Prevalence of falls and associated factors in community-dwelling older Brazilians: a systematic review and meta-analysis

Elias Filho, José; Borel, Wyngrid Porfirio; Diz, Juliano Bergamaschine Mata; Barbosa, Alexandre Wesley Carvalho; Britto, Raquel Rodrigues; Felício, Diogo Carvalho

doi:10.1590/0102-311X00115718

Acessibilidade / Reportar erro

Brasil

Cadernos de Saúde Pública

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Cad. Saúde Pública 35 (8) • 2019 • https://doi.org/10.1590/0102-311X00115718 copy

Prevalence of falls and associated factors in community-dwelling older Brazilians: a systematic review and meta-analysis

Prevalência de quedas e fatores associados em uma amostra comunitária de idosos brasileiros: uma revisão sistemática e meta-análise

Prevalencia de caídas y factores asociados en ancianos brasileños residentes en una comunidad: revisión sistemática y metaanálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Falls determine huge epidemiological, clinical, and economic burden in the older population worldwide, presenting high odds of severe disability. The present study aimed to estimate the prevalence of falls and associated factors in older Brazilians using a systematic review with meta-analysis. Searches were performed in SciELO, PubMed, LILACS, Web of Science, Scopus and PsycINFO databases with no date or language restrictions. Studies on community-dwelling older persons aged ≥ 60 years from both sexes and with a sample size of ≥ 300 participants included. Exclusion criteria were studies conducted specifically for older adults diagnosed with chronic disabling diseases that predispose them to falls. Risk of bias of included studies was assessed using a critical appraisal tool focusing on prevalence designs. A random-effects meta-analysis was used to pool the prevalence of falls across studies. Exploratory analysis was conducted examining subgroup estimates, prevalence ratios and meta-regression. Thirty-seven studies involving 58,597 participants were included. Twelve-month prevalence of falls was 27% (95%CI: 24.3-30.0), with significantly higher estimates in female than male (PR = 1.57; 95%CI: 1.32-1.86), in age group ≥ 80 years than age group 60-69 years (PR = 1.46; 95%CI: 1.15-1.84), and in participants from the Central region than participants from the South region (PR = 1.36; 95%CI: 1.10-1.69) of Brazil. Risk of bias scores did not impact heterogeneity in the 12-month meta-analysis. These estimates strongly support evidence-based public interventions to prevent falls in older Brazilians, especially in women and the oldest-old population.

