos sem AVE e com relato de quedas. As variÃveis Ãndice de Barthel, Atividades Instrumentais de Vida DiÃria, Escala GeriÃtrica e de Tinetti, alÃm de ForÃa de preensÃo palmar direita tambÃm apresentaram associaÃÃo estatÃstica entre o grupo caso de indivÃduos com AVE e quedas e aqueles sem AVE, com ou sem quedas. As quedas aconteceram predominantemente no perÃodo da manhÃ, em ambiente iluminado, sem corrimÃo ou objetos, com piso Ãspero e seco, uso de chinelo com solado de borracha. NÃo se constatou ser o AVE um evento associado Ãs quedas, fortalecendo a relaÃÃo causal multifatorial. As variÃveis envolvidas com o evento queda estiveram fortemente relacionadas aos fatores intrÃnsecos envolvidos com o equilÃbrio. Os fatores extrÃnsecos, contudo, podem ser os mais facilmente modificÃveis. Nesse Ãmbito, os profissionais de saÃde devem avaliar rotineiramente todas as variÃveis envolvidas com o evento queda, no intuito de melhorar a qualidade de vida desses indivÃduos.
The falls occurrence represents a serious health problem for aged. Therefore the factors involved must be continuous assess in order to improve the aged life quality. The aim was to investigate the falls occurrence in the last six months at elderly with and without stroke and to identify the intrinsic and extrinsic factors involved. A case-control study carried at three Beneficent Associations of Rehabilitation from Cearà and a Reference Center of Social Worker in Fortaleza city from January to April 2010. A case group and three control groups were established with 15 elderly paired off by sex, age, falls occurrence in the last six months and stroke occurrence. It was used a form organized in four parts with the objective to characterize the patient, actual intrinsic and extrinsic conditions, falls occurrence and environment factors involved. The data were gathered with the Research Ethical Committee approval and when the elderly were enlightened at the collected data unit about the aim of the research, and the patient signing of authorization term. The data obtained was analyzed by Predictive Analysis Software 18.0. The groups were mainly composed by women, retired people, persons with partners, low school grade and low financial income. The elderly with stroke presented an average of 1,4 occurrence in an average period of 5,6 years and the main consequence was hemiparesis. As far as statistical associated variables concern, the followings were here highlighted: Use of antihypertensive among the groups with falls despite the occurrence of a stroke; Use of ACE inhibitor at aged with stroke whom were fallers or not; Foot alterations between the case group and people without falls neither stroke. Besides the variables Decreased strength at lower members, excess of home furniture, Gait difficulty and Impaired physical mobility was found in all association among the fallers participants with stroke and those without stroke neither falls. Gait difficulty and Impaired physical mobility were statistically associated between the case group and people without stroke and fall occurrence. The Barthel index, daily instrumental life activities, Geriatric scale and Tinetti scale, besides right hand grip strength, also found statistical association between the case group and aged without stroke fallers or not. The falls occurred mostly in the morning, in bright environment without handrail or objects, in rough and dry floor, use of rubber slippers. It was not verified to be the stroke an event associated to falls, a fact that strengthens the multifarious cause relation. The variables involved with fall event were strongly related to intrinsic factors involved with the balance issue. The extrinsic factors, however, could be easily modified. Therefore health professionals should routinely assess all fall variables involved in order to improve the life quality of elderly people.
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Cook, Andrew, and Rachael Cook. "An interactive approach to educate older adults on fall safety & prevention." The University of Arizona, 2012. http://hdl.handle.net/10150/623595.
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Class of 2012 AbstractSpecific Aims: The purpose of this study was to test an interactive educational program for older adults on preventing accidental falls. Methods: This was a prospective, descriptive study evaluating the helpfulness of an interactive educational program. English speaking residents were recruited from five independent senior living communities in Arizona. The intervention consisted of a 30-minute interactive PowerPoint presentation followed by a 10-minute question and answer session. Information provided during the presentation focused on information from the CDC and the Fall Prevention Center of Excellence. Participants completed an anonymous questionnaire to rate the helpfulness of the program. The primary dependent variable was overall helpfulness of the educational session. Other variables included: intention of changing future behavior related to preventing falls, whether participants would recommend the program to others, participant perception of gained knowledge, change in fear of falling, and interest in meeting with pharmacist to discuss medications. Categorical data was analyzed by calculating frequencies and percentages and continuous data by calculating means and SDs. A t-test for independent groups was used to compare men and women. Main Results: A total of 93 individuals attended the presentations. Out of 81 completed surveys, 5 did not indicate gender, 7 additional did not indicate age, and 6 were over 89 years of age. Demographic data for the men and women was similar. 90% of participants indicated that the program was either "very helpful" or "moderately helpful". 92% of participants responded “absolutely yes” or “likely” that they would recommend the program. No participants strongly disagreed that they had a better understanding of fall risks or medications that increase fall risk. 87% of participants responded “absolutely yes” or “likely” that they plan to increase daily exercise . 42% of participants said it was “not likely” that they plan to make changes in their living environment. Conclusions: An interactive educational program on fall safety and prevention is helpful for older adults. As one of the most widely accessible health care providers, pharmacists and pharmacy students are well suited to provide patient education and improve outcomes. The results of this study provide preliminary data supporting the usefulness of a patient education program on fall safety prevention administered by pharmacy students.
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Ha, Soon Young. "Model for Falls with Major Injury in Nursing Home Residents." Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1533165953236171.
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Lundin-Olsson, Lillemor. "Prediction and prevention of falls among elderly people in residential care." Doctoral thesis, Umeå universitet, Geriatrik, 2000. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100576.
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Among elderly people, falls lead to a considerable amount of immobility, morbidity, and mortality. The purpose of this study was to develop and evaluate methods for predicting falls, and to evaluate a fall prevention program among elderly people living in residential care facilities. A fall was defined as any event in which the resident unintentionally came to rest on the floor or the ground regardless of whether or not an injury was sustained. In developing the prediction methods, it was hypothesised that older persons showing difficulties in performing a familiar second task while walking were more likely to fall within six months. For residents who stopped walking when talking, the relative risk of falling was 3.5 (95% CL2.0-6.2) compared to those who continued walking. For residents with a time difference (diffTUG) of at least 4.5 seconds between two performances of the Timed Up&Go test, with and without carrying a glass, the hazard ratio for falls was 4.7 (95% Cl: 1.5-14.2) compared to those with a shorter diffTUG. A screening tool, the Mobility Interaction Fall (MIF) chart, was developed and evaluated, then validated in a new sample. This tool included a mobility rating, ‘Stops walking when talking’, ‘diffTUG’, a test of vision, and a concentration rating. In the first sample, the hazard ratio was 12.1 (95% 0:4.6-31.8) for residents classified as ‘high-risk’ compared to ‘low-risk’. The positive predictive value was 78%, and the negative predictive value, the sensitivity, and the specificity were above 80% for falling in six months. In the second sample the prediction accuracy of the MIF chart was lower (hazard ratio 1.7, 95% Cl: 1.1-2.5) and a 6-month fall history or a global rating of fall risk by staff were at least equally valuable. A combination of any two of the methods - the MIF chart, staff judgement, fall history - was more accurate at identifying high risk residents than any method alone. Half of the residents classified by two methods as ‘high risk’ sustained a fall within 6 months. In a randomised study a prevention program directed to residents, staff, and environment resulted in a significant reduction in the number of residents falling (44% vs. 56%; odds ratio 0.62, 95% CF0.41-0.92), the incidence of falls (incidence rate ratio IRR 0.80, 95% CF0.69-0.94) and of femoral fractures (IRR 0.25, 95% 0:0.08-0.82) in the intervention compared to the control group. In conclusion, a combination of any two of the staff judgement, fall history or MIF chart has the potential to identify a large proportion of residents at particular high fall risk. A multidisciplinary and multifactorial fall prevention program directed to residents, staff, and the environment can reduce the numbnumber of residents falling, of falls and of femoral fractures.Diss. (sammanfattning) Umeå : Umeå universitet, 2000,, härtill 5 uppsatser
digitalisering@umu
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Cho-Young, Danielle. "Understanding Fear of Falling Levels in Community-Dwelling Older Adults: A Mixed Methods Study." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39139.
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Background: Fear of falling is now recognized as an independent fall risk factor due to its prevalence in older adults. Objectives: The purpose of this study was to gain a better understanding of fear of falling levels in community-dwelling older adults before and after attending a fall prevention clinic. Methods: An explanatory sequential mixed methods design was used. The Falls Efficacy Scale-International (FES-I) tool assessed fear of falling levels before and after attending a fall prevention clinic (n=32). Semi-structured interviews were then conducted in a sample of these participants (n=12). Results: There was no statistically significant difference in the before (M=30.44, SD=9.8) and after (M=31.72, SD=8.3) FES-I scores. Three themes emerged from the qualitative analysis: 1. Concerns about falling, 2. Decreased concerns about falling and 3. An increased self-awareness of fall risks. Conclusion: Further use of cognitive-behavioural therapy should be considered in falls risk reduction interventions for community-dwelling older adults with fear of falling.
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Rezende, Débora Aparecida Paccola de. "Prevalência de quedas referidas e fatores associados na transição e após menopausa." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/6/6136/tde-13032014-082136/.
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INTRODUÇÃO: Frente ao aumento gradativo de quedas da própria altura com o avançar da idade, torna-se imprescindível conhecer os fatores de risco implicados na sua ocorrência em mulheres na transição e após menopausa, com o intuito de contribuir com estratégias de prevenção e promoção da saúde no cotidiano. OBJETIVO: Estimar a prevalência de quedas referidas e caracterizar a associação entre as quedas com variáveis clínicas e epidemiológicas das mulheres da Estratégia de Saúde da Família do Município de Pindamonhangaba, SP. MÉTODOS: Em estudo com delineamento observacional do tipo transversal vinculado ao Projeto de Saúde de Pindamonhangaba (PROSAPIN), foram utilizados dados secundários randomizados de 875 mulheres com idade entre 35 a 65 anos e investigadas por meio de um inquérito domiciliar e medidas antropométricas. A variável queda foi incluída como dependente, enquanto que as independentes foram representadas pela idade, estado civil, renda, escolaridade, raça, ocupação, histórico ginecológico, doenças crônicas referidas e mensuradas, medicamentos, obesidade (índice de massa corpórea), hábito alimentar, consumo de bebidas alcoólicas, tabagismo, sono, depressão e atividade física habitual. RESULTADOS: Participaram do estudo 749 mulheres com média de 47,7 anos (com desvio padrão de 8,1); a prevalência de quedas da própria altura foi de 17,6 por cento (IC de 14,9 - 20,5), sendo a maioria (54,6 por cento) na pós menopausa. Das mulheres que caíram, a prevalência de recorrência foi de 45,2 por cento. As principais causas foram escorregões (29,4 por cento) e tropeços (19,8 por cento). Após análise multivariada constatou-se associação das quedas com a idade (p=0,018), qualidade do sono ruim (0,007) e comorbidades como a hipertensão arterial (p=0,032) e depressão (p=0,003). As comorbidades hipertensão arterial (p=0,055) e depressão (p=0,001) associaram-se também as quedas recorrentes, bem como restrições às atividades de vida diária (p=0,000). CONCLUSÃO: A maior prevalência de quedas ocorreu após a menopausa e entre os principais fatores associados à sua gênese emergiram a idade, hipertensão arterial, depressão e sono ruimINTRODUCTION: Faced the gradual increase of falls from height with advancing age, it becomes essential to know the risk factors of the falls on women in transition and after menopause, in order to contribute with strategies for prevention and health promotion in their daily routine. OBJECTIVE: To estimate the prevalence of referred falls and characterize the association between falls and clinical and epidemiological variables of women of the Family Health Strategy of Pindamonhangaba City, SP. METHODS: In a study with observational design of the type cross-sectional linked to Health Project of Pindamonhangaba (PROSAPIN), it was used secondary randomized data from 875 women from 35 to 65 years old and they were investigated through a household survey and anthropometric measurements. The falls were included as a dependent variable and age, marital status, income, education, race, occupation, gynecologic history, chronic disease and those measured, medicines, obesity (body mass index), dietary habits, alcohol consumption, smoking, sleep, depression and physical activity. RESULTS: There were 749 women investigated with average age of 47.7 years (standard deviation 8.1); the prevalence of falls from height was 17.6 percent (95 percentCI: 14.9 - 20.5), the majority (54.2 percent) of the fallers were in the post menopausal. Of the women who fell, the prevalence of recurrence was 45.2 percent. The main causes were slipping (29.4 percent) and setbacks (19.8 percent). After multivariate analysis, it was found an association of falls with age (p=0.018), poor sleep quality (p=0.007) and comorbidities as hypertension (p=0.032) and depression (p=0.003). The comorbidities hypertension (p=0.055) and depression (p=0,001) associated too with recurrent falls, as well restricted the activities of daily living (p=0.000). CONCLUSION: The highest prevalence of falls occurred after the menopause and among the main factors associated its genesis emerged the age, hypertension, depression and bad sleep
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Guillaume, Donna M. "Characteristics of the Middle-Age Adult Inpatient Fall: A Dissertation." eScholarship@UMMS, 2015. https://escholarship.umassmed.edu/gsn_diss/37.
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Falls remain one of the most reportable, serious and costly type of adverse events costing an estimated $3,500 to $27,000 depending on the injury. The research often focuses on the elderly and their risk for falls and injury. Increasingly higher rates of falls are being reported in the middle-age inpatient 45 to 64 years of age. While predictors of falls and injuries have been studied across all adult inpatients, research has not specifically addressed fall risk characteristics in the middle-age. The World Health Organization’s (WHO), “Risk factor model for fall in older age”, framework was adapted for the middle-age inpatient. This framework identifies extrinsic and intrinsic variables from four risk factor groupings of biological, socioeconomic, behavioral, environmental and related outcomes to describe characteristics of the middle-age inpatient’s fall injury risk. Hitcho et al. (2004) seminal article was also used to identify pertinent inpatient characteristics. The purpose of this exploratory retrospective quantitative study described fall risk factors specific to the middle-age inpatient. The aims: (1) described risk factors of falls and fall injury; (2) described unit specific data, fall numbers with type of falls, injuries from falls, and prevention strategies (3) compare the incidence of fall and injury rates in the middle-age (45- 64) patients to the other hospital adult age-groups (ages 21-44 and 65-90). This study used retrospective hospital occurrence data to identify middle-age inpatient falls and related characteristics reported by staff. Chart review of inpatient falls identified 439 individual falls occurring from January 2012 through July 2014. The study sample included inpatients that fell either one-time or had a repeat fall during the study period. Analysis for data included use of descriptive statistics, crosstabs, and Poisson regression. Outcomes collected included demographics, admitting diagnosis, chief complaints, cormorbities, and discharge status, type of falls and areas of falls. There was no significant difference in rates of falls between units or in staffing ratios that had a bearing on the middle-age inpatient. Fall prevention interventions were found to be universally applied, not specific to the individual, nor based on outcomes of risk screening of anticipated physiological risk factors. In comparison of the middle-age inpatient population with those age 65 -90 years of age the rates per 1000 patient days for both falls (p=.637) and injuries (p=.626) had no significant difference. Males fell at a significantly higher rate (p=.000) than females in the middle-age inpatient and those aged 64-90 years. The middle-age inpatient fell at an alarming rate of 42% of all falls.
This research provided insight into a population with acute and multiple chronic disease conditions and comorbidities that contribute to altered mental status, abnormal gait and frequently awaking at night to void. This population often overestimates their limitations and strives to maintain their autonomy. The age of the patient should not influence staff assessment of alertness and orientation. The findings of the characteristics in this research provide rich information for further research in how to include the middle-age patient in clinical decision making and education of this age group.
