Fragilidad en el anciano: posibilidades de rastreo en la Atención Primaria de Salud

Ribeiro, Edmar Geraldo; Mendoza, Isabel Yovana Quispe; Cintra, Marco Túlio Gualberto; Bicalho, Maria Aparecida Camargos; Guimarães, Gilberto de Lima; Moraes, Edgar Nunes de

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (02) • 2022 • https://doi.org/10.1590/0034-7167-2020-0973 copiar

Fragilidad en el anciano: posibilidades de rastreo en la Atención Primaria de Salud

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

evaluar dos instrumentos de rastreo de fragilidad en el anciano en la Atención Primaria de Salud.

Métodos:

se trata de un estudio observacional, del tipo transversal, con abordaje cuantitativo, con 396 ancianos. Los análisis estadísticos fueron realizados con auxilio del software SPSS. Fueron usados el coeficiente kappa y la correlación de Spearman.

Resultados:

el coeficiente kappa entre el Índice de Vulnerabilidad Clínico Funcional 20 y la Escala de Fragilidad de Edmonton fue de 0,496, considerado moderado. Hubo correlación positiva y significante (r = 0,77; p < 0,001) entre las condiciones de fragilidad y la puntuación total de los dos instrumentos.

Conclusiones:

al evaluar la fragilidad, ambos los instrumentos presentaron correlación positiva y concordancia cuando verificados por el coeficiente kappa. Entretanto, la identificación de la fragilidad fue superior cuando utilizada la Escala de Fragilidad de Edmonton.

Descriptores:
Anciano; Envejecimiento; Fragilidad; Atención Primaria de Salud; Evaluación Geriátrica

	EFE
	No fragility		With fragility		Total		kappa^* * Value of kappa.
	n	%	n	%	n	%
CFVI-20							0.496
No fragility	293	97.3	53	55.8	346	87.4
With fragility	08	2.7	42	44.2	50	12.6
Total	301	100.0	95	100.0	396	100.0

Variables	Final score - EFS	Final score - CFVI
Variables	r (p value)¹ 1 Spearman correlation (value of p).	r (p value) ¹ 1 Spearman correlation (value of p).
Final score-CFVI-20	0.77 (0.001)	-
Total score-EFS	-	0.77 (0.001)

Variables	n	%
Age
Age (n = 395)
60 to 74 years	256	64.81
75 to 84 years	114	28.86
85 years or older	25	6.33
Self-perception of Health
Self-perception of Health (n = 396)
Excellent	39	9.85
Very good	50	12.63
Good	187	47.22
Regular	108	27.27
Bad	12	3.03
Instrumental daily life activity
Did you stop shopping because of your health or physical condition? (n = 396)
No	341	86.11
Yes	55	13.89
Have you stopped controlling your money, spending or paying bills because of your health or physical condition? (n = 396)
No	366	92.42
Yes	30	7.58
Have you stopped doing small housework because of your health or physical condition? (n = 395)
No	363	91.90
Yes	32	8.10
Basic daily living activity
Did you stop bathing alone because of your health or physical condition? (n = 396)
No	381	96.21
Yes	15	3.79
Cognition
Are you forgetting things? (n = 396)
No	154	38.89
Yes	242	61.11
Is this forgetfulness getting worse in recent months? (n = 396)
No	285	71.97
Yes	111	28.03
Is this forgetfulness preventing the realization of some activity of everyday life? (n = 396)
No	368	92.93
Yes	28	7.07
Mood
Were you sad or hopeless? (n = 396)
No	209	52.78
Yes	187	47.22
Lost interest or pleasure in previously pleasurable activities? (n = 396)
No	312	78.79
Yes	84	21.21
Mobility
Are you unable to raise your arms above shoulder level? (n = 396)
No	380	95.96
Yes	16	4.04
Are you unable to handle small objects? (n = 396)
No	384	96.97
Yes	12	3.03
Has any of the four conditions: unintentional weight loss; BMI less than 22 kg/m2; calf circumference less than 31 cm or walking speed greater than 5 seconds? (n = 392)
No	285	72.70
Yes	107	27.30
Is the difficulty of walking able to prevent the realization of some activity of everyday life? (n = 392)
No	358	91.33
Yes	34	8.67
Have you had two or more falls in the last year? (n = 395)
No	296	74.94
Yes	99	25.06
Do you lose urine or feces, unintentionally, at some point? (n = 396)
No	201	50.76
Yes	195	49.24
Communication
Vision problems (n = 396)
No	345	87.12
Yes	51	12.88
Hearing problems (n = 396)
No	356	89.90
Yes	40	10.10
Multiple Comorbidities
Do you have any of three conditions: five or more chronic diseases; regular use of five or more medications a day; recent hospitalization or in the last six months? (n = 396)
No	227	57.32
Yes	169	42.68

Variables	n	%
Cognition
Clock test (n = 389)
Approved	117	30.08
Failed with minimum errors	109	28.02
Failed with significant errors	163	41.90
General state of health
How many times have you been hospitalized? (n = 395)
No time	335	84.81
One to two times	54	13.67
More than twice	6	1.52
Health description (n = 395)
Excellent	28	7.09
Very Good	53	13.42
Good	191	48.35
Reasonable	104	26.33
Bad	19	4.81
Functional independence
How many activities do you need help with? (n = 394)
From zero to one activity	321	81.47
Two to four activities	47	11.93
Five to eight activities	26	6.60
Need help preparing meal? (n = 395)
No	364	92.15
Yes	31	7.85
Need help with transportation? (n = 395)
No	341	86.33
Yes	54	13.67
Need help taking care of the house? (n = 395)
No	347	87.85
Yes	48	12.15
Need help managing your money? (n = 395)
No	361	91.39
Yes	34	8.61
Need help shopping? (n = 395)
No	333	84.30
Yes	62	15.70
Need help using the phone? (n = 395)
No	355	89.87
Yes	40	10.13
Need help washing clothes? (n = 394)
No	363	92.13
Yes	31	7.87
Need help taking medicine? (n = 395)
No	359	90.89
Yes	36	9.11
Social support
When you need help, can you count on the help of someone willing and able to meet your needs? (n = 395)
Always	266	67.34
Sometimes	104	26.33
Never	25	6.33
Use of medicines
Do you use five or more medicines? (n = 395)
No	240	60.76
Yes	155	39.24
Do you forget to take your meds? (n = 394)
No	234	59.39
Yes	160	40.61
Nutrition
Have you lost weight recently? (n = 395)
No	327	82.78
Yes	68	17.22
Mood
Do you often feel sad or depressed? (n = 395)
No	249	63.04
Yes	146	36.96
Continence
Do you have a problem losing control of your urine? (n = 395)
No	216	54.68
Yes	179	45.32
Functional performance
Stand and walk test (n = 392)
From 0 to 10 seconds	251	64.03
From 11 to 20 seconds	110	28.06
More than 20 seconds	31	7.91

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[1] Corresponding author: Edmar Geraldo Ribeiro E-mail: edmargribeiro@gmail.com