Keywords:
Accidental Falls; Aged; Prevalence

Study	Region	Sample n (F/M); age ± SD	Prevalence (%)
Study	Region	Sample n (F/M); age ± SD	Total	F	M
One-month prevalence of falls
Cesar et al. ⁶⁴64. Cesar JA, Oliveira-Filho JA, Bess G, Cegielka R, Machado J, Gonçalves TS, et al. Perfil dos idosos residentes em dois municípios pobres das regiões Norte e Nordeste do Brasil: resultados de estudo transversal de base populacional. Cad Saúde Pública 2008; 24:1835-45.	PA, PI	1,013 (376/637); 70.0 ± 7.8 years	11.4	NA	NA
Three-month prevalence of falls
Benedetti et al. ⁶⁵65. Benedetti TRB, Binotto MA, Petroski EL, Gonçalves LHT. Atividade física e prevalência de quedas em idosos residentes no sul do Brasil. Rev Bras Geriatr Gerontol 2008; 11:145-54.	SC	875 (438/437); 71.6 ± 7.9 years	11.4	9.6	13.2
Six-month prevalence of falls
Campos et al. ⁶¹61. Campos ACV, Ferreira EF, Vargas AMD. Determinantes do envelhecimento ativo segundo a qualidade de vida e gênero. Ciênc Saúde Colet 2015; 20:2221-37.	MG	2,052 (1,226/826); 70.9 ± 8.1 years	32.0	37.6	23.7
		60-69 years	29.3
		70-79 years	33.0
		≥ 80 years	38.5
Ribeiro et al. ⁶²62. Ribeiro EE, Maia-Ribeiro EA, Brito E, Viegas K, Silva T, Mota KM, et al. Aspects of the health of Brazilian elderly living in a riverine municipality of Amazon rainforest. Revista Amazonense de Geriatria e Gerontologia 2013; 5:4-17.	AM	3,314 (1,676/1,635); 72.4 ± 7.8 years	21.5	26.3	22.7
		60-69 years	21.4
		70-79 years	26.2
		≥ 80 years	29.0
Stamm et al. ⁶³63. Stamm B, Leite M, Hildebrandt LM, Kirchner RM, Menezes LP. Cair faz parte da vida: fatores de risco para quedas em idosos. Rev Pesqui Cuid Fundam 2016; 8:5080-6.	RS	368 (239/129); 71.9 ± 7.7 years	53.0	37.8	15.2
12-month prevalence of falls
Antes et al. ³⁵35. Antes DL, d'Orsi E, Benedetti TRB. Circumstances and consequences of falls among the older adults in Florianopolis. EpiFloripa Aging 2009. Rev Bras Epidemiol 2013; 16:469-81.	SC	1,637 (1,045/592); 70.7 ± 8.0 years	19.0	21.5	14.3
		60-69 years	13.5
		70-79 years	17.6
		≥ 80 years	11.4
Aveiro et al. ³⁶36. Aveiro MC, Driusso P, Barham EJ, Pavarini SCI, Oishi J. Mobilidade e risco de quedas de população idosa da comunidade de São Carlos. Ciênc Saúde Colet 2012; 17:2481-8.	SP	739 (434/305); 69.0 ± 7.2 years	27.6	32.3	21.0
Berlezi et al. ³⁷37. Berlezi EM, Farias AM, Dallazen F, Oliveira KR, Pillatt AP, Fortes CK. Analysis of the functional capacity of elderly residents of communities with a rapid population aging rate. Rev Bras Geriatr Gerontol 2016; 19:643-52.	RS	528 (273/255); 72.3 ± 9.4 years	19.9	25.3	14.1
Brito et al. ³⁸38. Brito TA, Coqueiro RS, Fernandes MH, Jesus CS. Determinants of falls in community-dwelling elderly: hierarchical analysis. Public Health Nurs 2014; 31:290-7.	BA	314 (173/141); 74.2 ± 9.7 years	25.8	32.3	17.7
		60-69 years	25.2
		70-79 years	25.0
		≥ 80 years	27.3
Carneiro et al. ³⁹39. Carneiro JA, Ramos GCF, Barbosa ATF, Vieira EDS, Silva JSR, Caldeira AP. Falls among the non-institutionalized elderly in northern Minas Gerais, Brazil: prevalence and associated factors. Rev Bras Geriatr Gerontol 2016; 19:613-25.	MG	683 (443/240); 70.9 ± 8.0 years	28.4	32.5	20.8
		60-69 years	27.3
		70-79 years	25.7
		≥ 80 years	37.7
Coimbra et al. ⁴⁰40. Coimbra AM, Ricci NA, Coimbra IB, Costallat LT. Falls in the elderly of the Family Health Program. Arch Gerontol Geriatr 2010; 51:317-22.	SP	2,209 (1,332/877); 70.6 ± 7.8 years	27.1	NA	NA
Confortin et al. ⁴¹41. Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Positive self-rated health in the elderly: a population-based study in the South of Brazil. Cad Saúde Pública 2015; 31:1049-60.	SC	1,656 (1,058/598); 70.3 ± 7.7 years	18.6	NA	NA