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Costa, Alice Gabrielle de Sousa. "Resultado de Enfermagem Comportamento de PrevenÃÃo de Quedas - ValidaÃÃo de Indicadores." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=11850.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorEste estudo teve como objetivo validar o resultado de enfermagem Comportamento de prevenÃÃo de queda, apresentado pela Nursing Outcomes Classification (NOC). O processo de validaÃÃo focalizou pessoas acometidas por acidente vascular cerebral (AVC) e seus cuidadores, com foco no contexto domiciliar. Estudo do tipo metodolÃgico, realizado em duas etapas (validaÃÃo de conteÃdo e clÃnica) a partir de um instrumento proposto por Vitor (2010), o qual apresentou para o resultado 28 indicadores e definiÃÃes operacionais direcionadas inicialmente à populaÃÃo em geral. Estes foram revistos e organizados em 22 indicadores voltados ao ambiente domiciliar, local onde acontece o tipo mais comum de queda, a da prÃpria altura. A etapa de validaÃÃo de conteÃdo foi iniciada com avaliaÃÃo do instrumento por juÃzes quanto à aparÃncia. Em seguida, 22 especialistas avaliaram os tÃtulos e definiÃÃes de cada indicador, segundo os critÃrios psicomÃtricos de simplicidade, clareza, precisÃo e adequaÃÃo. ApÃs atendimento Ãs sugestÃes dos especialistas, procedeu-se à validaÃÃo clÃnica, precedida por um teste piloto para ajustes à populaÃÃo. Etapa realizada por duas duplas de profissionais treinados, no ambulatÃrio de dois hospitais de referÃncia ao atendimento a pacientes com AVC, com participaÃÃo de 106 pacientes e/ou cuidadores. Uma dupla aplicou o instrumento com as definiÃÃes operacionais e outra aplicou o instrumento contento apenas tÃtulos e escala da NOC. Os dados foram organizados em planilhas e analisados com o software SPSS 22. Para a etapa de validaÃÃo de conteÃdo foi calculado teste binomial, enquanto que, para a etapa clÃnica, utilizaram-se os testes de Friedman para verificar diferenÃa entre avaliadores, anÃlise da diferenÃa mÃnima significante (DMS), Alfa de Cronbach e Coeficiente de CorrelaÃÃo Intraclasse (CCI) para comparaÃÃo das avaliaÃÃes. O projeto foi apreciado por Comità de Ãtica em Pesquisa, aprovado sob os Pareceres n 49.912 e n 392.531; todos os participantes foram orientados quanto aos objetivos e assinatura do Termo de Consentimento. Na validaÃÃo de conteÃdo, a maioria dos especialistas foi de mulheres, mÃdia de 33,1 anos, 9,5 anos de formaÃÃo, doutores, profissionais de InstituiÃÃes de Ensino Superior. Os indicadores que se apresentaram estatisticamente significantes, pelo teste binomial, foram: Prende pequenos tapetes e Controla a inquietaÃÃo, e todos apresentaram-se apropriados ao paciente com AVC (100% e p=1,000). Na etapa clÃnica, houve discreta predominÃncia de homens participantes (51,9%), na maioria idosos, casados, aposentados, com baixa escolaridade e renda, residindo com a famÃlia e com sequelas fÃsicas do AVC, implicando a necessidade de um cuidador. O teste de Friedman indicou diferenÃas entre avaliaÃÃo das duplas em doze indicadores (p <0,05), destes, cinco demonstraram diferenÃas nas mÃdias de postos maiores que a DMS. Todos os indicadores apresentaram-se estatisticamente significantes (p<0,001) e satisfatÃrios segundo o (CCI). Esta etapa foi importante para constataÃÃo da manutenÃÃo ou nÃo de indicadores, que totalizaram 18 ao final. Assim, de forma geral, observou-se que houve maior concordÃncia entre a dupla que utilizou o instrumento com as definiÃÃes de cada indicador. Destaca-se a eficÃcia do processo de construÃÃo de referentes empÃricos e adequaÃÃo a populaÃÃes especÃficas, bem como a necessidade contÃnua de estudos nesta linha de conhecimentos.
This study aimed to validate the nursing outcome Fall prevention behavior from the Nursing Outcomes Classification (NOC). The validation process focused on people with stroke and their caregivers in the home context. This is a methodological study performed in two stages (content and clinical validation) by a tool proposed by Vitor (2010) who presented 28 indicators and operational definitions related to the general population. The tool was revised and organized in 22 indicators towards to the home environment which is the most common place where falls from height happen. The content validity stage was started with assessment by judges about the appearance. Then, 22 specialists evaluated the titles and definitions of each indicator according to psychometric criteria of simplicity, clearness, precision and suitability. After perform the changes suggested by the specialists, the clinical validation was performed at first by a pilot test in order to adjust the tool to the population. This stage was developed with 106 patients and/or caregivers interviewed by two pairs of trained professionals in the ambulatory service of two hospitals that are reference in the care of people with stroke. One pair of evaluators applied the form with the operational definitions while the other pair applied the form with only the titles and NOC scale. The data were organized in sheets and analyzed by the SPSS 22 program through the calculation of the binomial test. The clinical validation stage applied the Friedman test to verify differences among the evaluators, the calculation of the minimum significant difference (MSD), Cronbach alpha and intraclass correlation coefficient (ICC) to compare the evaluatorsâ assessment. The study was approved by an Ethical Committee by the nÂ49.912 and nÂ392.531; all the participants (specialists, patients and caregivers) were oriented about the goals and the Consent Term. At the content stage, the specialists were most female, with age average of 33.1 years old, 9.5 years of graduation, PhD, working in Post-secondary Institutions. The indicators statistically significant by the Binomial test were: Attaches small rugs and Controls restlessness and all of them were appropriated to the patient with stroke (100% and p=1.000). Most participants were male (51.9%), elderly people, married, retired, with low school grade and low income, living with family and with physical sequelae from the stroke, which requires the need of a caregiver. The Friedman test showed differences in the evaluations of the pairs of professionals for twelve indicators (p<0.05), five of them showed difference in the mean rank higher than the MSD. All the indicators showed statistical significance (p<0.001) and the ICC. This stage was important to realize the need of keeping or not the indicators, which were 18 at the end. Thus, it is noted that the tests showed more agreement between de pair that used the tool with the indicators for each definition. It is possible to highlight the efficiency of empirical references construction and its suitability to specific populations, besides the need of continuous researches in this field of study.
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Koh, Ling, Lynette Mackenzie, and Meryl Lovarini. "The understanding and experience of falls among older people living in the community with mental illness: A qualitative study." Thesis, Discipline of Occupational Therapy, 2019. http://hdl.handle.net/2123/19815.
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Introduction: Compared to the general older population, older adults with mental illness living in the community have an increased risk of falls. However, little is known about falls experienced by this group. This study aimed to explore the understanding and experience of falls from the perspectives of older adults living in the community with mental illness as well as to identify any falls prevention strategies valued by them. Methods: Ten consumers aged 50 and over with experiences of falling were recruited at a community mental health service in Sydney ( four male and six female; mean age 70.4 years). An audiotape, semi-structured interview was conducted with each participant. Recordings were transcribed verbatim and data were thematically analysed using Nvivo11 software to identify key themes. Results: Four major themes were generated: 1. Making sense of falls, 2. Being self reliant, 3. Enduring the consequences of falls, and 4. Preventing future falls - perceptions and strategies. Conclusion: Most participants were uncertain about the cause of their falls and seemed to not understand their falls risks. They were also less likely to seek help after a fall, despite injuries. Consequences of falls included physical injury negative emotional impacts. Most participants expressed concern about future falls, however their strategy to prevent falls was simply to be careful. Future occupational therapy practice should focus on designing targeted fall prevention approaches tailored to the needs of this group of older adults.
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Menz, Hylton Physiology UNSW. "Walking stability in young, old and neuropathic subjects." Awarded by:University of New South Wales. Physiology, 2002. http://handle.unsw.edu.au/1959.4/18637.
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This thesis investigates walking patterns in healthy young people and in people with an increased risk of falling, and determines the physiological contributions to walking stability. First, a review of the relevant literature on techniques for assessing walking stability, age-related changes in balance and gait, and the contributions of vision, vestibular function, peripheral sensation and strength was undertaken. In response to a critical analysis of these findings, a new technique and protocol for the assessment of walking stability was developed. This involved measuring and analysing head and pelvis accelerations while subjects walked on a level surface and an irregular surface. Gait patterns were studied in 30 young healthy subjects and two groups known to be at increased risk of falling - 100 subjects over the age of 75, and 30 subjects with diabetic peripheral neuropathy. A series of vision, sensation, strength, reaction time and balance tests were also undertaken to identify subjects??? physiological abilities and risk of falls. Acceleration patterns of the head and pelvis differed according to physiological risk of falling, particularly when walking on the irregular surface. Those with a high risk of falling walked with a reduced velocity, cadence and step length, and exhibited less rhythmic acceleration patterns at the head and pelvis. Gait patterns were significantly associated with leg strength, peripheral sensation and reaction time. It is concluded that subjects with a high physiological risk of falling exhibit characteristic patterns of walking that indicate an impaired ability to control the movement of the pelvis and head, which may predispose to loss of balance.
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Price, Thomas, Lynette Mackenzie, and Claire O'Connor. "An evaluation of the falls prevention practice of community-based allied health professionals working in primary care." Thesis, Discipline of Occupational Therapy, 2017. http://hdl.handle.net/2123/16305.
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Objectives: This study aimed to explore allied health professional’s (AHP) current practice and understanding of falls prevention and to investigate self-reported change following a professional development workshop. Methods: Four professional development workshops were designed targeting exercise, home safety interventions, the LiFE program and medication reviews. Self-reported surveys were collected pre, post and at three-month follow-up. Results: Seven workshops were run in Northern Sydney with 161 participants. AHP identified practice barriers were regularly assessing falls risk and collaborating with other service providers. At three months, change in practice was reported by participants in the exercise (88.1%), home safety (48%), LiFE (78.6%), and medication review (62.5%) workshops. Discussion: These findings provide good support for the effectiveness of professional development workshops in knowledge translation for medication review and exercise based interventions. Further studies and initiatives into promoting screening for falls risk and greater collaboration between community service providers is recommended.
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Rosendahl, Erik. "Fall prediction and a high-intensity functional exercise programme to improve physical functions and to prevent falls among older people living in residential care facilities." Doctoral thesis, Umeå : Samhällsmedicin och rehabilitering Community Medicine and Rehabilitation, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-756.
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Lojudice, Daniela Cristina. ""Quedas de idosos institucionalizados: ocorrência e fatores associados"." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/17/17139/tde-04102006-140850/.
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Quedas entre pessoas idosas constituem importante problema de saúde pública devido à sua incidência, às complicações para a saúde e aos altos custos assistenciais. Estudos realizados no Brasil e em outros países referem que as quedas são mais freqüentes em idosos institucionalizados e apresentam causa multifatorial. Com o objetivo de verificar a ocorrência de quedas em idosos institucionalizados e identificar os seus fatores determinantes, foi realizado um levantamento de dados de 105 indivíduos com idade igual ou superior a 60 anos, residentes em 4 instituições asilares do município de Catanduva, São Paulo. O método utilizado para a coleta dos dados foi entrevista. Foram utilizados os instrumentos: GDS (Escala de Depressão Geriátrica), MEEM (mini Exame do Estado Mental) e a escala de Equilíbrio e Marcha de Tinetti, instrumentos estes destinados à avaliação dos estados de humor, cognitivo e equilíbrio e marcha respectivamente. Os achados mostraram que 40% dos idosos relataram quedas nos últimos 6 meses, e os fatores de risco considerados significativos foram: sexo feminino (p=0,035), uso de medicamentos (p=0,047), visão deficiente (p=0,029), ausência de atividade física (p=0,035), presença de osteoartrose (p=0,000), Depressão (p=0,034), déficit de força de preensão palmar (p=0,0165) e distúrbios no equilíbrio e marcha (p=0,038). Os resultados apontam para a necessidade da implementação de programas de prevenções de quedas em instituições asilares, através de intervenção multidisciplinar buscando, portanto, uma melhoria na qualidade de vida dessa população.Falls among the elderly constitute an important public health problem due to their incidence, to health complications, and to the high assistance cost. Research conducted in Brazil and other countries refer that falls are the more frequent in institutionalized elderly people and present multifactorial causes. Aiming at verifying the occurrence of falls among institutionalized elderly people and at identifying their determining factors, data collection of 105 individuals age 60 or over was carried out. The subjects are all residents of 4 home institutions in the city of Catanduva São Paulo. The method used in data collection was a interview. The following instruments were used: GDS (Geriatric Depression Scale), NEEN (Mental Status Mini Exam), and the Tinetti´s Balance and March Scale. These instruments are destined to the evaluation of mood, cognitive status, balance and march, respectively. The finds show that 40% of the elderly reported falls over the last 6 months, and the risk factors considered to be significant were: female sex (p=0.035), medicine use (p=0.047), visual disability (p=0.029), lack of physical activity (p=0.035), presence of osteoarthritis (p=0.000), Depression (p=0.034), palm prehension strength deficit (p=0.0165), and balance and march disorder (p=0.038). The results point at the necessity of implementing fall prevention programs in home institutions, through multidisciplinary intervention, therefore aiming at improving this populations quality of life.
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Kallin, Kristina. "Falls in older people in geriatric care settings : predisposing and precipitating factors." Doctoral thesis, Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-307.
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Iinattiniemi, S. (Sari). "Fall accidents and exercise among a very old home-dwelling population." Doctoral thesis, University of Oulu, 2009. http://urn.fi/urn:isbn:9789514290268.
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Abstract
High age is a distinguished risk factor of falling, but there remains gaps in epidemiological data among very old people. Also, effects of exercise-oriented intervention implemented by geriatric teams is not known.
The aims were to describe the incidence and risk factors of falls, the risk of fall-related injuries associated with physical activity, and to investigate the effect of pragmatic exercise intervention on fall risk among a home-dwelling population aged 85 years and older.
The target population consisted of home-dwelling citizens of Oulu aged 85 years or more (N = 827). Altogether 555 people (mean age 88 SD ± 3), representing 67% of the population sample, were evaluated by interviews and clinical assessments. Falls and physical activity were monitored via telephone nine times during a 27-month follow-up constituting 1114 person years. Risk factors of falls were determined during an 11-month period before intervention, as were the effects of the intervention during a 16-month period thereafter. Negative binomial regression, pooled logistic regression and Cox regression analyses were used to analyze data.
The incidence rates of falls, major soft tissue injuries and fractures were 1039 (95% CI 974–1093), 74 (58–92) and 89 (72–108), respectively. The probability of getting injured was higher in the morning and evening than in the daytime. The contribution of the ongoing activity and the type of falling to the risk of injury was less than that previously reported among younger home-dwellers. The risk factors of falls were a history of recurrent falling, trouble with vision when moving, use of an antipsychotic drug, and feelings of anxiety, nervousness or fear. Exercise other than walking was associated with a reduced risk of injury-causing falls. Pragmatic intervention wasn’t effective in preventing falls, but it was effective in preserving balance performance. Among those with better functional abilities, intervention was effective in reducing the risk of the first four falls. Adherence to recommended interventions was relatively low.
In conclusion, the frequency of falls and fall-related fractures increases up to the highest ages. Anxiety-related disorders may be more important risk factors of falls than are drugs commonly used in treatment. Exercise related to everyday activities is safe among the most elderly. The effects of practical exercise intervention are promising, but attention needs to be paid to adherence to exercise in order to improve these effects.
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Kelley, Carolyn Joyce Pavelka. "Falling and general mobility viewpoints of survivors of stroke and spousal caregivers." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2010r/kelley.pdf.
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Ribeiro, Natalia Camarão Telles. "Fatores associados a quedas em idosos portadores da doença de chagas assistidos em ambulatorio de hospital universitario." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310906.
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Orientador: Maria Elena GuarientoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: No Brasil, estima-se que 30% dos idosos caem pelo menos uma vez ao ano. A preocupação com este tema incide em questões de ordem médico-assistenciais, particularmente na crescente demanda por estes serviços. Acredita-se que os fatores associados a quedas possam atuar em menor ou maior intensidade entre os idosos, conforme suas condições de vida. Um contingente cada vez maior de portadores de doença de Chagas está envelhecendo e, assim, expondo-se mais ao risco de quedas, além de enfrentar as complicações decorrentes dessa enfermidade infecciosa crônica. Sendo assim, delineou-se este estudo com o propósito de se analisar o comportamento dos fatores de risco para quedas em idosos com doença de Chagas, considerando-se: características sócio-demográficas, clínicas, de auto-avaliação de saúde e de prática de atividade física. Os instrumentos utilizados foram: Instrumento de Coleta de Informações Sócio-Demográficas e Clínicas, retiradas do Banco de Dados do Projeto Temático "Doença de Chagas, Envelhecimento e Qualidade de Vida" e Questionário para Identificação de Agentes Predisponentes a Quedas em Idosos. As variáveis foram analisadas pelos testes Qui-quadrado ou Exato de Fischer, de Mann-Whitney, Análises de Cluster e de Regressão Logística Univariada. Foram entrevistados 43 idosos chagásicos de ambos os gêneros, sendo 21 (48,84%) mulheres, 35 (81,4%) entre os 60 e 69 anos. Verificou-se que 14 (32,54%) relataram queda, em consonância com achados de estudos com idosos não infectados pelo T. cruzi. A Análise de Cluster permitiu formar dois agrupamentos: um deles composto predominantemente por homens, cardiopatas, com maior referência à prática de atividade física e o outro composto predominantemente por mulheres, com idosos classificados nas formas clínicas mista, digestiva e indeterminada e menor referência à prática de atividade física. Dentre as variáveis estudadas, nenhuma foi preditiva para ocorrência de quedas.
