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      Prevalência e fatores associados a quedas em idosos em um município do Rio de Janeiro Translated title: Prevalence and factors associated to falls in elderly in a county from Rio de Janeiro, Brazil

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          Abstract

          INTRODUÇÃO: Estima-se que 50% das quedas em idosos resultem em algum tipo de lesão. O objetivo deste estudo é estimar a prevalência e identificar fatores associados a quedas em idosos em um município no Rio de Janeiro. METODOLOGIA: Um inquérito foi conduzido em residentes com mais de 60 anos capazes de prestar informações por si, através de um questionário de avaliação multidimensional, aplicado por agentes comunitários treinados. As análises incluíram cálculos de proporções e respectivos intervalos de confiança de 95%. RESULTADOS: Foram entrevistados 1.064 idosos, em sua maioria mulheres (57%), com idade média de 71,4 anos. No ano anterior à entrevista, 322 participantes (30,3% - IC95% 27,6-33,2) caíram, dos quais 148 (13,9% - IC95% 11,9-16,2) o fizeram pelo menos duas vezes. Algumas associações se evidenciaram: sexo feminino, idade avançada, ser divorciado, morar só, assim como as variáveis indicadoras de más condições de saúde, capacidade funcional e satisfação com a vida. CONCLUSÃO: Este estudo ratifica fatores associados a quedas em idosos já conhecidos. O grande desafio deste conhecimento é a proposição de intervenções nos fatores modificáveis e a identificação ativa dos idosos sob risco, objetivando a reabilitação preventiva.

          Translated abstract

          INTRODUCTION: Fifty percent of falls in elderly result in some kind of injury. This study aims to assess the prevalence and identify factors associated with falls in aged people in a county of the state of Rio de Janeiro, Brazil. METHODS: A survey was conducted with people 60 years-old or more who were able to respond by themselves to a multidimensional assessment questionnaire applied by trained community health agents. We calculated proportions and 95% confidence intervals. RESULTS: 1,064 individuals were included. They were mostly women (57%), with mean age of 71,4 years. 322 participants (30,3% - 95%CI 27,6-33,2) fell during the previous year, and 148 (13,9% - 95%CI 11,9 -16,2) fell at least twice. Some associations became evident: female sex, advanced age, being divorced, living alone, as well as indicators of bad health condition, functional capacity and satisfaction with life. CONCLUSION: This study highlights already known factors associated to falls in the elderly. The major challenge is the proposition of interventions towards modifiable factors and active identification of persons under risk of falling aiming at preventive rehabilitation.

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          A multifactorial intervention to reduce the risk of falling among elderly people living in the community.

          Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors. We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling: postural hypotension; use of sedatives; use of at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet (transfer skills), or gait. These subjects were given either a combination of adjustment in their medications, behavioral instructions, and exercise programs aimed at modifying their risk factors (intervention group, 153 subjects) or usual health care plus social visits (control group, 148 subjects). During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subjects who had a particular risk factor at base line, a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of reassessment, as follows: at least four prescription medications, 63 percent versus 86 percent, P = 0.009; balance impairment, 21 percent versus 46 percent, P = 0.001; impairment in toilet-transfer skills, 49 percent versus 65 percent, P = 0.05; and gait impairment, 45 percent versus 62 percent, P = 0.07. The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group, as compared with the control group. Thus, risk-factor modification may partially explain the reduction in the risk of falling.
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            Guideline for the Prevention of Falls in Older Persons

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              Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials.

              To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group. Systematic review and meta-analyses. Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews. Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education. 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7). Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbgg
                Revista Brasileira de Geriatria e Gerontologia
                Rev. bras. geriatr. gerontol.
                Universidade do Estado do Rio Janeiro (Rio de Janeiro )
                1981-2256
                April 2010
                : 13
                : 1
                : 83-91
                Affiliations
                [1 ] Universidade do Estado do Rio de Janeiro Brazil
                [2 ] Universidade Estácio de Sá Brazil
                [3 ] Fundação Oswaldo Cruz Brazil
                [4 ] Fundação Oswaldo Cruz Brazil
                Article
                S1809-98232010000100009
                10.1590/S1809-98232010000100009
                fc9228ed-9fae-46c2-b6b4-148b0193f9e2

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1809-9823&lng=en
                Categories
                GERIATRICS & GERONTOLOGY

                Geriatric medicine
                Accidental Falls,Aged,Risk Factors,Acidentes por Quedas,Idoso,Fatores de Risco
                Geriatric medicine
                Accidental Falls, Aged, Risk Factors, Acidentes por Quedas, Idoso, Fatores de Risco

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