Diagnóstico de enfermería de Riesgo de Caídas en los ancianos en atención primaria

Santos, Paulo Henrique Fernandes dos; Stival, Marina Morato; Lima, Luciano Ramos de; Santos, Walterlânia Silva; Volpe, Cris Renata Grou; Rehem, Tania Cristina Morais Santa Barbara; Funghetto, Silvana Schwerz

doi:10.1590/0034-7167-2018-0826

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (Suppl 3) • 2020 • https://doi.org/10.1590/0034-7167-2018-0826 linkcopiar

Diagnóstico de enfermería de Riesgo de Caídas en los ancianos en atención primaria

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: evaluar el Diagnóstico de Enfermería (ND) de Riesgo de Caídas en ancianos en atención primaria de salud en Distrito Federal.

Métodos: investigación descriptiva, cuantitativa, transversal realizada en dos unidades básicas de salud. La recolección de datos incluyó recolección de sangre, consulta de enfermería y evaluación física de 156 ancianos con enfermedades crónicas.

Resultados: los factores de riesgo intrínsecos más prevalentes de NANDA-I fueron la discapacidad visual (73.7%), movilidad disminuida (70.5%) y antecedentes de caídas (69.9%); y los factores extrínsecos fueron el uso insuficiente de material en el baño (60.3%) y alfombras sueltas (58.3%). Los factores intrínsecos que aumentaron el riesgo de caídas fueron el uso de dispositivos de asistencia (OR 3.50; p=0.030), dificultades de la marcha (OR 2.84; p=0.019) y deterioro cognitivo (OR 1.26; p=0,019); y el factor extrínseco fue el uso de alfombras sueltas (OR 1.59; p=0.041).

Conclusión: este ND ha demostrado ser una herramienta valiosa para identificar factores de riesgo de caídas en ancianos en atención primaria de salud.

Descriptores: Anciano; Accidentes por caídas; Factores de riesgo; Diagnóstico de Enfermería; Atención Primaria de Salud

Variable	Description	n	%
Sex	Female	124	79.5
Sex	Male	32	20.5
Age (years)	60 to 64	53	34.0
	65 to 69	49	31.4
	70 to 74	34	21.8
	75 to 79	12	7.7
	≥ 80	8	5.1
Age	(M±SD/Min/Max)	67.9± 5.8/60/85
Marital status	Single	21	13.5
	Married	80	51.3
	Divorced	15	9.6
	Widowed	40	25.6
	White	52	33.3
Race	Mixed race	82	52.6
	Black	22	14.1
Occupation	Active	30	19.2
	Inactive^* *does not perform any paid activity and does not receive a pension or retirement;	65	41.7
	Retired^ receives pension or retirement.	61	39.1
	Illiterate	17	10.9
Schooling	1 to 4 years	52	33.3
	5 to 8 years	52	33.3
	≥ 9 years	35	22.5
Monthly income	≤ 1 minimum wage	82	52.6
	2 to 3 minimum wages	61	39.1
	≥ 4 minimum wages	13	8.3
Number of residents in the house	1	18	11.5
	2	34	21.8
	3	46	29.5
	4	30	19.2
	≥ 5	28	17.9
Nr. Residents in the house	(M±SD/Min./Max.)	3.2± 1.6/1/9

Variable	n	%
Smoking
Yes	12	7.7
No	144	92.3
Alcoholism
Yes	9	5.8
No	147	94.2
Sedentary lifestyle
Yes	41	26.3
No	115	73.7
Sleep
Normal	86	55.1
Altered	70	44.9
SAH
Yes	126	80.8
No	30	19.2
DM
Yes	93	59.6
No	63	40.4
SAH and DM
Yes	75	48.1
No	81	51.9
Use of insuline
Yes	17	10.9
No	139	89.1
Inflammatory diseases
Yes	13	8.3
No	143	91.7
Medications^* * medication classes according to ATC classification.
A – alimentary tract and metabolism	100	64.1
B - blood and hematopoietic system	31	19.9
C - cardiovascular system	132	84.6
G – hormonal preparations	11	7.0
M – musculoskeletal system	11	7.0
N – nervous system	11	7.0
R – respiratory system	4	2.5