Abstract: It is estimated that 30% of the aged in Brazil fall at least once a year. The importance of this fact has to do with medical and social assistance care and with the increasing demand for the related services. It is believed that the factors which cause these falls of the aged are associated with their living conditions. A growing group of people with the Chagas disease are getting older and, therefore, have more propensity to fall, besides having to deal with the complications associated with this chronic infectious disease. In view of these facts, we formulated this study the risk factors of the aged with the Chagas disease, while taking into account the social-demographic, clinical, self health evaluation and physical activity characteristics of the study group. To perform the study we used the following instruments: "The Instrument for Collection of Social-Demographic and Clinical Information", of which were taken the Data Bank of the Thematic Project: "Chagas Disease, Aging and Quality of Life" and "The Questionnaire for Identification of Causes of Falls among the Aged". We analysed the numerical results with the following: Chi-square Test , Fischer's Exact Test, Mann-Whitney Test, Univariate Logistic Regression Analysis and Cluster Analysis. We interviewed 43 aged persons of both sexes with the Disease of Chagas: 21 (48.84%) female and 35 (81.4%) between 60 and 69 years of age.We found that 14 (32.54%) reported falls, in agreement with the results of studies of the aged not infected with T. Cruzi. Cluster analysis permitted the formation of two groups of the results: one, predominantly male, with heart disease, with more intense physical activity and the other, predominantly female, classified clinically as mixed, digestive and indeterminate, with less intense physical activity. None of the studied variables was predictive of falls.
Mestrado
Mestre em Gerontologia
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Lavôr, Rogéria Máximo de. "Morbimortalidade por causas externas em idosos atendidos em hospital de emergência e trauma." Universidade Estadual da Paraíba, 2015. http://tede.bc.uepb.edu.br/jspui/handle/tede/2909.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Introduction: The set of health disorders defined as external causes is categorized into unintentional called accidental and intentional, called violence. The routine of the elderly population is increasingly active, increasing the chances of occurrence of injuries from external causes. Objective: To identify morbidity and mortality from external causes in older adults admitted in a public Emergency and Trauma hospital of João Pessoa, Paraíba. Material and methods: Cross-sectional study through the analysis of 621 medical records of patients aged over 60 years hospitalized due to external causes from January to December 2011. The survey instrument consisted of a specific form developed from the analysis of medical records. The variables used were gender, age, marital status, time of occurrence, occurrence over the weekend, etiology, type of fall, presence of fracture, presence of femur fracture, site of femur fracture, Traumatic brain injury (TBI), and death. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 18, also using the Pearson's chi-square and Fisher's exact tests, considering the statistical significance value (p <0.05). Results: There was predominance of female victims (51.2%) and age group of 60-69 years, accounting for 38% of cases. The main causes of morbidity and mortality were falls and traffic accidents (68.6% and 18.8%, respectively). Fractures were more common in females aged 80 years and over and cases of TBI were more prevalent in males in the age group of 60 -69 years. The main cause of death was fall (69.9%) in males aged 80 years or more. Significant associations were observed (p <0.001) among variables "gender," "etiology", "presence of fractures", "TBI" according to "age group". As for hospital admissions due to fall, there was predominance of females (62.4%) aged 80 years and over (41.6%), and the most frequent fractures were those involving femur (57%); presence of TBI was observed in 14.3% of cases and the highest proportions of deaths occurred in the age group of 80 years and over (21.8%). Conclusion: Falls and traffic accidents were the most prevalent causes of morbidity and mortality from external causes, female gender and age group of 60-79 years were predominant and falls were the main cause. These data are useful for the development of preventive measures and hospital care based on potential demand, providing better quality of life for this specific population and reducing spending for rehabilitation.
Introdução: O conjunto de agravos à saúde definido como causas externas é categorizado em causas não intencionais ditas acidentais e intencionais, como a violência. A rotina da população idosa é cada vez mais ativa, potencializando as chances de ocorrência de agravos por causas externas. Objetivo: Identificar a morbimortalidade por causas externas em idosos hospitalizados em um Hospital Público de Emergência e Trauma de João Pessoa, Paraíba. Material e Métodos: Estudo transversal por meio da análise de 621 prontuários de pacientes com idade igual ou superior a 60 anos, hospitalizados por causas externas, no período de janeiro a dezembro de 2011. O instrumento de pesquisa consistiu de um formulário específico, desenvolvido a partir da análise dos prontuários. As variáveis utilizadas foram: sexo, faixa etária, situação conjugal, horário, ocorrência no final de semana, etiologia, tipo de queda, presença de fratura, presença de fratura de fêmur, local da fratura de fêmur, Traumatismo Cranioencefálico (TCE), e óbito. Os dados foram analisados com o SPSS (Statistical Package for the Social Sciences) na versão 18, sendo utilizado o teste do Qui - quadrado de Pearson e teste Exato de Fisher, considerando o valor de significância estatística (p< 0,05). Resultados: Houve predomínio de vítimas do sexo feminino (51,2%), sendo a faixa etária de 60 a 69 anos a mais atingida, correspondendo a (38%) dos casos. As principais causas de morbimortalidade foram as quedas e os acidentes de transporte (68,6% e 18,8%, respectivamente). As fraturas foram mais comuns no sexo feminino, na faixa etária de 80 anos ou mais e os casos de TCE foram mais prevalentes no sexo masculino e no grupo etário de 60 a 69 anos. A principal causa de mortalidade foi a queda (69,9%), em idosos do sexo masculino e com faixa etária de 80 anos ou mais. Foram observadas associações significativas (p<0,001) entre as variáveis: “sexo”, “etiologia”, “presença de fraturas”, “TCE” de acordo com a “faixa etária”. Quanto às internações por queda, houve predominância do sexo feminino (62,4%), na faixa de 80 anos ou mais (41,6%), as fraturas mais freqüentes foram as de fêmur (57%), a presença de TCE foi observada em (14,3%) dos casos e as maiores proporções de óbito ocorreram na faixa etária de 80 anos ou mais (21,8%). Conclusão: As quedas e acidentes de transporte foram as causas mais prevalentes de morbimortalidade por causas externas, o sexo feminino e a faixa etária de 60 a 79 anos foram os protagonistas e a queda foi a principal causa. Esses dados são elucidativos para o planejamento de medidas preventivas da assistência hospitalar baseada na demanda potencial, proporcionando melhor qualidade de vida aos idosos e redução de gastos destinados à reabilitação.
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Dellaroza, Mara Solange Gomes. "Idosos com dor crônica, relato de queda e utilização de serviços de saúde: estudo SABE." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-23082012-142905/.
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Objetivo: Caracterizar a dor crônica em idosos da comunidade e avaliar sua associação entre a utilização de serviços de saúde e o autorrelato de quedas. Método: estudo transversal com amostra populacional obtida por meio de inquérito domiciliar, envolvendo idosos com dor crônica sem déficit cognitivo. Neste estudo consideram-se dor crônica aquela com duração igual ou superior a seis meses e idoso aquele com 60 anos ou mais. O critério para utilização do serviço de saúde foi ter feito mais de quatro consultas ou uma internação no último ano. A ocorrência de quedas foi o relato de, no mínimo, uma queda nos 12 meses anteriores à pesquisa. Por meio da estatística descritiva os idosos foram caracterizados quanto às características da dor crônica, dos aspectos sociodemográficos, morbidade autorreferida, dependência nas atividades básicas e instrumentais de vida diária e mobilidade. Para os idosos com dor há pelo menos um ano, testou-se a existência de associação entre uso do serviço de saúde e ocorrência de queda com variáveis independentes (características da dor, sociodemográficas e morbidades autorreferidas), por meio de análises univariadas (teste de associação de RaoScott) e multivariadas (Regressão Múltipla de Cox com variância robusta). Para as análises estatísticas utilizou-se o programa Stata 11.0 e adotou-se como valor de significância p<0,05. Resultados: A prevalência de dor crônica foi de 29,7% (IC95% 25,4 - 33,9); os locais mais frequentes de dor foram a região lombar (25,4%) e membros inferiores (21,9%); a dor foi moderada em 45,8% das vezes e intensa em 46% dos indivíduos. A dor foi mais frequente em mulheres (p<0,007) e esteve associada à maior dependência para as atividades da vida diária e à pior mobilidade (p<0,001). Intensidade da dor e renda familiar associaram-se (p=0,005): renda familiar igual ou superior a três salários mínimos foi relatada por 37% dos idosos com dor fraca/moderada e por 17% daqueles com dor intensa. A prevalência de utilização do serviço de saúde nos idosos com dor foi de 44% (IC95% 35,1 52,8), e não diferiu dos idosos sem dor (50,5% [IC95% 45,1-55,9]) A análise multivariada mostrou que a chance de utilização do serviço de saúde foi 33% menor nos idosos com dor há mais de dois anos do que naqueles com dor entre um e dois anos (p=0,002). Foi 55% maior nos idosos com dor intensa (p=0,003) e 45% maior entre os que relataram interferência moderada da dor (p=0,015). A prevalência de queda, no último ano, entre os idosos com dor foi de 31,6% (IC95%: 26,4 37,5] e não diferiu dos idosos sem dor (26,4% [IC95%: 23,1 30,0]) e p=0,145. A maioria (58,9%) dos idosos com dor crônica caiu uma vez no último ano, e 27,6% deles caíram três vezes ou mais. O risco de quedas foi 50% maior (p=0,019) em idosos com dor e osteoporose, enquanto foi 48% maior naqueles com dor e incontinência urinária (p = 0,010). Conclusão: estudo populacional com idosos da cidade de São Paulo, constatou-se que a dor crônica foi frequente e esteve associada a maiores prejuízos na independência e mobilidade. A dor crônica mais intensa, a mais recente e a com impacto no trabalho resultaram em maior uso dos serviços de saúde. Aqueles com dor há um ano ou mais e osteoporose, dor e incontinência urinária tiveram maiores chance de quedas.Objective: To characterize chronic pain in community-dwelling elderly and evaluate its association with the use of health services and self-reported falls. Method: Crosssectional study whose population sample was obtained by home surveys of elderly with chronic pain and without cognitive deficit. The study considered pain lasting for six or more months as chronic and those at least 60 years old as elderly. The criterion for health service use was more than four doctor appointments or having been admitted to a hospital during the past year. The occurrence of falls included at least one reported fall in the 12 months prior to the study. Descriptive statistics were used to characterize the elderly according to chronic pain and socio-demographic characteristics, self-reported morbidity, mobility and dependence regarding activities of daily living. For those in chronic pain for at least one year, the existence of an association between the use of health services and the occurrence of falls and independent variables (pain and sociodemographical characteristics and self-reported morbidities) was tested using univariate (RaoScott test of association) and multivariate analysis (Cox Multiple Regression with robust variance). Stata 11.0 was used for the statistical analysis, and the significance level adopted was p<0.05. Results: The prevalence of chronic pain was 29.7% (CI95% 25.4 33.9); pain was most frequently in the lumbar area (25.4%) and lower limbs (21.9%); the pain was moderate 45.8% and intense in 46% of the individuals. Pain was more frequent among women (p<0.007) and was associated with greater dependence in activities of daily living and lower mobility (p<0.001). Intensity of pain and family income were associated (p=0.005): 37% of the elderly with weak/moderate pain and 17% of those with intense pain reported family income at least three times the minimum wage. The prevalence of health service use among the elderly with pain was 44% (CI95% 35.1 52.8) and did not differ for elderly individuals without chronic pain (50.5% [CI95% 45.1- 55.9]) The multivariate analysis showed that the chance of using health services was 33% lower for elderly individuals with pain for more than two years than those with pain between one and two years (p=0.002). The chance was 55% higher for those with intense pain (p=0.003) and 45% higher for with moderate pain (p=0.015). The prevalence of falls in the last year for elderly individuals with pain was 31.6% (CI95% 26.4 37.5] and did not differ from elderly individuals without pain (26.4% [CI95%: 23.1 30.0): p=0.145. Most (58.9%) of those with chronic pain had fallen once during the past year and 27.6% had fallen three or more times. The risk of falls was 50% higher (p=0.019) for those with pain and osteoporosis and 48% higher for those with pain and urinary incontinence (p= 0.010). Conclusions: The findings of this study, a population study of elderly from the city of São Paulo, included that chronic pain was frequent and associated with greater independence and mobility deficits. More intense and recent chronic pain that affected work resulted in greater use of health services. Those in pain for one year or longer and suffering from osteoporosis, pain and urinary incontinency had a higher chance of falling.
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von, Heideken Wågert Petra. "Health, physical ability, falls and morale in very old people: the Umeå 85+ Study." Doctoral thesis, Umeå universitet, Geriatrik, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-871.
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The very old, aged 80 years and over, is the fastest growing age group today, and the demands for healthcare and services will be even higher in the future. It is, therefore, of great importance to advance our knowledge about this group. The main purpose of this thesis was to describe living conditions and health, with a special focus on physical ability, falls and morale, in women and men in three different age groups of very old people in northern Sweden. Half the population aged 85, and the total population aged 90 and ≥95 (-103) in the municipality of Umeå were selected for participation (n=348) in this population-based cross-sectional study, entitled the Umeå 85+ Study. Structured interviews and assessments were performed with the participants in their homes, and data were also collected from next-of-kins, caregivers and medical charts. Cognition was screened for using the Mini-Mental State Examination (MMSE), depressive symptoms using the Geriatric Depression Scale-15 (GDS-15), and nutritional status using the Mini Nutritional Assessment (MNA). Activities of Daily Living (ADL) were assessed using the Staircase of ADL (including the Katz Index of ADL) and morale using the Philadelphia Geriatric Center Morale Scale (PGCMS). Participants also rated their own health and answered a questionnaire about symptoms. Physical ability was assessed using a gait speed test over 2.4 meters (8 feet), three consecutive chair stands, and the Berg Balance Scale (BBS). A follow-up study for falls was performed during a period of six months with fall calendars and telephone calls. The very old people in this northern population have more depression, hypertension and hip fractures, as well as a higher consumption of drugs than comparable, more southern populations. In general, younger participants had lower rates of diagnoses and prescribed drugs, were less dependent in ADL and other functional variables than older participants, and men had lower rates of diagnoses and reported symptoms than women. However, there were no age or sex differences in self-rated health or morale, which were both rated as good by the majority of the participants. There was a wide range of physical ability among these very old people, especially in women, where an age-related decline was seen. The results also demonstrate that men had greater physical ability than women. The BBS had no floor or ceiling effects in the present sample. In contrast, a large proportion was unable to perform the gait speed and chair stands test, resulting in a floor effect for the timed performances, especially in women. Falling is a major public health problem in very old people. From the results of the present study, it could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture over a period of one year. The independent explanatory risk factors for time to first fall in this sample of very old people were dependency in personal (P-) ADL but not bedridden, thyroid disorders, treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) and occurrence of fall/s in the preceding year. These factors should all be considered in fall prevention programmes. The morale of very old people was found in this study to be rather high, with similar scores among age groups and sexes. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and having few symptoms. The PGCMS seems applicable in the evaluation of morale in very old people. In conclusion, there were wide variations in health status and physical ability in this northern population of very old people. Women had poorer health and physical ability than men. Falls and fractures were common and serious health problems. Morale seemed to be high, despite the fact that a large proportion of the participants suffered from many diseases and functional decline.
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Elliott, David B., Anna Vale, David J. Whitaker, and John G. Buckley. "Does my step look big in this? A visual illusion leads to safer stepping behaviour." Public Library of Science, 2009. http://hdl.handle.net/10454/3265.
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Background.
Tripping is a common factor in falls and a typical safety strategy to avoid tripping on steps or stairs is to increase foot clearance over the step edge. In the present study we asked whether the perceived height of a step could be increased using a visual illusion and whether this would lead to the adoption of a safer stepping strategy, in terms of greater foot clearance over the step edge. The study also addressed the controversial question of whether motor actions are dissociated from visual perception.
Methodology/Principal Findings.
21 young, healthy subjects perceived the step to be higher in a configuration of the horizontal-vertical illusion compared to a reverse configuration (p = 0.01). During a simple stepping task, maximum toe elevation changed by an amount corresponding to the size of the visual illusion (p<0.001). Linear regression analyses showed highly significant associations between perceived step height and maximum toe elevation for all conditions.
Conclusions/Significance.
The perceived height of a step can be manipulated using a simple visual illusion, leading to the adoption of a safer stepping strategy in terms of greater foot clearance over a step edge. In addition, the strong link found between perception of a visual illusion and visuomotor action provides additional support to the view that the original, controversial proposal by Goodale and Milner (1992) of two separate and distinct visual streams for perception and visuomotor action should be re-evaluated.College of Optometrists
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Barros, Iarema Fabieli Oliveira de. "QUEDAS EM IDOSOS BRASILEIROS: MORBIMORTALIDADE E PROJEÇÃO DE INTERNAÇÕES NO ESTADO DO RIO GRANDE DO SUL (1998-2020)." Universidade Federal de Santa Maria, 2016. http://repositorio.ufsm.br/handle/1/9613.
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Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorPopulation aging is a global reality. Initially observed in developed countries, today presents intensively in developing countries. Brings with it many concerns to managers, as is becoming a public health problem, especially when considering the external causes of morbidity and mortality, especially falls. This research aims to evaluate the morbidity and mortality due to falls in elderly Brazilians and analyze the temporal trend of hospital admissions for people aged sixty or older, residing in the State of Rio Grande do Sul (RS), from 1998 to 2012 and were drawn their projections relative and absolute, by the year 2020. This study consists of three articles. The former is a reflection article about the human aging process, the second, an integrative review of literature on the morbidity and mortality due to falls in elderly Brazilians and the third refers to the temporal trend and projection of hospital admissions by falls for elderly residents in the RS. This study did not require submission to the Research Ethics Committee (CEP) of the Universidade Federal de Santa Maria (UFSM) because it is a search using secondary data in the public domain, available online at DATASUS (www.datasus.gov.br) and thus there is no variables that allow the identification of the research subjects.
