Family participation to elderly rehabilitation with femoral fracture

verify if the mode of care adopted by caregivers favored functional independence recovery by elderly with and without the presence of nervous system disease and mental and behavioral disorders; and, if disease interfered with their functional independence.

Method:

transversal study, with 12-month follow-up of 89 Brazilian elders (≥ 60 years) after proximal femoral surgery, and their family caregiver.

Results:

the Functional Independence Measure scores decreased by 0.7 points per year of life, and in the case of presenting nervous system disease and mental and behavioral disorders, this loss amounted to 20.5 points.

Conclusion:

The incentive to ambulate increased by 18.8 for self-care, 12.8 for self-care, and 11.5 for leisure activities on the Functional Independence Measure. Encouraging movement and ambulation, self-care and leisure activities, especially with those elderly with nervous system diseases and mental and behavioral disorders, is recommended.

Key words:
Aged; Caregivers; Femoral Fractures

Variables	n	%
Sex
Feminine	60	67.4
Masculine	29	32.6
Age (years)
60 - 69	18	20.2
70 - 79	30	33.7
≥ 80	41	46.1
Maximum/Moderate Dependency	21	23.6
Minimal/Supervision	34	38.2
Modified/Complete Independence	34	38.2
FIM Total^* * Note: Summary in median (minimum - maximum) FIM: Functional Independence Measure	92	(25 -125)
FIM Motor^* * Note: Summary in median (minimum - maximum) FIM: Functional Independence Measure	69	(16 - 91)
FIM Cognitive^* * Note: Summary in median (minimum - maximum) FIM: Functional Independence Measure	25	(5 - 35)

Variables	n	%
Sex
Feminine	68	76.4
Masculine	21	23.6
Age (years)
< 60	66	74.2
≥ 60	23	25.8
Kinship
Child	57	64.0
Partner	11	12.3
Grandchild	5	5.6
Niece/Nephew	5	5.6
Daughter/Son-in-law	5	5.6
Others	6	6.9
Years of study
< 1 year	2	2.2
1 - 5 years	36	40.5
6 - 9 years	13	14.6
≥ 10	38	42.7
Incentive of elderly mentioned
Movement	61	68.2
Self-care	60	67.4
Leisure	42	47.2

Variables	β	ep	p value	CI (β;95%)
Intercept	118.5	20.7	<0.001	(77.9 - 159.1)
Masculine gender	0.1	4.9	0.989	(-9.6 - 9.7)
Age	-0.7	0.3	0.009	(-1.2 - -0.2)
Incentivized for self-movement	18.9	7.5	0.012	(4.2 - 33.5)
Incentivized for self-care	12.8	7.6	0.093	(-2.1 - 27.8)
Incentivized for leisure	11.5	5.3	0.031	(1.1 - 21.9)
Nervous system disease or mental and behavioral disorders.	-20.5	4.5	<0.001	(-29.3 - -11.7)

FIM	General	Without nervous system disease or mental and behavioral disorders.	With nervous system disease or mental and behavioral disorders.	p value^ª ª Mann-Whitney
FIM	(N = 89)	(n = 60)	(n = 29)	p value^ª ª Mann-Whitney
Self-Care	33 (9 - 42)	36 (9 - 42)	26 (10 - 42)	0.009
Feeding	7 (3 - 7)	7 (3 - 7)	7 (3 - 7)	<0.001
Personal hygiene	5 (1 - 7)	5,5 (1 - 7)	4 (2 - 7)	0.039
Bathing (washing the body)	5 (1 - 7)	6 (1 - 7)	4 (2 - 7)	0.01
Dressing oneself above the waist	5 (1 - 7)	6 (1 - 7)	4 (1 - 7)	0.004
Dressing oneself below the waist	5 (1 - 7)	5 (1 - 7)	4 (1 - 7)	0.037
Use of the toilet	6 (1 - 7)	6 (1 - 7)	4 (1 - 7)	0.057
Sphincter control	12 (2 - 14)	14 (2 - 14)	12 (2-12)	0.22
Control of urine	6 (1 - 7)	7 (1 - 7)	6 (1 - 7)	0.22
Control of feces	7 (1 - 7)	7 (1 - 7)	6 (1 - 7)	0.525
Mobility/Transfers	15 (3 -21)	16 (3 - 21)	12 (3-12)	0.017
Bed, chair, wheelchair	5 (1 - 7)	5 (1 - 7)	4 (1 - 7)	0.062
Toilet	5(1 - 7)	5 (1 - 7)	4 (1 - 7)	0.013
Bath or shower	5 (1 - 7)	5 (1 - 7)	4 (1 - 7)	0.007
Locomotion	6 (2 - 14)	7 (2 - 14)	5 (2 - 14)	0.176
Walking/wheelchair	4 (1 - 7)	4 (1 - 7)	4 (1 - 7)	0.401
Stairs	1 (1 - 7)	1 (1 - 7)	1 (1 - 7)	0.139
Communication	10 (2 - 14)	12 (6 - 14)	8 (2 - 14)	<0.001
Comprehension	5 (1 - 7)	6 (3 - 17)	4 (1 - 7)	<0.001
Communication	5 (1 - 7)	6 (3 - 7)	4 (1 - 7)	<0.001
Social Cognitive	15 (3 -21)	16 (8 - 21)	9 (3 - 19)	< 0.001
Social Interaction	5 (1 - 7)	6 (2 - 7)	4 (1 - 7)	<0.001
Problem resolution	4 (1 - 7)	5 (1 - 7)	3 (1 - 7)	0.001
Memory	5 (1 - 7)	6 (1 - 7)	3 (1 - 6)	<0.001
FIM Motor	69 (16 - 91)	74 (16 - 91)	49 (19 - 91)	0.023
FIM Cognitive	25 (5 - 35)	28.5 (14 - 35)	18 (5 - 33)	< 0.001
FIM Total	92 (25-125)	100.5 (41-125)	66 (25 - 117)	0.001
Level of Dependency
Maximum dependency	21 (23.6%)	11 (18.3%)	10 (34.5%)
Minimum dependency	34 (38.2%)	20 (33.3%)	14 (48.3%)	0.082^b b Chi-squared
Modified independence	34 (38.2%)	29 (48.3%)	5 (17.2%)

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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[1] AUTOR CORRESPONDENTE: Silvia Cristina Mangini Bocchi. E-mail: sbocchi@fmb.unesp.br