Intrinsic risk factors	n (%)	Fall (n = 109)(%)	No fall(n = 47)(%)	OR	95% CI	p value*
In adults
History of falls
Age ≥ 65 years	103 (66.0)	74 (71.2%)	30 (28.8%)	1.19	0.58-2.45	0.376
Living alone	20 (12.8)	17(85.0)	3 (15.0)	2.15	0.73-2.79	0.089
Lower limb prosthesis	1 (0.6)	1 (100.0)	-	-	-	0.699
Use of auxiliary devices	24 (15.4)	21 (87.5)	3 (12.5)	3.50	1.6-7.8	0.030
Cognitives
Change in cognitive function (MMSE)
Compromised MMSE	85 (54.5)	53 (62.4)	32 (37.6)	1.26	1.03-1.55	0.019
Pharmacological agents
Pharmacological agent**
A – alimentary tract and metabolism	100 (64.1)	67(67.0)	33 (33.0)	1.26	0.22-2.71	0.261
B - blood and hematopoietic system	31 (19.9)	18 (58.1)	13(41.9)	1.53	0.92-2.55	0.080
C - cardiovascular system	132 (84.6)	92 (69.7)	40 (30.3)	1.08	0.72-1.62	0.443
G - hormonal preparations	11 (7.0)	8 (72.7)	3 (27.3)	1.05	0.72-1.54	0.545
M - musculoskeletal system	11 (7.0)	8 (72.7)	3 (27.3)	1.05	0.72-1.54	0.545
N - nervous system	11 (7.0)	8 (72.7)	3 (27.3)	1.05	0.72-1.54	0.545
R – respiratory system	4 (2.5)	3 (75.0)	1 (25.0)	1.08	0.61-1.93	0.638
Alcohol consumption	9 (5.8)	4 (44.4)	5 (55.6)	0.62	0.29-1.30	0.094
Physiological
Change in blood glucose level
Fasting blood glucose ≥ 126 mg/dl (hyperglycemia)	43 (27.6)	26 (60.5)	17 (39.5)	1.48	0.92-2.40	0.084
Fasting blood glucose < 70 mg/dl (hypoglycemia)	3 (1.9)	3 (100.0)	-	-	-	0.338
Anemia	7 (4.5)	2 (28.6)	5 (71.4)	2.5	1.48-4.32	0.026
Women: Hb< 12 g/dl
Men: Hb< 13 g/dl
Arthritis	30 (19.2)	25 (83.3)	5 (16.7)	2.00	0.86-4.62	0.055
Sleep deprivation (yes or no)	74 (47.4)
Condition affecting the feet	23 (14.7)	18 (78.3)	5 (21.7)	1.45	0.64-3.28	0.245
Hearing impairment	29 (18.6)	21 (72.4)	8 (27.6)	1.11	0.58-2.12	0.465
Visual impairment	115 (73.7)	85 (73.9)	30 (26.1)	2.00	0.95-4.24	0.052
Proprioceptive deficit	-	-	-	-	-	-
Fainting when extending the neck	1 (0.6)	-	1 (100.0)	-	-	0.301
Fainting when turning the neck	-	-	-	-	-	-
Diarrhea	8 (5.1)	5 (62.5)	3 (37.5)	1.12	0.65-1.94	0.452
Impaired walking	38 (24.4)	32 (84.2)	6 (15.8)	2.84	1.09-4.77	0.019
Acute disease	3 (1.9)	2 (66.7)	1 (33.3)	1.04	0.46-2.35	0.662
Vascular disease	21 (13.5)	16 (76.2)	5 (23.8)	1.30	0.58-2.92	0.345
Impaired Balance (BBS)
Normal (score ≥ 53 points)	88 (56.4)	64 (72.7)	24 (27.3)	1.45	0.69-3.0	0.320
Low to moderate risk for falls (score ≥ 46 and ≤ 52)	68 (43.6)	33 (64.7)	18 (35.3)	-	-	-
High risk for falls (score < 45)		12 (70.6)	5 (29.4)	1.30	0.39-4.30	0.657
Orthostatic hypotension	23 (14.7%)	16 (69.6)	7 (30.4)	1.00	0.75-1.34	0.575
Incontinence	33 (21.2%)	26 (78.8)	7 (21.2)	1.53	0.75-3.10	0.148
Impaired Mobility (TUG)
Normal (TUG - time ≤ 10 seconds)	46 (29.5%)	30 (65.2)	16 (34.8)	-	-	-
Low risk for falls (TUG - time ≥ 11 to ≤20 seconds)	110 (70.5)	61 (70.9)	25 (29.1)	1.30	0.60-2.79	0.499
High risk for falls (TUG - time >20 seconds)		18 (75.0)	6 (25.0)	1.60	0.52-4.83	0.402
Neoplasia	-	-	-	-	-	-
Postoperative Recovery Period	-	-	-	-	-	-
Reduced strength in lower limbs	32 (20.5)	26 (81.3)	6 (18.7)	1.76	0.82-3.78	0.084
Urge urinary incontinence	15 (9.6)	10 (66.7)	5 (33.3)	1.05	0.72-1.53	0.491

Extrinsic risk factors	n (%)	Fall (n = 109)(%)	No fall(n = 47)(%)	OR	95% CI	p value*
Environmental
Disorganized or object-filled environment	6 (3.8)	5 (83.3)	1 (16.7)	0.83	0.57-1.20	0.414
Little known scenario	-	-	-	-	-	-
Exposure to unsafe environmental condition (eg. wet floor, ice)	11 (7.1)	7 (63.6)	4 (36.4)	1.10	0.69-1.74	0.434
Insufficient lighting	6 (3.8)	5 (83.3)	1 (16.7)	0.83	0.57-1.20	0.414
Insufficient non-slip material in the bathroom	94 (60.3)	67 (71.3)	27 (28.7)	0.95	0.76-1.17	0.383
Use of immobilizers	2 (1.3)	2 (100.0)	-	-	-	0.487
Use of loose rugs	91 (58.3)	69 (75.8)	22 (24.2)	1.59	1.08-2.56	0.041

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Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[TFN1] Note: n: number of participants; %: percentage; M: Mean; SD: Standard Deviation; Min: Minimum; Max: Maximum; ±: More or less; ≥: greater than or equal; ≤ less than or equal; Minimum Wage: the minimum wage in Brazil in 2017: R$937;

[TFN2] *does not perform any paid activity and does not receive a pension or retirement;

[TFN3] **receives pension or retirement.