O envelhecimento populacional é uma realidade mundial. Inicialmente observado em países desenvolvidos, hoje se apresenta de forma intensa nos países em desenvolvimento. Trás consigo inúmeras preocupações aos gestores, uma vez que vem se tornando um problema de saúde pública, principalmente quando se analisam as causas externas de morbimortalidade, com destaque para as quedas Esta pesquisa buscou verificar a morbimortalidade por quedas em idosos brasileiros e analisar a tendência temporal de internações hospitalares para pessoas com sessenta anos ou mais de idade, residentes no Estado do Rio Grande do Sul (RS), no período de 1998 a 2012 e foram traçadas suas projeções relativas e absolutas, até o ano de 2020. O presente estudo é constituído de três artigos. O primeiro trata-se de um artigo de reflexão a cerca do processo de envelhecimento humano, o segundo, uma revisão integrativa da literatura a respeito da morbimortalidade por quedas em idosos brasileiros e o terceiro, refere-se à tendência temporal e projeção de internações hospitalares por quedas para idosos residentes no RS. O presente estudo não necessitou de submissão ao Comitê de Ética em Pesquisa (CEP) da Universidade Federal de Santa Maria (UFSM) por se tratar de uma pesquisa utilizando banco de dados secundários de domínio público, disponível online pelo DATASUS (www.datasus.gov.br) e, desta forma, não havendo variáveis que possibilitem a identificação dos sujeitos da pesquisa.
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Augusto, Valeria 1976. "Mulheres sadias no período pós menopausa : estudo eletromiográfico do quadríceps e suas relações com massa óssea, níveis plasmáticos de 25OH Vitamina D3, ângulo quadricipital e incidência de quedas." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309831.
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Orientador : João Francisco Marques NetoTese (Doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivo: verificar a atividade eletromiográfica de superfície dos músculos (EMG) Vasto Lateral (VL), Vasto Medial Oblíquo (VMO) e Reto Femural (Reto Femural) em mulheres no período pós menopausa e a relação dos resultados com níveis de 25OHD3, massa óssea, ângulo Q e incidência de quedas. Material e Métodos: Foram avaliadas 30 mulheres com menopausa instalada quanto a Eletromiografia de superfície dos músculos Reto Femural (RF), Vasto Medial Oblíquo (VMO) e Vasto Lateral (VL), dosagem sérica de 25OHD3 (Vitamina D3), densitometria óssea (DMO), medida do ângulo Q e questionamento sobre ocorrência de quedas nos 6 meses que antecederam a coleta dos dados. Para análise quantitativa da amplitude do sinal eletromiográfico foram utilizados o RMS (Root Mean Square - Raiz Quadrada da Média), expresso em ?V. Foi utilizados como instrumentos estatísticos o Teste de Diferença de Médias de Wilcoxon, Análise Exploratória dos dados para análises descritivas, e Análise de Correlação de Spearman juntamente com o Teste de Hipóteses para verificação das correlações entre as variáveis estudadas. O nível de significância utilizado foi de 95% de confiança (p?0,05). Resultados: As voluntárias apresentaram idade de 61,79 (49-73, ? 6,81) e correlação significantemente negativas (p?0,05) foram observadas entre os resultados dos músculos estudados e os valores de DMO e de 25-OH - Vitamina D3. Houve correlação negativa entre a atividade elétrica muscular e DMO (RF60, VMO100 e VMO60 com DMO em T score fêmur, e VMO60 com DMO de fêmur inteiro em g/cm2); e níveis de 25OHD3 com EMG de VLN. Houve correlações negativas entre ângulo Q e VMO100 e VMO 60, potencialmente influenciado pela incidência de quedas. Conclusões: Menores níveis de 25OHD3 e redução de massa óssea podem estar relacionados a um aumento na atividade elétrica muscular do quadríceps, podendo indicar uma diminuição de seu desempenho ideal em mulheres mais idosas no período pós menopausa, e o desequilíbrio da atividade entre VL e VMO sugere risco na ocorrência de quedas e disfunção patelo femural nestas pacientes
Abstract: Objective: This study evaluated the surface electromyographic activity (EMG) of the vastus lateralis (VL), vastus medialis oblique (VMO) and rectus femoris (straight femoral, RF) muscles in post-menopausal women and the relationship between EMG activity and 25OHD3 levels, bone mass, Q angle measurement and questioning about the occurrence of falls in the 6 months prior to data collection. Materials and Methods: Thirty menopausal women underwent surface electromyography of the RF, VMO and VL muscles and bone densitometry. Serum 25-OH-Vitamin D3 levels were also measured. The Root Mean Square (RMS) was used to quantitatively analyze the electromyographic signal amplitude in ?V. Several statistical analyses were performed to determine correlations between variables, including the Wilcoxon signed-rank test, exploratory data analysis for descriptive analyses and Spearman's rank-order correlation analysis with hypothesis testing. The level of significance was set at a 95% confidence level (p ? 0.05). Results: The volunteers showed age was 61.79 (49-73, ? 6.81) and negative and significant correlation (p ? 0.05) observed between the results from the muscles studied with BMD and 25OHD3. There was a negative correlation between muscle electrical activity and BMD (RF60, VMO and VMO60 with BMD T-score femur, and femoral BMD with VMO60 whole in g/cm2) and levels 25OHD3 with EMG VLN. There were negative correlations between Q angle and VMO100 VMO and 60, potentially influenced by the incidence of falls. Conclusions: Lower levels of 25OHD3 and reduced bone mass may be related to an increase in electrical activity of the quadriceps muscle, which may indicate a decrease of performance ideal for older women in the postmenopausal period, and the imbalance of activity between VMO and VL suggests the risk of falls and patellofemoral dysfunction in these patients
Doutorado
Ciencias Basicas
Doutora em Clínica Médica
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Rodrigues, Juliana. "Idosos vítimas de trauma: uma proposta de predição de risco." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/83/83131/tde-20092011-092425/.
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O Brasil cada vez mais torna-se um país de cabelos brancos, e, este processo traz reflexos para a sociedade brasileira e para a assistência à saúde desta população. Destaca-se as causas externas como um problema de saúde pública que oferecem grande impacto na saúde dos idosos. Estes têm capacidade reduzida de recuperação e permanecem hospitalizados por maior tempo. Portanto, nesta investigação buscou-se identificar a relação entre o idoso vítima de trauma e os fatores de risco envolvidos no acidente. Objetivo Geral: Desenvolver indicadores de predição de risco para o trauma em idosos. Objetivos Específicos: Caracterizar o perfil dos idosos vitimas de trauma atendidos no pronto-socorro; Verificar quais os mecanismos de trauma sofrido pelos idosos; Conhecer os fatores que contribuíram para a ocorrência do trauma; Analisar os fatores de risco para a ocorrência do trauma em idosos. Estudo quantitativo, transversal realizado no prontosocorro (PS) de dois hospitais da cidade de Curitiba, sendo aprovada por suas Comissões de Ética em Pesquisa. Os critérios de inclusão foram os seguintes: pacientes com 60 anos ou mais, de ambos os gêneros, vítimas de trauma, que estavam sendo atendidos no PS e que aceitaram participar da pesquisa de maneira voluntária ou por autorização de cuidadores ou familiares, em caso de déficit cognitivo e/ou auditivo. A coleta de dados foi realizada à beira do leito por meio de uma entrevista estruturada; os dados obtidos foram organizados em planilha Excel e analisados por meio do programa computacional Statistical Package for the Social Sciences - SPSS versão 15.0. Os resultados foram descritos por frequências e percentuais. Para avaliação da associação entre duas variáveis qualitativas, foi considerado o teste de Qui-quadrado ou o teste exato de Fisher. Para avaliação conjunta da associação de fatores com o mecanismo do trauma (queda ou outros eventos), foi ajustado um modelo de Regressão Logística (stepwise backward). A partir do ajuste, foram estimados os valores de odds ratio com respectivos intervalos de confiança de 95%. Os sujeitos foram 261 idosos que atenderam aos critérios de inclusão, sendo 148 mulheres (56,7%) e 43,3% homens. A faixa de idade variou de 60 a 103 anos, e a média foi de 72,6 ± 9,3 anos. Grande parte da amostra tinha idade abaixo de 70 anos (44,8%). Com relação ao estado civil, 43,3% dos pacientes eram casados; 35,2%, viúvos; 13%, separados, amasiados; e 8,4%, solteiros. Os mecanismos de trauma mais frequentes foram: queda (75,9%), atropelamento (9,6%), trauma direto (5,4%) e acidente automobilístico (3,8%). O medicamento mais utilizado foi o anti-hipertensivo (45,2%). A análise multivariada permitiu afirmar que, independentemente das outras variáveis incluídas no modelo, o gênero feminino, a presença de cuidador, medicação de uso contínuo e a presença de problemas auditivos aumentam significativamente a probabilidade de trauma por queda. Problemas de visão sem uso de óculos e idosos com renda de até 3 salários mínimos tendem a 7 ter maior probabilidade de trauma por queda. Esses resultados permitem estabelecer que os fatores que mais interferem no trauma em idosos podem, se avaliados durante a consulta de enfermagem, possibilitar ações de saúde para a sua prevenção.Brazil is becoming more and more a country of white hair and this process brings consequences for Brazilian society and the health care of its population. The highlights are the external causes as a matter of public health that offers great impact on the health of the elderly. The aged have their ability of recovery reduced and remain hospitalized for longer periods of time. Therefore, this research aimed to identify the relation between the aged victim of trauma and the risk factors involved in the accident. General objective: develop indicators of risk prediction for trauma in the aged. Specific objectives: describe the profile of aged victims of trauma seen in the emergency room; Check which mechanisms of trauma are suffered by the aged; Learn the factors that contributed to the occurrence of the trauma; Analyze the risk factors for the occurrence of the trauma in the aged. Quantitative cross study, held in the emergency department of two hospitals in Curitiba, which was approved by their Research Ethics Committees. The inclusion criteria were as follows: patients of 60 years old or more, both gender, victims of trauma that were being seen at the emergency room and accepted to participate in the research voluntarily or under authorization of caregiver or family in case of cognitive or/and hearing deficit. The data collection was made through a semi-structured interview by the bed; the data obtained were organized in an excel spreadsheet and analyzed by computer program Statistical Package for the Social Sciences - SPSS version 15.0. The results were described by frequencies and percentages. To evaluate the association between two qualitative variables, it was considered the Chisquare test or the Fishers exact test. To jontly evaluate the factors associated with the mechanism of trauma (fall and other events), it was adjusted a logistic regression model (stepwise backward). As from the ajustment, it were estimated the odds ratio values with respective confidence intervals of 95%. The subjects were 261 elderly people that met the inclusion criteria, 148 women (56,7%) and 43,3% men. The age ranged from 60 to 103 years old, and the average was 72,6 ± 9,3 years old. The great majority of the sample was under 70 years old (44,8%). Regarding to marital status, 43,3% of patients were married; 35,2%, widowed; 13%, separated, in cohabitation and 8,4%, single. The mechanisms of trauma more frequent were: fall (75,9%), running over (9,6%), direct trauma (5,4%) and car accident (3,8%). The medicament most used was the anti-hypertensive (45,2%). The multivariate analysis allowed to say that, independently of other variables included in the model such as the female gender, the presence of the caregiver, the continued use of medication and the presence of hearing problems increased significantly the probability of trauma by fall. Sight problems without wearing glasses and aged with incomes up to 3 minimal wages tend to have higher probability of trauma by fall. These results allowed establishing that the factors that most interfere in trauma in the aged may, if evaluated during the nursing consultation, enable health actions for its prevention.
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Luzia, Melissa de Freitas. "Análise do diagnóstico de enfermagem risco de quedas em pacientes adultos hospitalizados." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/72278.
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Estudo transversal retrospectivo realizado um hospital universitário de grande porte do sul do Brasil para analisar o Diagnóstico de Enfermagem (DE) Risco de quedas e os cuidados de enfermagem prescritos para pacientes adultos hospitalizados em unidades clínicas e cirúrgicas no ano de 2011. Especificamente, buscou-se identificar a prevalência do DE, o perfil clínico dos pacientes, os fatores de risco estabelecidos e os cuidados prescritos para esses pacientes, agrupando os últimos de acordo com as intervenções descritas na Nursing Interventions Classifications (NIC). A amostra constituiu-se de 174 pacientes, e os dados foram coletados em sistema de prescrição informatizado e prontuário online. A análise foi realizada pela estatística descritiva e o agrupamento dos cuidados de enfermagem nas intervenções NIC baseou-se no método de mapeamento cruzado. O estudo foi aprovado em Comitê de Ética e Pesquisa (nº 110631). Houve prevalência do DE Risco de quedas em 4% das internações estudadas, o perfil dos pacientes com este DE apontou para idosos, sexo masculino (57%), internados nas unidades clínicas (63,2%), com tempo mediano de internação de 20(10-24) dias, portadores de doenças neurológicas (26%), cardiovasculares (74,1%) e várias comorbidades (3±1,8). Os fatores de risco mais prevalentes foram alteração neurológica (43,1%), mobilidade prejudicada (35,6%) e extremos de idade (10,3%). Entre os 48 diferentes cuidados de enfermagem prescritos, os mais frequentes foram manter grades no leito (83,2%), orientar paciente/família quanto aos riscos e prevenção de quedas (49,4%) e manter campainha ao alcance do paciente (40,8%). O agrupamento dos cuidados nas intervenções NIC apontou Controle do Ambiente: segurança (29,2%), Prevenção de Quedas (20,6%) e Monitoração Neurológica (15%) como as mais prevalentes. A intervenção Prevenção de Quedas compreendeu o maior número de cuidados diferentes. Concluiu-se que a prevalência deste DE ainda é pequena no cenário de estudo, o que talvez possa ser modificado após o início da utilização de instrumento preditor de risco. O perfil dos pacientes com este DE mostra que são em maioria idosos, com doenças neurológicas e cardiovasculares e diversas comorbidades, o que requer cuidados preventivos à multiplicidade desses fatores. A intervenção Prevenção de Quedas mostrou-se realmente prioritária ao DE Risco de quedas, pois suas atividades se direcionam à multifatorialidade do evento. O uso de linguagens padronizadas na prática clínica pode contribuir para a qualificação do cuidado, norteando protocolos de prevenção e de segurança aos pacientes.Retrospective cross-sectional study performed in a large university hospital in southern Brazil to analyze the ND Risk for fall and nursing cares prescribed for adult patients hospitalized in clinical and surgical units in 2011. The specific objectives were: identify the prevalence of the ND Risk for fall; the clinical profile of patients; the risk factors established and nursing cares prescribed for these patients, grouping them according to the interventions described in the Nursing Interventions Classification (NIC). The sample consisted of 174 patients and the data were collected in medical records and computerized system. The data analysis was done by the descriptive and analytic statistics and the grouping of nursing cares in the NIC interventions was based on the cross-mapping method. The study was approved by Ethics and Research Committee (number 110631). The results showed a prevalence of the ND Risk for fall in 4% of the hospitalizations studied. The profile of the patients with this ND pointed to elderly, male (57%), hospitalized in clinical units (63.2%), with median time of hospitalizations of 20 (10-24) days, with neurological disorders (26%), cardiovascular (74,1%) and many comorbidities (3±1,8). The risk factors most prevalent were: Neurological alteration (43.1%), Impaired mobility (35.6%) and Age extremes (10.3%). Were identified 48 different nursing cares prescribed, being the most frequent Keep the bars in the bed (83.2%), Guide patient/family about the risks and prevention of falls (49.4%) and Keep the bell within reach of the patient (40.8%). The care grouping in the NIC interventions pointed to Environment control: security (29.2%), Prevention of falls (20.6%) and Neurological monitoring (15%) as the most prevalent. The intervention Prevention of falls comprehended the largest number of different cares. It was concluded that the prevalence of this ND is still low in the studied scenario, which may be modified after the beginning of the use of the risk predictor instrument. The profile of patients with this ND shows that they are most elderly, with neurological and cardiovascular diseases and many comorbidities, which requires preventive cares to the multiplicity of these factors. The intervention Prevention of falls proved to be really priority to the ND Risk for fall, because its activities are directed to the multifactorial of the event. The use of standardized language in clinical practice can contribute to qualify the care, guiding prevention and patient’s safety protocols.