Cruz et al. ¹²12. Cruz DT, Ribeiro LC, Vieira MT, Teixeira MTB, Bastos RR, Leite ICG. Prevalence of falls and associated factors in elderly individuals. Rev Saúde Pública 2012; 46:138-46.	MG	420 (148/272); 69.7 ± 6.9 years	32.1	37.1	23.0
		60-69 years	27.6
		70-79 years	34.5
		≥ 80 years	44.4
Dantas et al. ⁴²42. Dantas EL, Brito GEG, Lobato IAF. Prevalência de quedas em idosos adscritos à estratégia de saúde da família do município de João Pessoa, Paraíba. Rev APS 2012; 15:67-75.	PB	401 (271/130); 70.0 ± 9.0 years	42.4	49.4	27.7
		60-69 years	49.4
		≥ 70 years	38.7
Gullich et al. ⁴³43. Gullich I, Duro SMS, Cesar JA. Depression among the elderly: a population-based study in Southern Brazil. Rev Bras Epidemiol 2016; 19:691-701.	SC	552 (301/251); NA	28.3	30.9	25.1
		60-69 years	24.5
		70-79 years	31.9
		≥ 80 years	38.6
Lebrão & Laurenti ⁴⁴44. Lebrão ML, Laurenti R. Saúde, bem-estar e envelhecimento: o estudo SABE no Município de São Paulo. Rev Bras Epidemiol 2005; 8:127-41.	SP	2,143 (1,255/888); 68.0 ± 8.4 years	28.6	33.0	22.3
Lima et al. ⁴⁵45. Lima AP, Lini EV, Tomicki C, Dellani M, Portella M, Doring M. Fatores associados à atividade física em idosos de Estação, Rio Grande do Sul: estudo de base populacional. Rev Bras Ativ Fis Saúde 2016; 20:618-25.	SP	432 (263/169); 69.5 ± 7.6 years	24.5	27.7	19.5
		60-69 years	20.9
		≥ 70 years	30.5
Lima et al. ⁴⁶46. Lima MCP, Simão MO, Oliveira JB, Cavariani MB, Tucci AM, Kerr-Correa F. Alcohol use and falls among the elderly in Metropolitan São Paulo, Brazil. Cad Saúde Pública 2009; 25:2603-11.	RS	418 (239/181); 69 ± 7.6 years	25.1	NA	NA
Monego & Barbosa ⁴⁷47. Monego EA, Barbosa AR. Factors associated with daily sitting time in a rural community-dwelling of older adults from southern Brazil. Rev Bras Ativ Fís Saúde 2014; 19:371-81.	SC	477 (270/207); 74.2 ± 8.4 years	24.3	31.2	15.7
		60-69 years	21.0
		70-79 years	22.3
		≥ 80 years	41.8
Moreira et al. ³⁴34. Moreira MD, Costa AR, Caldas CP. The association between nursing diagnoses and the occurrence of falls observed among eldery individuals assisted in an outpatient facility. Rev Latinoam Enferm 2007; 15:311-7. *	RJ	490 (374/116); 79.0 ± NA years	27.9	31.0	18.1
Motta et al. ⁴⁸48. Motta LB, Aguiar AC, Coutinho ESF, Huf G. Prevalência e fatores associados a quedas em idosos em um município do Rio de Janeiro. Rev Bras Geriatr Gerontol 2010; 13:83-91.	RJ	1,064 (606/458); 71.4 ± 8.0 years	30.3	36.1	22.7
		60-69 years	28.3
		70-79 years	31.5
		≥ 80 years	34.0
Nascimento & Tavares ⁴⁹49. Nascimento JS, Tavares DMS. Prevalence and factors associated with falls in the elderly. Texto Contexto Enferm 2016; 25:e0360015.	MG	729 (487/242); NA	28.3	33.1	18.6
		60-80 years	26.4
		≥ 80 years	35.7
Nunes et al. ⁵⁰50. Nunes BP, Saes MO, Siqueira FV, Tomasi E, Silva SM, Silveira DS, et al. Falls and self-assessment of eyesight among elderly people: a population-based study in a south Brazilian municipality. Arch Gerontol Geriatr 2014; 59:131-5.	RS	1,591 (1,000/591); 70.6 ± 8.1 years	28.0	33.3	19.1
		60-69 years	24.0
		70-74 years	28.9
		≥ 75 years	33.8
Nunes et al. ⁵¹51. Nunes DP, Nakatani AYK, Silveira EA, Bachion MM, Souza MR. Capacidade funcional, condições socioeconômicas e de saúde de idosos atendidos por equipes de Saúde da Família de Goiânia (GO, Brasil). Ciênc Saúde Colet 2010; 15:2887-98.	GO	388 (227/161); 69.7 ± 7.5 years	38.7	42.7	32.9
		60-69 years	34.1
		70-79 years	40.3
		≥ 80 years	56.5
Pereira et al. ⁵²52. Pereira GN, Morsch P, Lopes DGC, Trevisan MD, Ribeiro A, Navarro JHN, et al. Fatores socioambientais associados à ocorrência de quedas em idosos. Ciênc Saúde Colet 2013; 18:3507-14.	RS	6,751 (3,494/3,257); 70.0 ± 7.3 years	10.7	13.4	10.4
		60-69 years	6.4
		70-79 years	13.4
		≥ 80 years	20.9
