Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis

Reis, Karine Marques Costa dos; Jesus, Cristine Alves Costa de

doi:10.1590/0104-1169.0285.2658

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Original Articles • Rev. Latino-Am. Enfermagem 23 (6) • Nov-Dec 2015 • https://doi.org/10.1590/0104-1169.0285.2658 copy

Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis¹ 1 Paper extracted from master's thesis "Avaliação do risco de queda em população idosa institucionalizada", presented to Universidade de Brasília, Brasília, DF, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to determine the incidence of falls in elderly residents of long-stay institutions of the Federal District, to identify the aspects involved in the falls, in terms of risk factors, from the application of scales and the Taxonomy II of NANDA-I, and to define the level of accuracy with its sensitivity and specificity for application in the clinical nursing practice.

Method:

this was a cohort study with the evaluation of 271 elderly people. Cognition, functionality, mobility and other intrinsic factors were evaluated. After six months, the elderly people who fell were identified, with significance analysis then performed to define the risk factors.

Results:

the results showed an incidence of 41%. Of the 271 patients included, 69 suffered 111 episodes of falls during the monitoring period. Risk factors were the presence of stroke with its sequelae (OR: 1.82, 95% CI 1.01 - 3.28, p=.045), presenting more than five chronic diseases (OR: 2.82, 95% CI 1.43 - 5.56, p=.0028), foot problem (OR: 2.45, 95% CI 1.35 - 4.44, p=.0033) and motion (OR: 2.04, 95% CI 1.15 - 3.61, p=.0145).

Conclusion:

the taxonomy has high validity regarding the detection of elderly people at risk of falling and should be applied consistently in the clinical nursing practice.

Accidental Fall; Aged; Institutionalization; Risk Factors; Nursing Diagnosis

Type of information	Variable	Categoría	Frecuencia	Porcentaje %
Sociodemographic	Gender	Female	156	57.56
	Gender	Male	115	42.44
	Education	3 years of study	74	27.82
		4 to 7 years of study	34	12.78
		Illiterate	129	48.5
		More than 8 years	29	10.9
	Marital status	Married	21	7.78
		Divorced	23	8.52
		Single	108	40
		Widowed	118	43.7
	Smoker	No	165	60.89
	Smoker	Yes	106	39.11
	Body mass index	Eutrophic	103	38.00
		Overweight	43	15.86
		Underweight	125	46.12
General physical and cognitive characteristics	Tinneti index	OK	51	18.82
	Tinneti index	Impaired	220	81.18
	Activity of daily living	Significant dependence	144	53.14
		Partial dependence	66	24.35
		Independent	61	22.51
	Mini Mental State Examination	Compromised	235	87.45
	Mini Mental State Examination	Uncompromised	36	12.91

Variable	Mean	Standard deviation	Minimum	Maximum
Age	79.14	9.71	60	111
Institutionalization (years)	4.72	4.71	1	30
Height	1.58	0.10	1	2
Weight	57.12	11.96	31	96
Body mass index	22.77	4.15	14	42
Number of medications	5.76	2.48	0	15

Risk factors	Fall (n=69) n (%)	No fall (n=202) n (%)	OR*	95% CI ^†	P-value
In elderly people
	Fall History	59 (85.51%)	145 (71.78%)	2.32	1.11-4.85	.0253
	Aged 60-90 years	12 (17.56%)	38 (18.91%)	1.52	0.57-4.09	.4664
	Aged 70-79 years	24 (35.29%)	73 (36.32%)	0.77	0.32-1.90
Cognitive
	MMSE^‡ compromised	62 (91.18%)	170 (85.6%)	1.70	0.67-4.31			.2616
Physiological								.2616
	Mobility & functionality
		ADL^§ high dependence	38 (55.07%)	106 (52.48%)	1.46	0.70-3.04	.4696
		ADL partial dependence	19 (27.54%)	47 (23.27%)	1.65	0.72-3.77
		ADL independence	12 (17.39%)	49 (24.26%)
		Foot problem	26 (37.68%)	40 (19.8%)	2.45	1.35-4.44	.0033
		Ambulation	46 (66.67%)	100 (49.5%)	2.04	1.15-3.61	.0145
		Tinneti impaired	61 (88.41%)	159 (78.7%)	2.06	0.92-4.63	.08
	Comorbidities
		Incontinence	30 (43.48%)	80 (39.6%)	1.17	0.67-2.04	.08	.5717
		Sleep disturbance	14 (20.29%)	37 (18.32%)	1.14	0.57-2.26	.7175
		Stroke	25 (36.23%)	48 (23.76%)	1.82	1.01-3.28	.0453
		Higher multiple diseases	19 (25.54%)	24 (11.88%)	2.82	1.43-5.56	.0028
Medications
	Higher multiple medication use	53 (76.81%)	136 (67.33%)	1.61	0.86-3.02	1.43-5.56		.141
	Antidepressants	17 (24.64%)	76 (37.62%)	0.54	0.29-1.01	.0518
	Diuretics	33 (47.83%)	103 (50.99%)	0.88	0.51-1.52	.6501

Cutoff point	Sensitivity	1-Specificity	Specificity
0.828	0.014	0.000	0.990
0.711	0.058	0.010	0.985
0.655	0.101	0.015	0.980
0.632	0.145	0.020	0.975
0.587	0.174	0.025	0.951
0.492	0.290	0.050	0.936
0.468	0.333	0.064	0.926
0.433	0.333	0.074	0.926
0.420	0.362	0.074	0.896
0.404	0.435	0.104	0.856
0.358	0.478	0.144	0.822
0.337	0.551	0.178	0.797
0.301	0.580	0.203	0.787
0.281	0.580	0.213	0.574
0.257	0.783	0.426	0.569
0.231	0.783	0.431	0.505
0.222	0.797	0.495	0.480
0.206	0.797	0.520	0.470

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Karine Marques Costa dos Reis Universidade de Brasília. Faculdade Ciências da Saúde Bairro: Asa Norte CEP: 70910-900, Brasília, DF, Brasil E-mail: karineresidf@hotmail.com

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Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis1 1 Paper extracted from master's thesis "Avaliação do risco de queda em população idosa institucionalizada", presented to Universidade de Brasília, Brasília, DF, Brazil.

Objective:

Method:

Results:

Conclusion:

Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis¹ 1 Paper extracted from master's thesis "Avaliação do risco de queda em população idosa institucionalizada", presented to Universidade de Brasília, Brasília, DF, Brazil.