Estudio transversal retrospectivo realizado en un hospital universitario de grande porte del sur de Brasil para analizar el Diagnostico de Enfermería (DE) Riesgo de Caídas y los cuidados de la enfermería prescriptos para pacientes adultos hospitalizados en unidades clínicas y cirúrgicas durante el año de 2011. Los objetivos específicos fueron: identificar la permanencia del DE Riesgo de caídas; el perfil clínico de los pacientes; los factores de riesgo establecidos y los cuidados prescriptos para esos pacientes, además de agrupar de acuerdo con las intervenciones descriptas en la Nursing Interventions Classifications (NIC). La muestra se constituyó de 174 pacientes y los datos colectados en sistema informatizado y prontuarios. El análisis fue realizada por la estadística descriptiva y agrupamiento de los cuidados de enfermería en las intervenciones NIC se ha basado en el método de mapeamiento cruzado. El estudio fue aprobado por el Comité de Ética e Investigación (nº 110631). El permanencia del DE Riesgo de caída fue de 4% en las internaciones estudiadas. El perfil de los pacientes puntó para ancianos, sexo masculino (57%), internados en las unidades clínicas (63,2%), con tiempo medio de internación de 20 (10-24) días, portadores de enfermedades neurológicas (26%), cardiovasculares (74,1%) y diversas morbilidades (3±1,8). Los factores de riesgo más permanentes fueron: Alteración neurológica (43,1%), Movilidad perjudicada (35,6%) y de los Extremos de edad (10,3%). Se identificaron 48 cuidados de enfermería prescriptos siendo los más frecuentes: mantener baranda en las camas (83,2%), orientar paciente/familia en cuanto a los riesgos y prevención de caídas (49,4%) y mantener el timbre al alcance del paciente (40,8%). El agrupamiento de los cuidados en las intervenciones NIC apuntaron Control de Ambiente: seguridad (29,2%). Prevención de Caídas (20,6%) y Monitoreo Neurológico (15%) como las más permanentes. La intervención Prevención de Caídas comprendió el mayor número de diferentes cuidados. Se concluyó que la permanencia de este DE todavía es pequeña en el escenario del estudio, lo que tal vez pueda ser modificado después del inicio de la utilización de instrumento predictor de riesgo. Los pacientes con este DE muestra que son en mayoría ancianos, con enfermedades neurológicas y cardiovasculares y diversas morbilidades, y que requieren cuidados preventivos a la multiplicidad de estos factores. La intervención Prevención de Caídas se mostró realmente prioritaria al DE Riesgo de Caídas, pues sus actividades se direccionan a los diferentes factores del evento. El uso de lenguajes padronizados en la práctica clínica puede contribuir para la cualificación del cuidado norteando protocolos de prevención y de seguridad a los pacientes.
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Gubel, Vanessa Maria Camargo Andrade Ribeiro 1971. "Relação entre quedas e fragilidade em idosos da comunidade : dados do FIBRA - Unicamp." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310909.
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Orientadores: Maria Elena Guariento, André FattoriDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivos: Descrever a ocorrência de quedas em uma amostra de idosos do município de Campinas (SP); investigar as relações entre quedas e fragilidade. Métodos: Participantes: Amostra probabilística de 689 idosos sem déficit cognitivo sugestivo de demência recrutados em domicílio no contexto do estudo multicêntrico e multidisciplinar "Perfil de Fragilidade de Idosos Brasileiros" (Rede FIBRA). Procedimentos: Primeira parte: Aplicou se um questionário com levantamento de dados sociodemográficos; doenças crônicas e / ou sintomas auto-referidos; uso regular de medicamentos auto-referido; medidas do fenótipo de fragilidade (segundo Fried et al., 2001); antecedentes de quedas. Resultados: A média de idade foi 72,27 anos; 68,37% eram mulheres; 69,10% relataram quedas; 50,87% eram pré-frágeis e 4,81% foram classificados como frágeis. Houve associação significativa entre ocorrência de quedas e as variáveis: idade ? 80 anos (p=0,004), sexo feminino (p<0,001), déficit visual (p=0,002), artrite referida (p=0,002) e sintomas depressivos (p=0,005). A análise de regressão logística multivariada evidenciou que sexo feminino, déficit visual e presença de critérios de fragilidade foram os fatores que apresentaram maior associação com quedas. Conclusões: Faz-se necessário identificar os fatores associados ao maior risco de quedas para que se obtenha um efetivo controle das mesmas. Entre esses, há que se destacar a presença de um ou mais dos critérios que compõem o fenótipo de fragilidade
Abstract: Objectives: to describe the occurrence of falls in community-dwelling elders from Campinas (SP); to investigate the relationship between falls and fragility. Methods: Participants: 689 community-dwelling elderly recruited during the multicenter and multidisciplinary project "Estudo do Perfil de Fragilidade de Idosos Brasileiros-FIBRA.UNICAMP", that means Frailty Profile of the Brazilian Elderly. Procedures: Fist part: It was applied a questionnaire which collected socio-demographic data; daily life activities; presence of depressive symptoms; cognitive evaluation; self-referred diseases and / or symptoms; self-referred medicines; body mass index; measures of the frailty's phenotype (according Fried et al., 2001); previous falls. Results: Mean age was 72.27 years, 68.37% were women. 69.10% of the elderly reported falls, and 55.68% presented at least one frailty criteria. There was significant association between falls and the variables: age ? 80 years (p = 0.004), female gender (p <0.001), visual impairment (p = 0.002), reported arthritis (p = 0.002), and depressive symptoms (p = 0.005). Multivariate analysis showed that female gender; visual impairment and frailty criteria had a greater association with falls. Conclusions: It's necessary to identify the events which are associated to the biggest risk of falls to obtain an effective control of them. Therefore, as it was demonstrated in this study it's important to recognize the presence of the criteria of frailty (Fried et al., 2001)
Mestrado
Gerontologia
Mestra em Gerontologia
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Silva, Marília Egues da. "Fatores de risco para quedas em idosos: revisão integrativa da literatura a partir do diagnóstico de enfermagem da NANDA." reponame:Repositório Institucional da FURG, 2011. http://repositorio.furg.br/handle/1/3079.
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Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2011.Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2013-01-10T12:59:40Z No. of bitstreams: 1 mariliasilva.pdf: 482712 bytes, checksum: 9f9f81371db911f8600f3787acd71661 (MD5)
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As quedas entre os idosos representam importante problema de saúde pública. Dessa forma, a presente pesquisa, procedente de um projeto oriundo do Projeto Universal 2008, teve como objetivo: analisar a produção científica brasileira e estrangeira dos últimos cinco anos, a partir do diagnóstico de enfermagem da NANDA “risco de quedas”, acerca dos fatores de risco para população idosa. A metodologia utilizada foi a revisão integrativa, realizada em cinco fases: formulação do problema; coleta dos dados; avaliação dos dados; análise e interpretação dos dados; e apresentação dos dados. Para a coleta de dados utilizou-se os descritores: acidente por quedas e idoso, nas bases de dados da CINAHL e LILACS, tendo sido encontrados seiscentos e trinta e sete estudos, e sendo selecionados trinta e dois para análise de conteúdo. Os resultados foram apresentados considerando-se: informações relacionadas aos artigos e informações de relevância à pesquisa- fatores de riscos indicados na NANDA-I. Assim, após a análise dos dados, emergiram como categorias de fatores de risco: ambientais: ambiente com móveis e objetos/tapetes espalhados pelo chão, pouca iluminação e condições climáticas- piso escorregadio; cognitivos: estado mental rebaixado; em adultos: história de queda, idade acima de 65 anos, uso de dispositivos auxiliares; fisiológicos: dificuldades na marcha, dificuldades visuais, equilíbrio prejudicado, incontinência, neoplasia; medicamentos. Parece evidente que, da identificação dos fatores de risco para quedas nos idosos, emerge a necessidade do desenvolvimento de alternativas e estratégias que possibilitem modificações nos ambientes e componentes intrínsecos, passíveis de alterações. Assim, espera-se que essa pesquisa e as possíveis propostas de intervenção que surjam a partir dela sirvam como interconexão entre os serviços de saúde e a Academia, a fim de promover melhorias no cuidado ao idoso.
Falls among the elderly pose a major problem in public health. Thus, the following study, founded in a project of Universal Project 2008, aimed: to analyze the scientific production regarding the risk factors for falls, in the elderly population, both in Brazilian and foreign scientific literature within the last five years. The methodology applied was the integrative review, carried out in five stages: problem formulation; data collection; data assessment; data analysis and interpretation; and data presentation. For data collection, the following descriptors were used: fall accident and elderly, in the database of CINAHL and LILACS, where six hundred and thirty- seven studies were retrieved, from which thirty-two were selected for analysis of content. The results were presented taking into account: data related to the articles and relevant data to the research- risk factors indicated in NANDA-I. After data analysis, the following categories for risk factors emerged: environmental: environment with furniture and objects/rugs scattered around the floor, poor lighting, climatic conditions-slippery floor; cognitive: lowered mental state; In adults: history of falls, over 65 years of age, use of aid devices; physiological: marching difficulties, impaired vision, loss of balance, incontinence, neoplasia; medications. Understandably, by identifying the risk factors for falls among elderly there is a growing need for the development of alternatives and strategies to enable improvement in the environment as well as intrinsic components, open to alterations. Therefore, it is expected that this research and the following proposals of intervention which come up from it, may be an interconnection between the health services and the Academy, in order to promote improvements in the care of the elderly.
Las caídas entre los ancianos representan un importante problema de salud pública. Por lo tanto, la presente investigación, que se originó en un proyecto derivado del proyecto Universal 2008, tubo por objetivo: revisión de la literatura científica sobre los factores de riesgo de caídas en la población anciana, en la literatura nacional y extranjera, en los últimos cinco años. La metodología utilizada fue la revisión integradora, llevada a cabo en cinco fases: formulación del problema; recopilación de datos; evaluación de los datos; análisis e interpretación de los datos; y presentación de datos. Para la selección de datos se utilizaó los siguientes descriptores: accidente por la caída y anciano, en las bases de datos de la CINAHL y la LILACS, se ha encontrado seiscientos treinta y siete estudios, y se seleccionaron treinta y dos para el análisis de contenido. Los resultados fueron presentados teniendo en cuenta: informaciones relacionadas con los artículos e informaciones de interés para la investigación - factores de riesgo listados en NANDA-I. Así, después del análisis de los datos, surgió como categorías de factores de riesgo: ambientales: ambiente con muebles y objetos/alfombras en el suelo, con poca luz, condiciones del clima – piso resbaladizo; cognitivos: el estado mental degradado; en los adultos: historia de caída, edad superior a 65 años, uso de dispositivos de asistencia; fisiológicos: dificultad para caminar, dificultades visuales, equilibrio dañado, incontinencia, neoplasia; medicamentos. Parece claro que, de la identificación de factores de riesgo de caídas entre los ancianos, surge la necesidad de elaborar alternativas y estrategias que permitan cambios en los ambientes y los componentes intrínsecos, sujetos a cambios. Por lo tanto, se espera que esta investigación y las posibles propuestas de acción que surjan de ella sirvan como la interconexión entre los servicios de salud y de la Academia, para promover mejora de la atención para los ancianos.
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Teixeira, Lucas Emmanuel Pedro de Paiva [UNIFESP]. "Treinamento de carga progressiva para quadríceps associado a exercícios de propriocepção na prevenção de quedas em mulheres com osteoporose pós-menopausa: um ensaio clínico randomizado." Universidade Federal de São Paulo (UNIFESP), 2009. http://repositorio.unifesp.br/handle/11600/10144.
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Publico-11922.pdf: 2026305 bytes, checksum: 6748d516ad453759f76cc254710a50b1 (MD5)OBJETIVO: avaliar o efeito de um programa de treinamento de força muscular progressiva e propriocepção, na força muscular do quadríceps, no equilíbrio, na qualidade de vida e na redução do risco de quedas em mulheres com osteoporose pós-menopausa. MÉTODOS: Foram selecionadas cem mulheres sedentárias com idade entre 55 e 75 anos com osteoporose pós-menopausa, randomizadas em dois grupos: grupo intervenção composto por 50 pacientes submetidas a 18 semanas de treinamento de força muscular progressiva do quadríceps (a 50%, 60%, 70% até 80% de 1-RM – uma repetição máxima), e de propriocepção, associados ao tratamento clínico medicamentoso para osteoporose; e grupo controle também composto por 50 pacientes que receberam apenas o tratamento clínico medicamentoso. Força muscular, equilíbrio, mobilidade funcional e qualidade de vida foram avaliados no início e ao final da pesquisa através do Teste de Uma Repetição Máxima (1-RM), Berg Balance Scale (BBS), Timed Up & Go Test (TUG) e SF-36. Número de quedas foi avaliado 6 meses que antecederam à pesquisa e nos 6 meses seguintes. RESULTADOS: 85 pacientes concluíram a pesquisa. Os valores para SF-36 melhoraram em todas as oito sub-escalas no grupo intervenção (p ≤ 0.0018), Timed Up & Go Test (p < 0,0001), do teste de 1-RM (p < 0,0001), da Berg Balance Scale (p < 0,0001), e, ainda, uma redução do risco de quedas no grupo intervenção comparada ao grupo controle (IRR 0.263, 95% IC 0.10, 0.68). CONCLUSÃO: A associação do treinamento de força muscular progressiva para quadríceps e o treinamento proprioceptivo é efetivo na redução do risco de quedas, no aumento da força muscular do quadríceps, na melhora do equilíbrio estático e dinâmico, na melhora da capacidade funcional e da qualidade de vida em mulheres com osteoporose pós-menopausa.
OBJECTIVE: To evaluate the effect of a progressive muscular strength and proprioception training program on the muscle strength of the quadriceps, balance, quality of life and reduction in the risk of falls in postmenopausal women with osteoporosis. METHODS: One hundred sedentary postmenopausal women with osteoporosis, ages ranging from 55 to 75, were selected and randomized into two groups: the intervention group comprised of 50 patients who underwent a 18-week of progressive load training for the quadriceps muscle (50%, 60%, 70% up to 80% of 1- RM – one maximum repetition) and proprioception training associated to a drug treatment of osteoporosis and the control group that included 50 patients who only underwent a drug treatment of osteoporosis. The muscular strength, balance, functional mobility and quality of life were evaluated in the beginning and end of the research through the One Maximum Repetition Test (1-RM), Berg Balance Scale (BBS), Timed Up & Go Test (TU & GT) and SF-36. The number of falls was evaluated 6 months preceding the research and in the following six months. Results: Eighty-five patients concluded the research. The program promoted a significant difference among the groups for SF-36 in the eight sub-scales (p ≤ 0.0018), Timed Up & Go Test (p < 0.0001), 1-RM test (p < 0.0001), Berg Balance Scale (p < 0.0001) and also a decrease in the number of falls in the intervention group compared to control (IRR 0.263, 95% CI 0.10, 0.68). Conclusion: The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls, increasing the muscle power, the static and dynamic balance and increasing the speed of the motor responses, therefore improving the performance of daily activities.
TEDE
BV UNIFESP: Teses e dissertações
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Cartaxo, Carla Kalline Alves. "Perfil epidemiológico do trauma por quedas atendidos em serviços de urgência de Sergipe." Universidade Federal de Sergipe, 2012. https://ri.ufs.br/handle/riufs/3704.
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Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorAmong the external causes of morbidity and mortality, trauma due to fall represents the main cause of hospitalizations in the Brazilian public health system. It is a descriptive crosssectional quantitative study that aimed to trace the epidemiology profile of trauma due to falls assisted in the emergency services of Sergipe and know the effects of falls in the return to daily life activities of adult victims. It was carried out in two public hospitals of reference in trauma care in the state of Sergipe during thirty consecutive days in November 2010, through a structured interview. The sample consisted of 509 victims of falls, both genders, aged between 0.2 and 103 years. The Chi-squared test was used for the association between the variables, considering the significance level of 5%. The results revealed that victims of trauma from falls were mostly male (53.4%) between 0.2 and 12 years (33.2%), 19 to 59 years (40.7%) and 60 years or older (15.5%), single (42.6%), brown skin (48.9%), coming from the Metropolitan Area of Aracaju (83.5%) without disabilities (92.5%) or pre-existing disease (76.6%) and not using regular medication (79.8%) or alcohol (97.5%). The most frequent place of occurrence was at home (45.4%), predominantly falls from the same level (63.9%). Concerning the nature of the injury, were more common the treatments were the victim showed fracture (34.8%), contusion (27.4%) and sprains (22.0%), with discharge in the urgency ward (89.8%). There was significant association between age and gender (p<0.0001), place of fall and gender (p <0.0001), age (p <0.0001) and type of fall (p<0.0001). Most victims recovered partially and returned to daily life activities, while 28.9% of these have ceased to work, walk and play football.