Pereira et al. ⁵³53. Pereira SG, Santos CB, Doring M, Portella MR. Prevalence of household falls in long-lived adults and association with extrinsic factors. Rev Latinoam Enferm 2017; 25:e2900.	PR	350 (212/138); 87.3 ± 3.7 years	46.9	NA	NA
		80-89 years	49.4
		≥ 90 years	17.9
Perracini & Ramos ⁵⁴54. Perracini MR, Ramos LR. Fatores associados a quedas em uma coorte de idosos residentes na comunidade. Rev Saúde Pública 2002; 36:709-16.	SP	1,415 (917/498); 70.0 ± NA years	30.9	NA	NA
Pimentel et al. ⁵⁵55. Pimentel WRT, Pagotto V, Stopa SR, Hoffmann MCCL, Andrade FB, Souza Junior PRB, et al. Falls among Brazilian older adults living in urban areas: ELSI-Brazil. Rev Saúde Pública 2018; 52 Suppl 2:12s.	AL, AM, BA, CE, ES, DF, GO, MA, MG, MS, MT, PA, PB, PE, PI, PR, RJ, RN, RS, SC, SE, SP	4,174 (2,362/1,812); 70.2 ± NA years	25.1	30.2	18.4
		60-64 years	23.6
		65-74 years	22.1
		≥ 75 years	31.4
Rodrigues et al. ⁵⁶56. Rodrigues IG, Fraga GP, Barros MB. Falls among the elderly: risk factors in a population-based study. Rev Bras Epidemiol 2014; 17:705-18.	SP	1,520 (904/616); 69.9 ± 7.8 years	6.5	8.7	3.4
Sampaio et al. ⁵⁷57. Sampaio RAC, Sampaio PYS, Castano LAA, Barbieri JF, Coelho HJJ, Arai H, et al. Cutoff values for appendicular skeletal muscle mass and strength in relation to fear of falling among Brazilian older adults: cross-sectional study. São Paulo Med J 2017; 135:434-43.	RJ, MG, PR, SC, SP	578 (456/122); 70.0 ± 6.6 years	22.5	24.8	13.9
		60-69 years	20.3
		70-79 years	24.4
		≥ 80 years	33.3
Sandoval et al. ⁵⁸58. Sandoval RA, Menezes R, Pagotto V, Nakatani AYK, Bachion M. Quedas de idosos não institucionalizados e fatores associados: estudo de base populacional em uma metrópole da região Centro-Oeste no Brasil. Rev Cient Esc Estadual Saúde Pública de Goiás Cândido Santiago 2015; 1:91-107.	GO	938 (570/348); 71.5 ± 8.4 years	34.0	37.9	29.6
		60-69 years	29.2
		70-79 years	37.1
		≥ 80 years	45.3
Silva et al. ⁵⁹59. Silva SLA, Neri AL, Ferrioli E, Lourenço RA, Dias RC. Fenótipo de fragilidade: influência de cada item na determinação da fragilidade em idosos comunitários - Rede Fibra. Ciênc Saúde Colet 2016; 21:3483-92.	CE, MG, PA, PE, PI, RN, RS, SP	5,532 (3,629/1,903); 73.1 ± 6.2 years	29.2	NA	NA
Siqueira et al. ¹⁵15. Siqueira FV, Facchini LA, Silveira DS, Piccini RX, Tomasi E, Thume E, et al. Prevalence of falls in elderly in Brazil: a countrywide analysis. Cad Saúde Pública 2011; 27:1819-26.	AC, AL, BA, CE, ES, GO, MA, MG, MS, PA, PB, PE, PI, PR, RJ, RN, RO, RS, SC, SE, SP, TO	6,616 (3,903/2,713); 70.9 ± 7.9 years	27.6	32.1	21.2
		60-69 years	24.4
		70-79 years	27.9
		≥ 80 years	37.1
Siqueira et al. ¹⁴14. Siqueira FV, Facchini LA, Piccini RX, Tomasi E, Thumé E, Silveira DS, et al. Prevalência de quedas em idosos e fatores associados. Rev Saúde Pública 2007; 41:749-56.	AL, PB, PE, PI, RN, RS, SC	4,003 (2,450/1,553); 73.9 ± 7.0 years	34.8	40.1	26.5
		65-70 years	31.8
		71-75 years	33.2
		76-80 years	36.8
		≥ 80 years	42.0
Vieira et al. ⁶⁰60. Vieira LS, Gomes AP, Bierhals IO, Farías-Antúnez S, Ribeiro CG, Miranda VIA, et al. Falls among older adults in the South of Brazil: prevalence and determinants. Rev Saúde Pública 2018; 52:22.	RS	1,451 (914/537); 70.7 ± 8.2 years	28.1	NA	NA
Zazzetta et al. ¹³13. Zazzetta MS, Gomes GA, Orlandi FS, Gratao AC, Vasilceac FA, Gramani-Say K, et al. Identifying frailty levels and associated factors in a population living in the context of poverty and social vulnerability. J Frailty Aging 2017; 6:29-32.	SP	304 (173/131); 70.1 ± 7.6 years	16.1	19.0	13.0
Lifetime-prevalence of falls
Chehuen Neto et al. ⁶⁶66. Chehuen Neto JA, Brum IV, Braga NAC, Gomes GF, Tavares PL, Silva RTC, et al. Percepção sobre queda como fator determinante desse evento entre idosos residentes na comunidade. Geriatr Gerontol Aging 2017; 11:25-31.	MG	472 (276/285); 70.6 ± NA years	55.1	55.1	55.1