Dentre as causas externas de morbidade e mortalidade, o trauma por quedas representa a principal causa de internações no sistema público de saúde brasileiro. Trata-se de um estudo descritivo, de corte transversal, quantitativo com os objetivos de traçar o perfil epidemiológico do trauma por quedas atendidos em serviços de urgência de Sergipe e conhecer os efeitos das quedas no retorno às atividades da vida diária das vítimas adultas. Foi realizado em dois hospitais públicos de referência no atendimento ao trauma do estado de Sergipe durante trinta dias consecutivos no mês de novembro de 2010, por meio de entrevista estruturada. A casuística foi constituída de 509 vítimas de quedas, de ambos os sexos, com idades entre 0,2 e 103 anos. O Teste do Quiquadrado foi utilizado para a associação entre as variáveis, sendo considerado o nível de significância de 5%. Os resultados encontrados revelaram que as vítimas de trauma por quedas eram em sua maioria do sexo masculino (53,4%) entre 0,2 e 12 anos (33,2%), 19 a 59 anos (40,7%) e de 60 anos ou mais (15,5%), solteiro (42,6%), pardos (48,9%), procedentes da Grande Aracaju (83,5%), sem deficiência (92,5%) e doença preexistente (76,6%) e sem uso de medicamento regular (79,8%) e bebida alcoólica (97,5%). O local de ocorrência mais frequente foi a residência (45,4%) com predomínio de quedas do mesmo nível (63,9%). Quanto à natureza da lesão, foram mais comuns os atendimentos em que a vítima apresentava fratura (34,8%), contusão (27,4%) e entorse (22,0%), com o desfecho de alta no setor de urgência (89,8%). Houve associação significativa entre a faixa etária e o sexo (p<0,0001), o local da queda e o sexo (p<0,0001), faixa etária (p<0,0001) e tipo de queda (p<0,0001). A maioria das vítimas se recuperou de forma parcial e retornou as atividades da vida diária, embora 28,9% destes, tenham deixado de trabalhar, andar e jogar bola.
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Silva, Raimunda Beserra da. "Quedas em mulheres na pós-menopausa com e sem osteporose : prevalência e fatores de risco intrínsecos." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313379.
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Orientador: Lucia Helena Simões da Costa PaivaTese (doutorado) - Universidade Estadual e Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivo: Avaliar a prevalência de quedas e correlacioná-las com a força muscular da coluna lombar e membros inferiores, flexibilidade da coluna vertebral e equilíbrio corporal em mulheres na pós-menopausa com e sem osteoporose. Sujeitos e métodos: Estudo de corte transversal com 133 mulheres com osteoporose e 133 mulheres sem osteoporose, acima de 60 anos, em amenorréia há no mínimo 12 meses, acompanhadas no Ambulatório de Menopausa do CAISM/UNICAMP. Os critérios de exclusão foram: referir doença musculoesquelética, neurológica com alteração do equilíbrio, sintomas clínicos como tontura, zumbido, hipoacusia e plenitude auricular, antecedente de neoplasia maligna, deficiências visuais, diabetes mellitus e distúrbios tireoidianos não controlados, hipotensão postural e ingestão de medicamentos que alteram o equilíbrio corporal. As mulheres foram entrevistadas sobre a ocorrência de quedas nos últimos 12 meses, informações sociodemográficas e clínicas. O diagnóstico de osteoporose foi realizado através de densitometria óssea, considerando-se T-score = -2,5DP (adulto jovem) na coluna lombar (L1-L4). A força muscular da coluna lombar e membros inferiores foi medida com dinamômetro dorsal, a flexão e extensão da coluna vertebral foram verificadas com aparelho testes de Mann-Whitney e qui-quadrado, coeficiente de correlação de Spearman, flexímetro e o equilíbrio corporal foi analisado através da plataforma de força que avaliou amplitude, velocidade e área elíptica dos movimentos. Na análise estatística foram calculados médias, desvios-padrão e percentuais das variáveis estudadas, odds ratio ajustado e análise múltipla através de regressão logística binária com critério de seleção de variáveis stepwise. Resultados: Mulheres com osteoporose apresentaram menor IMC, menor escolaridade, menor tempo de uso de terapia hormonal e menor idade na menopausa. A média do T-Score da coluna lombar (L1-L4) do grupo osteoporose foi - 2,9 (±0,4 DP) e do grupo sem osteoporose foi 0,0 (±0,9 DP). A maioria das mulheres nos dois grupos era branca, sedentária e aproximadamente 75% fizeram uso de terapia hormonal. A prevalência de quedas foi significativamente maior no grupo de mulheres com osteoporose (51%) quando comparadas ao grupo sem osteoporose (29%) (p<0,01). Mulheres com osteoporose apresentaram risco ajustado de 1,97(1,30 a 3,42) vez maior de quedas e de 3,26(1,23 a 8,21) vezes maior de quedas recorrentes que o grupo sem osteoporose. Aproximadamente 56% das quedas ocorreram em ambiente doméstico. Houve correlação significativa e inversa entre força da coluna lombar (p<0,03) e amplitude de flexão do tronco (p<0,04) com a ocorrência de quedas. A análise de regressão logística mostrou que o aumento da força da coluna lombar diminui o risco de quedas para 0,97, enquanto a presença de osteoporose aumenta o risco de quedas em 2,17 vezes. Conclusões: Mulheres com osteoporose pós-menopausa apresentam maior prevalência de quedas e maior risco de quedas recorrentes quando comparadas com mulheres sem osteoporose. A força muscular da coluna lombar e a presença de osteoporose são fatores intrínsecos associados ao risco de quedas. É necessário identificar fatores de risco para quedas em idosos em geral e criar estratégias para a prevenção, visando a minimizar suas consequências, particularmente as fraturas em mulheres com osteoporose
Abstract: Objective: To evaluate the prevalence of falls and their correlation with muscle strength of the lumbar spine and lower limbs, flexibility of the lumbar spine and body balance in postmenopausal women with and without osteoporosis. Subjects and methods: A cross-sectional study of 133 women with osteoporosis and 133 women without osteoporosis, aged over 60 years, experiencing amenorrrhea for at least 12 months with follow-up in the Menopause Outpatient Facility at CAISM/UNICAMP. Exclusion criteria were: report of muscular skeletal disease, neurologic disorder with change in balance, clinical symptoms such as dizziness, tinnitus, hypoacusis and feeling of fullness in the ear, history of malignancy, visual deficiencies, diabetes mellitus and uncontrolled thyroid disorders, postural hypotension and ingestion of drugs that alter body balance. Women were interviewed about the occurrence of falls in the last twelve months. Information on clinical and social demographics was collected. Osteoporosis was diagnosed by bone densitometry and defined as T-score = -2.5SD (young adult) at the lumbar spine (L1-L4). Muscle strength of the lumbar spine and lower limbs was measured by a dorsal dynamometer, flexion and extension of the spine was measured with a flexion meter device and body balance was assessed by a strength platform that assessed the amplitude, velocity and areas of elliptical Spearman's correlation coefficient, Odds Ratio (95%CI) and multivariate analysis by movement. For statistical analysis, the means, standard deviations and variable percentages were calculated, using the Mann-Whitney and chi-square tests, binary logistic regression analysis with a stepwise variable criteria selection. Results: Osteoporotic women had a lower BMI, lower school education, shorter use of hormone therapy and younger age at menopause. The mean T-Score at the lumbar spine (L1-L4) was - 2.9 (±0.4 SD) for the osteoporotic group and 0.0 (±0.9 SD) for the control group. Most women in both groups were white, had a sedentary lifestyle and approximately 75% had used hormone therapy. The prevalence of falls was significantly higher in the group of women with osteoporosis (51%) than in the group without osteoporosis (29%)(p<0.01). Osteoporotic women had higher adjusted odds of falling equal to 1.97 (1.30 to 3.42) and higher adjusted odds of recurrent falling equal to 3.26 (1.23 to 8.21) than did the group without osteoporosis. Falls occurred in the home environment in approximately 56% of women. There was a significant and inverse correlation between strength of the lumbar spine (p<0.03) and amplitude of trunk flexion (p<0.04) with the occurrence of falls. Logistic regression analysis showed that increasing strength in the lumbar spine decreased the risk of falls to 0.97, while the presence of osteoporosis increased risk factors 2.17 times. Conclusions: Women with postmenopausal osteoporosis had a greater prevalence of falls and a higher risk of recurrent falls than women without osteoporosis. Muscle strength of the lumbar spine and the presence of osteoporosis are intrinsic factors associated with the risk of falls. It is necessary to identify risk factors for falls in the elderly in general. Furthermore, strategies must be developed to prevent falls, aimed at minimizing their consequences, particularly fractures in osteoporotic women
Doutorado
Ciencias Biomedicas
Doutor em Tocoginecologia
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Cruz, Danielle Teles da. "Prevalência de quedas e fatores associados em idosos na cidade de Juiz de Fora, Minas Gerais." Universidade Federal de Juiz de Fora, 2011. https://repositorio.ufjf.br/jspui/handle/ufjf/2142.
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FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais
As quedas configuram-se como um dos principais agravos que acometem a saúde do idoso, sendo responsáveis pelo declínio da capacidade funcional e da qualidade de vida do indivíduo. Além disso, são também importantes preditores da mortalidade. Esses eventos são responsáveis por altos custos sociais e aumento da demanda dos serviços de saúde, entre as principais consequências da queda cabe ressaltar: fraturas, lesões na cabeça, ferimentos graves, ansiedade, depressão e medo de cair. O objetivo do presente estudo foi verificar a prevalência de quedas e analisar os fatores a elas associados. Trata-se de um estudo transversal realizado por meio de inquérito domiciliar, com amostra composta por 420 idosos cuja coleta de dados foi realizada entre os meses de março e julho de 2010. A população acessível foi constituída de indivíduos com 60 anos ou mais de idade, de ambos os sexos, não institucionalizados, residentes na Zona Norte de Juiz de Fora. Para a análise dos fatores associados à ocorrência do evento queda, presença ou não nos últimos 12 meses, foi construído um modelo teórico de determinação com 3 blocos hierarquizados de variáveis às quais foram ajustadas entre si dentro de cada bloco, num primeiro momento. Os dados foram processados em um banco de dados criado por meio do software Statistical Package for Social Sciences (SPSS), em seu módulo de análise complexa, versão 14.0, sendo o nível de significância do estudo de 5%. O uso do software Stata 9.2 permitiu na análise bivariada verificar a associação entre cada uma das variáveis independentes com a variável dependente, através da utilização do teste Qui-quadrado (c²). Foram estimadas razões de prevalência brutas e ajustadas por regressão de Poisson, tendo como referência um modelo teórico de determinação com blocos hierarquizados. O nível de significância foi testado, usando-se os testes de Wald para heterogeneidade e tendência linear. A prevalência de quedas entre os idosos foi de 32,1% (IC95% = 27,7; 36,9). Entre aqueles que sofreram queda, 53,3% tiveram uma única queda e 18,5% tiveram fratura como consequência. A maior parte das quedas, 59,17%, ocorreu no próprio domicílio do idoso. A prevalência de quedas associou-se idade superior a 80 anos RPajustada (IC95%) = 2,68 (1,0; 7,22), sexo feminino RPajustada (IC95%) = 1,89 (1,04;3,47), necessidade de ajuda para locomoção por auxilio humano RPajustada(IC95%) = 3,68 (1,2; 11,34) ou por dispositivo auxiliar RPajustada (IC95%) = 5,8 (1,32;11,34) e diagnóstico autorreferido de osteoporose RPajustada (IC95%) = 2,06 (1,07; 3,96). Esses dados chamam a atenção para a necessidade de políticas públicas e ações de saúde voltadas para essa população, com ênfase em ações educativas, preventivas, e de promoção à saúde, que permitam a identificação dos fatores associados e intervenções multiprofissionais efetivas sobre as potencias consequências, advindas com as quedas, modificando-se, assim, o panorama atual.
The falls appear as one of the main damage that affects the health of the elderly, being responsible for the decline of the functional capacity and the life quality of the individual. Moreover, they are also important predictors of mortality. These events are responsible for high social costs and the increase of the demand for health services, among the main consequences of the fall it should be noted: fractures, head injuries, serious injuries, anxiety, depression and fear of falling. The aim of this present study was to verify the prevalence of falls and analyze the factors related to them. This is a cross-sectional study done through the domicile survey with a sample consisting of 420 elderly people whose collection of data was done between March and July in 2010. The accessible population was consisted of individuals with 60 years old or over this age, of both sexes, non-institutionalized, residents in the northern district of Juiz de Fora. For the analysis of factors associated with the occurrence of falls, presence or absence in the last 12 months, we built a theoretical model for determining three hierarchical blocks of variables which were adjusted each one in every block, at first. The data were processed on a database created through the software Statistical Package for Social Sciences (SPSS), in its complex analysis module, version 14.0, being the study significance level of 5%. The use of the Software Stata 9.2 allowed the different analysis to verify the association between each one of the independent variables and the dependent variable, through the use of the chi-square test (c ²). It was estimated PR crude and adjusted by Poisson regression, having as reference a theoretical model of determination with hierarchical blocks. The level of significance was tested, using the Wald tests for the heterogeneity and linear tendency. The prevalence of the falls among the elderly was 32.1% (CI95% = 27,7; 36,9). Among those who suffered fall, 53.3% had a unique fall and 18.5% had fracture as consequence. Most of the falls, 59.17%, happened in the own elderly home. The prevalence of the falls associated with people who are over 80 years old PRadjusted (CI95%) = 2,68 (1,0;7,22), females PRadjusted (CI95%) = 1,89 (1,04; 3,47), need for help to locomotion for human help PRadjusted (CI95%) = 3,68 (1,2; 11,34) or by auxiliary device PRadjusted (CI95%) = 5,8 (1,32; 11,34) and selfreferred diagnosis of osteoporosis PRadjusted (CI95%) = 2,06 (1,07; 3,96). These data call our attention to the need for policies and health public actions focused on this population, with emphasis on educational actions, preventive and promotion to the health, which allow the identification of factors associated with effective multi professional interventions in the potential consequences, because of the falls, changing, thus the current situation.
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Santo, Adriana de Sousa do Espirito. "Avaliação do equilíbrio em mulheres com e sem fibromialgia e sua relação com dor, flexibilidade e qualidade de vida." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5163/tde-27082009-155257/.
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As quedas atualmente constituem um importante problema de saúde pública, por gerar intercorrências á saúde do indivíduo e até levar a internações hospitalares e ao óbito. Quedas apresentam fatores causadores múltiplos, incluindo elementos ambientais extrínsecos e fatores intrínsecos como aspectos fisiológicos, musculoesqueléticos e psicossociais. O estudo sobre quedas tem privilegiado os idosos e pessoas portadoras de dor musculoesquelética, sendo que muitos idosos também têm queixa de dor. A fibromialgia é uma síndrome dolorosa de etiopatogenia desconhecida que acomete preferencialmente mulheres, sendo caracterizada por dores musculoesqueléticas difusas, locais dolorosos específicos à palpação associados freqüentemente a distúrbio do sono, fadiga, cefaléia crônica e distúrbios psíquicos, como depressão. Assim sendo as pessoas portadoras dessa síndrome apresentam fatores intrínsecos (dor, depressão, fadiga) que podem estar associados às quedas e o objetivo desse estudo foi verificar o risco de quedas nesta população sua relação com intensidade da dor, flexibilidade e qualidade de vida. Participaram do estudo 48 mulheres entre 40-59 anos, sendo 22 com fibromialgia (GF) encaminhadas do Serviço de Reumatologia do Hospital das Clínicas e 26 assintomáticas que constituíram o grupo controle (GC). Para avaliar o equilíbrio foi utilizada a Berg Balance Scale (escala Berg), Activities-specific Balance Confidence scale (escala ABC) e teste de tempo de reação. A avaliação da flexibilidade foi utilizando o teste de 3o dedo ao solo. Para caracterizar os sujeitos fibromiálgicos foram realizados: Questionário do Impacto da Fibromialgia (QIF) e Escala Visual Analógica (EVA). Para a análise dos dados foi utilizada Análise Descritiva e Análise Inferencial (teste t student, teste de Mann-Whitney U e correlação simples e de Spearman com nível de significância a = 0,05). Os resultados dos testes de equilíbrio (escala Berg e ABC) mostraram diferença estatisticamente significativa entre os grupos. A média de dor no GF foi 5,4cm(2,6) e o grupo controle não apresentava dor no dia da avaliação. Houve correlação negativa entre dor e escala de Berg e ABC e não houve correlação entre dor, flexibilidade e qualidade de vida. Correlação entre as escalas: Berg X ABC nos grupos só foi observada no GF. Concluímos que mulheres com fibromialgia apresentam alteração do equilíbrio e que isto pode estar correlacionado com a dor que essas mulheres apresentam constantemente. E o desempenho nos testes está correlacionado, ou seja, quanto mais confiança o indivíduo expressava mais alto foi seu escore na escala de Berg (sem risco de queda).Abstract: Background Fibromyalgia is a rheumatic syndrome with unknown etiopathogeneis more prevalent in woman. This disorder is characterized by chronic widespread pain, painful tender points that frequently associated to fatigue, sleep problems, chronic headache and physic disturbs, such as depression and anxious. Some of these symptoms, such as depression, pain and fatigue, recognized, as intrinsic factors can be associated to fall experimented by the person. So studies about falls are focusing on elderly people and people with muscle pain. The objective of this study is doing the assessment of the balance in person with fibromyalgia and its relationship with the intensity of the pain, flexibility and life quality. The study interviewed 48 women, from 40th to 59th years old, which 22 women have fibromyalgia (GF) and 26 women asymptomatic that represent the control group (GC). To evaluate the balance, the flexibility and fibromyalgia subjects, the tools used were, respectively: the Berg scale, Activities-specific Balance Confidence scale (scale ABC); Analogical Visual Scale; and The Fibromyalgia Impact Survey (QIF). The data were analysed using Descriptive and Inferential Analysis (Student t test, Mann-Whitney U and Spearman correlation simple, with significance level a = 0.05). Results: balance test and fear of fall are shown significant difference between the groups (p<0,05). The intensity pain average in the GF group was 5,4 (2,6) and zero in the GC group; and the flexibility decreased in the GF group (p=0,01). There was a negative correlation between pain and Berg scale (rs = -0,48 e p=0,02) and ABC scale (rs = -0,56 and p=0,006) and there was no correlation between pain, flexibility and quality of life. The correlation between the scales: Berg X ABC in both groups was only observed in the GF (rs= 0,55 e p=0,007). This study showed that women with fibromyalgia have pain intensively, higher risk of falls, lower confidence for doing daily activities, lower quality of life and less flexibility.
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Sá, Ana Claudia Antonio Maranhão. "Avaliação de um programa de intervenção com exercícios físicos em grupo para prevenir quedas em idosos residentes em instituições de longa permanência." Universidade Federal de Goiás, 2011. http://repositorio.bc.ufg.br/tede/handle/tede/7658.
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Falls in the elderly constitute an important public worldwide health problem, because they are an important cause of morbidity and mortality among elderly. This study aimed to evaluate an intervention program with group physical exercises in the prevention of falls in elderly living at long-term care institutions (LTCI). This is a non-randomized clinical trial, conducted with 20 elderly people of both sexes, residents in two LTCI in Goiânia, Brazil. The interventions were based on previous studies and occurred three times a week for a period of 18 weeks, totaling 40 sessions of group exercises, lasting about two hours each one, in which warm-up exercises were performed, muscle strength, balance, flexibility and relaxation. Standardized measures were used to assess falls (self-reports of participants), balance and gait (Performance - Oriented Mobility Assessment - POMA - Brazil), muscular strength (Hydraulic Hand Dynamometer and 30 second chair stand test), flexibility (Goniometer commuting – Fleximeter and Chair sit-and-reach test), fear of falling (Falls Efficacy Scale - International - FES I - Brazil). After a period of twelve months from the beginning of the intervention the decrease in the number of falls was significant (p = 0.046). Significant differences were observed for POMA-Equilibrium (p = 0.001), POMA-Total (p = 0.007), muscular strength of hand grip (p = 0.001) and lower limbs (p<0.001), flexibility of the bending motion of the shoulders (p = 0.001). The intervention by a physical exercises program proved to be adequate to improve balance, muscle strength of lower and upper limbs, shoulder flexibility, helping to significantly decrease the number of falls among elderly participants, but not enough to improve gait and multiple joint flexibility of spine and hip, as well as to reduce the number of elderly who suffered falls from the beginning of the intervention program.
As quedas em idosos constituem um problema de saúde pública em todo o mundo, pois são importante causa de morbidade e mortalidade entre pessoas dessa faixa etária. Assim, é necessário que os profissionais de saúde desenvolvam intervenções para prevenir essa ocorrência. Este estudo teve como objetivo geral avaliar um programa de intervenção com exercícios físicos em grupo para prevenir quedas em idosos residentes em instituições de longa permanência (ILPI). Trata-se de um ensaio clínico não randomizado realizado com 20 idosos de ambos os sexos, moradores em duas ILPI na cidade de Goiânia, Brasil. As intervenções ocorreram três vezes por semana, por um período de 18 semanas, totalizando 40 sessões de exercícios em grupo, cada uma delas com duração aproximada de 2 horas, nas quais foram realizados exercícios de aquecimento, força muscular, equilíbrio, flexibilidade e relaxamento. Medidas padronizadas foram utilizadas para avaliar quedas (autorrelato dos participantes), equilíbrio e marcha (Performance – Oriented Mobility Assessment – POMA – Brasil), força muscular (Hydraulic Hand Dynamometer e 30 segundos chair stand test), flexibilidade (Goniômetro pendular - Flexímetro e Chair sit-and-reach test) e medo de quedas (Escala de Eficácia de Quedas – Internacional –FES – I – Brasil). A partir do período de doze meses do início da intervenção, houve redução significativa (p = 0,046) no número de quedas. Foram observadas diferenças significantes para POMA-Equilíbrio (p = 0,001), POMA-Total (p = 0,007), força muscular de preensão palmar (p = 0,001) e de membros inferiores (p < 0,001) e flexibilidade do movimento de flexão dos ombros (p = 0,001). A intervenção realizada mediante um programa de exercícios físicos mostrou-se adequada para melhorar equilíbrio, força muscular de membros superiores e inferiores e flexibilidade de ombro, contribuindo para redução significativa do número de quedas entre os idosos participantes do estudo, porém não suficiente para melhorar a marcha e a flexibilidade multiarticular da coluna e quadril, bem como para reduzir o número de idosos que sofreram quedas a partir do início do programa de intervenção.
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Stenvall, Michael. "Hip fractures among old people : their prevalence, consequences and complications, and the evaluation of a multi-factorial intervention program designed to prevent falls and injuries and enhance performance of activities of daily living." Doctoral thesis, Umeå : Univ, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-870.
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Pasa, Thiana Sebben. "Avaliação do risco de quedas em pacientes adultos hospitalizados." Universidade Federal de Santa Maria, 2014. http://repositorio.ufsm.br/handle/1/7411.
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The fall of hospitalized patients is a world reality and the most frequent adverse events in this environment. This study aims to evaluate the risk of falls among adult patients in clinical and surgical unit of a university hospital. It is a cohort study with follow up of patients admitted in the Surgical Clinic and Medical I and II Clinic of the Hospital Universitário de Santa Maria (HUSM) between March to June 2013 (122 days). For data collection was utilized semi-structured form with demographic and clinical questions of patients and the Brazilian version of the Morse Fall Scale (SPS) was used. The data were organized in Excel ® with double entered independently. After the correction of errors and inconsistencies the analysis was realized in PASW ® Statistics (Predictive Analytics Software, Chicago - USA) version 18.0 for Windows, using the descriptive and inferential statistics. The study included 831 patients. Of these patients 60.2 % were male, the mean age was 58.1 (± 16.1) years , were on average 7.7 days (± 9.2) and were hospitalized on average 5.4 days (± 5.2) for evaluation. During the period 19 patients fell the floor / ground representing an average of 4.7 falls / month, a percentage of 2.28 % (95% CI: 1.66 to 2.91) falls in the period and a fee incidence of 1.68 % (95% CI: 1.51 to 1.72 % ). The MFS score had averaged 39.37 points (± 19.4). In the first evaluation and in the average final evaluation higher percentage of patients were classified as high risk for falls (36.6 %, 37.7 % and 41.2 %, respectively), with strong positive correlation between the first and final evaluation (r = 0.810, p = 0.000). The falls occurred between the 1st and 10th day of evaluation (85.7 %) during the morning (52.4 %), in the ward (at the bedside), bathroom and during the displacement, resulting in psychological harm (58.8 %) and physical (29.4%). Among the contributing factors highlight overestimate of the ability of patient, dizziness, agitation, gloom, high bed and inadequate and / or difficult of handle bars. It is concluded that MFS is an important tool for evaluation of risk of falls and recommended the deploying of the same as a quality indicator of health care in the research institution. It is hoped that this study will serve as subsidy for health professionals, particularly the nursing staff to implement of strategies that prevent the occurrence of falls during the hospitalization.A queda de pacientes hospitalizados é uma realidade mundial e um dos eventos adversos mais frequentes neste ambiente. Este estudo tem por objetivo avaliar o risco de quedas de pacientes adultos internados em unidades clínica e cirúrgica de um hospital universitário. Trata-se de um estudo de coorte, com acompanhamento de pacientes internados nas Unidades de Clínica Cirúrgica e Clínica Médica I e II do Hospital Universitário de Santa Maria (HUSM), no período de março a julho de 2013 (122 dias). Para a coleta dos dados foram utilizados um formulário semiestruturado, com questões demográficas e clínicas dos pacientes, e a versão brasileira da Morse Fall Scale (MSF). Os dados foram organizados no programa Excel®, com dupla digitação independente. Após a correção de erros e inconsistências a análise foi realizada no PASW Statistics® (Predictive Analytics Software, Chicago - USA) versão 18.0 for Windows, utilizando-se da estatística descritiva e inferencial. Participaram do estudo 831 pacientes. Destes, 60,2% eram do sexo masculino, a média de idade foi de 58,1 (±16,1) anos, permaneceram em média 7,7 dias (±9,2) internados e tiveram em média 5,4 dias (±5,2) de avaliação. Durante o período, 19 pacientes tiveram queda ao solo/chão, representando uma média de 4,7 quedas/mês, um percentual de 2,28% (IC95%: 1,66 2,91) de quedas no período e uma taxa de incidência de 1,68% (IC95%; 1,51 1,72%). O escore da MFS teve uma média de 39,37 pontos (±19,4). Tanto na primeira avaliação quanto na média das avaliações e na última avaliação, maior percentual de pacientes foi classificado na categoria de risco elevado para quedas (36,6%, 37,7% e 41,2%, respectivamente), com correlação positiva forte entre a primeira e a última avaliação (r=0,810; p=0,000). As quedas ocorreram entre o 1º e o 10º dia de avaliação (85,7%), no turno da manhã (52,4%), na enfermaria (à beira do leito), no banheiro e durante o deslocamento, resultando em dano psicológico (58,8%) e físico (29,4%). Dentre os fatores contribuintes destacaram-se a superestima da capacidade por parte do paciente, vertigem, agitação, penumbra, cama alta e grades inadequadas e/ou de difícil manuseio. Conclui-se que a MFS é um importante instrumento para avaliação do risco de quedas e recomenda-se a implantação da mesma como um indicador de qualidade da assistência à saúde na instituição pesquisada. Espera-se que este estudo sirva de subsídio para os profissionais de saúde, em especial a equipe de enfermagem, para a implementação de estratégias que previnam a ocorrência de quedas de pacientes durante a internação.
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Schimchak, Gabriella Assumpção Alvarenga. "Tontura e vertigem posicional paroxística benigna em idosos na atenção primária e associação com quedas." Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/8080.
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Thesis held in the papers format. The first article is a systematic review that aimed to investigate the relationship between BPPV and falls (with and without fracture). The review was carried out independently by two researchers, using the combined descriptors in English, Portuguese and Spanish, "vertigo" and "elderly" and "accidental falls"; "benign paroxysmal positional vertigo" and "accidental falls"; in the Virtual Health Library and United States National Library of Medicine (PubMED) databases, being the last search in August 2016. Six scientific papers were selected. The results showed that there were double falls in the elderly with the diagnosis of BPPV and this the relationship increased with advancing age. There was evidence of a decrease in episodes of falls above 60% of the elderly who were treated for BPPV. In elderly people with more than one cause for dizziness, BPPV can not be considered as an independent risk factor for falls. However, in the hospital environment, the relationship between BPPV and falls was not observed when the investigation was performed from the hip fracture. However, when the study included elderly patients hospitalized for various consequences of falls, BPPV could be identified in more than 50% of the patients. It can be concluded that BPPV is associated with falls. The second article, whose primary objective was to evaluate dizziness in the elderly in the primary care for the recognition of BPPV and the secondary one, to analyze the association between dizziness and BPPV with falls. It was a cross-sectional study of 298 diabetic and / or hypertensive elderly individuals enrolled in the Hypertensive and Diabetic Monitoring System of the Basic Family Health Unit of the Madre Germana II neighborhood of Goiânia, Goiás. The evaluation was carried out at the residence of the elderly, including the Mini Mental State Examination, sociodemographic profile, record of self-reported health conditions with emphasis on reporting dizziness and / or vertigo and record of falls in the last 12 months. The elderly who reported dizziness and/or vertigo were revisited for functional otoneurological evaluation for BPPV, using the Dix Hallpike test for the posterior and anterior semicircular canals and the Supine Roll test for the horizontal semicircular canal. The study included 150 elderly individuals with a mean age of 69.7 (+/- 7.36), the majority of them were female. Dizziness was reported by 50 elderly (33.3%). Among the 50 patients who reported dizziness, 19 had objective and subjective BPPV (38.8%). There was association between the complaint of dizziness and falls (p = 0.05), which did not occur with BPPV. The assessment of dizziness and BPPV can be performed in the home of the elderly in primary care. This proactive approach can help prevent falls because dizziness has increased the chances of the elderly falling. Although elderly people who presented objective or subjective BPPV did not increase their chances of falls, the identification of this disease, which has a known, effective and financially inexpensive treatment, may lead to the resolution of this clinical condition.
Tese construída na forma de artigos científicos. O primeiro artigo é uma revisão sistemática que objetivou investigar a relação entre VPPB e quedas (com e sem fratura). A revisão foi realizada de forma independente por duas pesquisadoras, utilizando os descritores combinados em inglês, português e espanhol, “vertigem” and “idoso” and “acidentes por quedas"; “vertigem posicional paroxística benigna” and idoso and acidentes por quedas”; vertigem posicional paroxística benigna” and “acidentes por quedas”, nas bases de dados Biblioteca Virtual em Saúde (BVS), United States National Library of Medicine (PubMED), sendo a última busca em agosto de 2016. Foram selecionados seis artigos. Observou-se diversidade metodológica entre os estudos. Quedas ocorreram o dobro de vezes em idosos com o diagnóstico de VPPB e esta relação aumentou com o avanço da idade. Houve evidência de diminuição de episódios de quedas acima de 60% dos idosos que foram tratados da VPPB. Em idosos com mais de uma causa para a tontura, a VPPB não pode ser considerada como fator de risco independente para quedas. Contudo, no ambiente hospitalar, a relação entre VPPB e quedas não foi observada quando a investigação foi realizada a partir da fratura de quadril. No entanto, quando o estudo incluiu idosos internados por consequências diversas de quedas, a VPPB pôde ser identificada em mais de 50% dos pacientes. Pode-se concluir que a VPPB está associada a quedas. O segundo artigo, teve como objetivos, avaliar a tontura em idosos na atenção primária para o reconhecimento da VPPB e analisar a associação entre tontura e VPPB com quedas. Foi um estudo do tipo transversal sendo estudados 298 idosos diabéticos e/ou hipertensos, cadastrados no Sistema de Acompanhamento de Hipertensos e Diabéticos da Unidade Básica de Saúde da Família do bairro Madre Germana II de Goiânia, Goiás. A avaliação foi realizada na residência dos idosos incluindo o Mini Exame do Estado Mental, perfil sociodemográfico, registro das condições de saúde auto referidas com ênfase no relato de tontura e/ou vertigem e registro de quedas nos últimos 12 meses. Os idosos que referiram tontura e/ou vertigem foram revisitados para avaliação funcional Abstract xvi otoneurológica para VPPB, utilizando o teste de Dix Hallpike para os canais semicirculares posterior e anterior e Supine Roll test para o canal semicircular horizontal. Foram incluídos no estudo 150 idosos com média de idade de 69,7(+/-7,36), a maioria do sexo feminino e 26% referiam queda. Tontura foi referida por 33% dos idosos, dentre os quais, 38,8% apresentaram VPPB. Houve associação entre a queixa de tontura e quedas (p=0,05), o que não ocorreu com a VPPB objetiva ou subjetiva. A avaliação da tontura e VPPB pode ser realizada no domicílio de idosos na atenção primária.
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Fonseca, Renata Francielle Melo dos Reis. "Prevenção de quedas nos idosos: adesão na atenção primária." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/22/22134/tde-30052018-105526/.