Subgroup	Estimate * % (95%CI)	I²	PR (95%CI)	p-value
Sex
Male (k = 23)	19.8 (17.1-22.8)	0%	1.00
Female (k = 23)	30.8 (27.2-34.6)	0%	1.57 (1.32-1.86)	< 0.001
Age (years)
60-69 (k =15)	23.8 (18.9-29.5)	2%	1.00
70-79 (k = 12)	26.6 (20.6-33.5)	0%	1.09 (0.86-1.38)	0.494
≥ 80 (k = 15)	35.7 (31.1-42.8)	0%	1.46 (1.15-1.84)	0.002
Region
North ** (k = 1)	18.6 (16.3-21.1) ***	-	-
South (k = 11)	24.0 (20.1-28.3)	22%	1.00
Southeast (k = 13)	28.0 (24.0-32.3)	27%	1.06 (0.83-1.35)	0.628
Northeast (k = 4)	31.4 (23.9-40.0)	0%	1.27 (0.96-1.68)	0.101
Central (k = 4)	33.7 (25.9-42.5)	0%	1.36 (1.10-1.69)	0.006

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence J. Elias Filho Universidade Federal de Juiz de Fora. Av. Eugênio do Nascimento s/n, Juiz de Fora, MG 36038-330, Brasil. joseeliasfilho@yahoo.com.br