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A complexidade da assistência proveniente o envelhecimento populacional e adesão às ações preventivas dos idosos da comunidade são um desafio para a Atenção Primária. As quedas para este segmento populacional representam um problema de saúde pública e uma ameaça à capacidade funcional, qualidade de vida, preservação da autonomia e independência dos idosos. O interesse surgiu quando, em experiência pessoal no trabalho no setor de urgência, observou-se o elevado número de idosos que sofreram queda. Assim, o estudo estabeleceu como objetivo elaborar um instrumento para auxiliar os trabalhadores de saúde no incremento na adesão de idosos às recomendações de prevenção de quedas. Fundamenta-se esta pesquisa com o referencial do Envelhecimento Saudável para direcionar a atenção à saúde do idoso. Estudo metodológico que se constituiu de revisão de literatura para amparar o referencial sobre o tema, da análise documental a fim de identificar o tema de quedas nas políticas públicas brasileiras e do grupo focal para avaliar o manejo para a prevenção de quedas nos idosos da comunidade abordadas pelos Agentes Comunitários de Saúde na Atenção Primária. Identificou-se a relevância do tema quedas por meio da revisão de literatura, a descrição dos fatores de risco associados e um esquadrinhamento sobre adesão em idosos. Ao avaliar e caracterizar as publicações oficiais sobre as quedas averiguaram-se lacunas quanto ao tema. O grupo focal indicou a realidade do envelhecimento no cotidiano do serviço, abordou as consequências do evento das quedas e apontou as dificuldades para adesão dos idosos. Os dados subsidiaram a elaboração de um instrumento com o propósito de auxiliar a equipe da Atenção Primária a incentivar a adoção de ações preventivas de quedas pelos idosos. A Atenção Primária precisa se embasar para promover a saúde dos idosos e prover um Envelhecimento Saudável. Há necessidade de intervenções para que as políticas se efetivem em ações junto aos idosos no âmbito da saúde e outros setores da sociedade, para prevenção e tratamento dos agravos provocados por quedas, assim como para promover autonomia e inserção social em defesa da cidadaniaThe complexity of care provided for the aging population and adherence to the preventive actions of the elderly in the community is a challenge for Primary Health Care. The falls in this population segment represents a public health problem and a threat to the functional capacity, quality of life, the preservation of autonomy and independence of the older people. The interest came when, in personal experience at work in the emergency sector, the high number of elderly people who suffered a fall was observed. Thus, the study aimed to develop an instrument to assist health workers in the adherence of the elderly to recommendations for falls prevention. This research is based Healthy Aging to direct attention to the health of the elderly. A methodological study that consisted of a Literature Review to support the reference on the subject, from the Documentary Analysis in order to identify the topic of falls in Brazilian public policies and the Focus Group to evaluate the management for the prevention of falls in elderly community members addressed by health workers in Primary Care. It was identified the relevance of the falls theme through a literature review, the description of the associated risk factors and scanning about adherence in the aged. In evaluating and characterizing the official publications on the falls, there were gaps in the subject. The focus group indicated the reality of aging in the daily life of the service of health, addressed the consequences of the fall event and pointed out the difficulties for elderly people to join. The instrument generated has the purpose of helping the Primary Health Care team to encourage the adoption of preventive actions by the older people. Primary Care needs to be grounded to promote the health of elderly and provide Healthy Aging. There is a need for interventions to ensure that policies are implemented in the elderly, in health and other sectors of society, to prevent and treat injuries caused by falls, as well as to promote autonomy and social inclusion in defense of citizenship.
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Sousa, Neto Raimundo de Assunção. "Associação entre o risco de queda e o medo de cair em idosos atendidos na Estratégia Saúde da Família." Universidade Federal do Maranhão, 2017. http://tedebc.ufma.br:8080/jspui/handle/tede/1781.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
The general objective of the research was to verify the association of the risk of falling to the fear of falling in the elderly served in the Family Health Strategy of São Luís, Maranhão. The specific objectives were: To characterize the sociodemographic and health profile of elderly people more susceptible to falls; To verify the factors influencing the risk of falls in the elderly served in the Family Health Strategy; To verify the influencing factors in the fear of falling from the elderly served in the Family Health Strategy. This was a cross-sectional, analytical study with a quantitative approach carried out at the Basic Health Units of the city of São Luís, between September and November 2015, with elderly individuals aged 60 years or older, reaching a total of 203 researched. A sociodemographic and health identification card, Downton risk scale and fall efficacy scale were used as instruments of the research. Initially, the descriptive analysis was performed by means of absolute and relative frequencies. The chi-square association test was then used to evaluate the relationship between the risk of falling and fear of falling, and their relationship with sociodemographic characteristics. For significant associations, logistic regressions were calculated. The collected data was stored in a specific database created on the Microsoft Excel version 2016 spreadsheet. After that, the statistical analysis of the data was performed in the IBM SPSS program. The research is part of the project "Chronic Conditions in the Elderly Served in the Family Health Strategy in São Luís-MA", meets the aspects recommended in resolution 466/12, and was approved with the opinion number 949.100. The sample studied is mostly composed of women, aged 60-69 years, married, with at least complete primary education, who do not live alone, do not have a diagnosis of osteoporosis, have already received guidance on falls prevention, which Do not practice physical activity and when they do it, they do it in the same age group, until they are 89 years old and they have already diagnosed basic diseases. From the Chi-Square test a highly significant p-value was obtained, demonstrating that the risk of falling depends on the fear of falling. The characteristics of age, schooling, diagnosis of osteoporosis, not practicing physical activity and presenting underlying disease influence the risk of falling and fear of falling, since they present p-value with high significance, just as the fact of living alone also influences the Fear of falling. It is concluded that the risk of falling is associated with the fear of falling, that they are influenced by age, schooling, diagnoses of underlying diseases or osteoporosis, and sedentary lifestyle. It is assumed a high risk of falling into it.
O objetivo geral da pesquisa foi verificar a associação do risco de queda ao medo de cair nos idosos atendidos na Estratégia Saúde da Família de São Luís, Maranhão. Os objetivos específicos foram: Caracterizar o perfil sóciodemográfico e de saúde dos idosos mais suscetíveis à quedas; Verificar os fatores influenciadores no risco de queda em idosos atendidos na Estratégia Saúde da Família; Verificar os fatores influenciadores no medo de cair de idosos atendidos na Estratégia Saúde da Família. Tratou-se de um estudo do tipo analítico, transversal, com abordagem quantitativa, realizado em Unidades Básicas de Saúde da cidade de São Luís, entre os meses Setembro e Novembro de 2015, com idosos de 60 anos ou mais, chegando a um total de 203 pesquisados. Foram utilizados como instrumentos da pesquisa uma ficha de identificação sociodemográfica e de saúde, a escala do risco de quedas de Downton e a escala de eficácia de quedas. Inicialmente, foi realizada a análise descritiva por meio de frequências absolutas e relativas. Em seguida, utilizou-se o teste de Qui-Quadrado de associação para avaliar a relação entre as variáveis risco de queda e medo de cair, e a relação destas, com características sociodemográficas. Para associações significativas, foram calculadas regressões logísticas. Os dados coletados foram armazenados em um banco de dados específico criado na planilha Microsoft Excel versão 2016. Após ocorrido, a análise estatística dos dados foi realizada no programa IBM SPSS. A pesquisa faz parte do projeto “Condições Crônicas em Idosos Atendidos na Estratégia Saúde da Família em São Luís- MA”, atende aos aspectos recomendados na resolução 466/12, sendo aprovada com o parecer de número 949.100. A amostra estudada é composta em sua maioria por mulheres, com idade entre 60 e 69 anos, casadas, com pelo menos o ensino fundamental completo, que não moram sozinhas, não tem o diagnóstico de osteoporose, já receberam orientação sobre prevenção de quedas, que não praticam atividade física e quando a realizam, fazem na mesma faixa etária perdurando até os 89 anos de idade e apresentam doenças de base já diagnosticadas. A partir do teste de Qui-Quadrado alcançou-se como resultado um p-valor altamente significativo, demonstrando que o risco de queda depende do medo de cair. As características idade, escolaridade, ter diagnóstico de osteoporose, não praticar atividade física e apresentar doença de base influenciam no risco de queda e no medo de cair, pois apresentam p-valor com alta significância, assim como o fato de morar sozinho também influencia no medo de cair. Conclui-se que o risco de queda esta associado ao medo de cair, que os mesmos são influenciados por idade, escolaridade, diagnósticos de doenças de base ou de osteoporose, sedentarismo e por isso, ao determinar presença de medo de cair em um idoso deve-se presumir alto risco de queda no mesmo.
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Lisbôa, Vanderlúcia Ribeiro de Souza. "Fratura de fêmur: aspectos clínicos e cirúrgicos de idosos atendidos em um hospital militar do Distrito Federal entre 2006 e 2017." Universidade Católica de Brasília, 2018. https://bdtd.ucb.br:8443/jspui/handle/tede/2451.
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Introduction: In recent years, there have been a number of changes in life cycles that have resulted in increased life expectancy, with a decline in mortality that has benefited people from all demographic regions. Parallel to the demographic changes, there are changes in morbidity and mortality patterns characterized by the increase of chronic-degenerative diseases and factors that may result in dependence and lower quality of life, especially the fall of the height and femur fracture. Objective: To describe the clinical and surgical aspects of the elderly with femoral fracture treated at a military hospital of the Federal District between 2006 and 2017. Method: The design of this research is an epidemiological investigation of the descriptive retrospective type of case series. The sample consisted of records of the elderly with femur fracture due to falls of the same height, attended at the hospital between 2006 and 2017. Data collection was done at the institution, using the records on clinical and surgical data available in the medical records. Patients, from their hospitalization to the end, using a data collection instrument developed by the author. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 22.0, with a significance level of 5% (p <0.05). The descriptive statistics were performed using the distribution measures (mean, standard deviation - SD, absolute and relative frequency), considering the variables of interest in order to characterize the sample. For the inferential analyzes of the clinical and surgical data, non-parametric chi-square. Results: the sample consisted of 31 medical records of the elderly with mean age of 79 old. The number of fractures was higher in the elderly with 80 years of age or older (51.6%). It was observed that the fractures prevailed in women (80.6%), who declare themselves to be white (71%) from the Southeast region, living in the Federal District, urban region and married. There was a predominance of transtrochanteric fractures of the left femur treated with osteosynthesis and SAH as comorbidities and use of antihypertensive as a medication for continuous use. Patients with ASA II were more frequent. As to the number of intercurrences, the majority of the elderly had 5 to 9 intercurrences. The variables that had a positive correlation with the hospitalization time were DM and ASA. Conclusion: It was verified that the characterization of the patients analyzed follows a pattern of clinical diagnosis and age distribution with predominance of fractures in elderly, female and white declared elderly.
Introdução: Nos últimos anos, ocorreram várias mudanças nos ciclos da vida, que resultaram no aumento da expectativa de vida, com queda da mortalidade, que beneficiou pessoas de todas as regiões demográficas. Paralelamente às mudanças demográficas, ocorrem alterações nos padrões de morbimortalidade, caracterizados pelo aumento de doenças crônico-degenerativas e de fatores, que podem resultar em dependência e menor qualidade de vida, destacando-se a queda da própria altura e fratura de fêmur. Objetivo: Descrever os aspectos clínicos e cirúrgicos dos idosos com fratura de fêmur atendidos em um hospital militar do Distrito Federal entre 2006 e 2017. Método: O desenho desta pesquisa é de uma investigação epidemiológica do tipo descritiva retrospectiva de série de casos. A amostra foi constituída por prontuários de idosos com fratura de fêmur por quedas da própria altura, atendidos no hospital entre 2006 e 2017. A coleta de dados foi realizada junto à instituição, utilizando os registros sobre dados clínicos e cirúrgicos disponíveis nos prontuários dos pacientes, desde a sua internação até o desfecho, empregando um instrumento de coleta de dados elaborado pela autora. A análise dos dados foi realizada por meio do software Statistical Package for the Social Sciences® (SPSS) versão 22.0, adotando-se o nível de significância de 5% (p < 0,05). A estatística descritiva foi realizada usando as medidas de distribuição (média, desvio padrão, frequência absoluta e relativa), considerando as variáveis de interesse, a fim de caracterizar a amostra. Para as análises inferenciais dos dados clínicos e cirúrgicos, foram rodados testes não paramétricos qui-quadrado. Resultados: A amostra foi constituída por 31 prontuários de idosos com média de idade de 79 anos. O número de fraturas foi maior em idosos com 80 anos de idade ou mais (51,6%). Observou-se que as fraturas prevaleceram em mulheres (80,6%), nos que se declararam brancos (71%), provenientes da Região Sudeste, residentes no Distrito Federal, em região urbana, e casados. Houve predomínio das fraturas transtrocantéricas de fêmur esquerdo, tratadas com osteossíntese, e a hipertensão arterial sistêmica como comorbidades e uso de anti-hipertensivo como medicação de uso contínuo. Pacientes com ASA II foram mais frequentes. Quanto ao número de intercorrências, a maioria dos idosos teve 5 a 9 intercorrências. As variáveis que tiveram correlação positiva com o tempo de internação foram o Diabetes Mellitus e a classificação ASA. Conclusão: Verificou-se que a caracterização dos pacientes analisados segue um padrão de diagnóstico clínico e distribuição etária com predominância de fraturas em idosos longevos, do sexo feminino e declarados brancos.
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Meira, Débora Martins. "Impacto da hospitalização na capacidade funcional e força muscular de pacientes adultos e idosos num hospital público de nível terciário: é possível predizer estas alterações?" Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-11052017-133702/.
Full textAbstract:
Introdução: A imobilização prolongada no leito pode desencadear alterações em diferentes sistemas do corpo e na capacidade funcional. Durante a internação hospitalar, o repouso acontece com frequência e alterações na funcionalidade instaladas neste período podem perdurar mesmo após a alta. Este ambiente pode induzir o paciente à inatividade física o que pode afetar principalmente a força muscular. Objetivos: Avaliar o impacto da internação hospitalar na capacidade funcional e força muscular de pacientes hospitalizados e identificar possíveis preditores de ocorrência de eventos pós alta. Métodos: Trata-se de um estudo coorte prospectivo que inclui 250 pacientes internados em enfermarias do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram incluídos pacientes de ambos os gêneros, com idade >=50 anos. Foram excluídos pacientes com déficits cognitivos, dellírium, aqueles que não conseguiram realizar os testes propostos e/ou apresentarem > 48 horas de admissão na enfermaria. Dados clínicos e sociodemográficos foram avaliados a partir da análise dos prontuários. A força de preensão palmar (FPP) foi avaliada pelo dinamomêtro palmar e a capacidade funcional (CF) avaliada pelo índice de Barthel. Para verificar a ocorrência de quedas e re-internações, foi realizado um acompanhamento por telefone de 1, 3 e 6 meses pós-alta. Análise estatística: As variáveis numéricas foram representadas em mediana e intervalo interquartil (5% a 95%) e média e desvio padrão (DP). As variáveis categóricas foram descritas em valores absolutos e porcentagem. A comparação entre os sujeitos adultos e idosos no momento da admissão, foi realizada através do teste de Mann-Whitney Rank Sum Test e teste de Qui-Quadrado. A comparação entre as pontuações da admissão e alta hospitalar da FPP e CF foi realizada através do teste t de Student e Wilcoxon Signed Rank Test. Um modelo de Regressão Logística Múltipla foi utilizado para identificar possíveis preditores de perda de FPP durante a hospitalização e a ocorrência de quedas e re-internação no acompanhamento pós-alta. Resultados: A CF avaliada pelo Índice de Barthel não sofreu alterações (p=0,83), no entanto, foi verificada uma redução significativa de FPP durante o período de hospitalização (p=0,03), sendo a FPP no momento admissão o principal preditor de perda de força. A ocorrência de quedas e re-internações aumentam progressivamente com o acompanhamento pós-alta, sendo os principais preditores de ocorrência de quedas o auto-relato de queda prévia e a idade e, para re-internação o tempo de hospitalização. Conclusão: A hospitalização pode gerar perda de força de preensão palmar, no entanto, a capacidade funcional avaliada pelo Indice de Barthel não se altera. A ocorrência de queda e re-internação aumentam com o período de acompanhamento pós-alta e foi possível identificar preditores para a ocorrência destes eventosIntroduction: Prolonged bed rest can trigger changes in different body systems and functional capacity. During hospitalization, the rest happens frequently and changes in functionality installed in this period can last even after hospital discharge. This environment can induce the patient to physical inactivity which can affect the musculoskeletal system, especially the muscular strength. Objectives: Evaluated the impact of hospitalization on functional capacity and muscle strength of hospitalized patients. Methods: This was a prospective cohort study including 250 patients in wards of the Hospital Central Institute of the Faculty of Medicine, University of São Paulo. They included patients of both genders, aged >= 50 years. Patients with cognitive deficits, dellírium, those who cannot perform the tests proposed and / or submit > 48 hours of admission to the ward. Clinical and sociodemographic data were evaluated from the analysis of medical records. The hand grip strength (HGS) was evaluated by the hand dynamometer and the functional capacity (FC) evaluated by the Barthel Index. To verify the occurrence of falls and re-hospitalizations, a telephone follow-up of 1, 3 and 6 months post-discharge was performed. Statistical analysis: Numerical variables were represented in median and interquartile range (5% to 95%) and mean and standard deviation (SD). Categorical variables were described in absolute values and percentage. The comparison between adult and elderly subjects at admission was performed using the Mann-Whitney Rank Sum Test and Chi-Square test. The comparison between admission and discharge scores of FPP and CF was performed using Student\'s t-test and Wilcoxon Signed Rank Test. A Multiple Logistic Regression model was used to identify possible predictors of FPP loss during hospitalization and the occurrence of falls and re-admission at post-discharge follow-up. Results: The FC assessed by the Barthel Index did not change (p = 0.83); however, there was a significant reduction in FPP during the hospitalization period (p = 0.03). The occurrence of falls and re-hospitalizations increase progressively with post-discharge follow-up, the main predictors of occurrence of falls being the self-reported prior fall and the age, and for re-hospitalization, hospitalization time (p < 0,001). Conclusion: Hospitalization may lead to loss of hand grip strength, however, the functional capacity assessed by the Barthel Index does not change. The occurrence of fall and re-hospitalization increased with the post-discharge period and it was possible to identify predictors for the occurrence of these events