Impacto da hospitalização e do estado nutricional e síndrome da fragilidade na capacidade funcional de idosos: estudo de coorte
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Data
2017-03-02
Autores
Carvalho, Tatiane Cristina [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: Durante a internação hospitalar de idosos, é possível a perda de capacidade funcional (CF), visto que o paciente é retirado do seu contexto familiar e submetido a diversos procedimentos que podem comprometer a realização de suas atividades habituais. Objetivo: verificar o impacto da hospitalização na CF de idosos. Método: Estudo descritivo, prospectivo, de coorte realizado entre 2015 e 2016. Foram avaliados idosos internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu – Unesp, quanto à CF por meio de avaliação de atividades básicas de vida diária (ABVD) pela escala de Katz, estado nutricional (índice de massa corporal – IMC) e presença de Síndrome da Fragilidade (índice StudyofOsteoporoticFractures – SOF; Fenótipo de fragilidade de Fried). Foi realizada descrição da trajetória da CF conforme o desempenho funcional antes de 15 dias da internação (M0), na internação (M1), na alta hospitalar (M2) e 30 dias após a alta (M3).Foi realizada análise descritiva das variáveis quantitativas com médias e desvio-padrão e para as variáveis qualitativas com frequências e percentagens; análise comparativa entre as médias das faixas etárias e tempo de internação e o tipo de trajetória da CF (testes de qui-quadrao, Anova e Tukey) e análises univariada e multivariada (teste do qui-quadrado e cálculo do risco relativo (RR)) com os desfechos de piora da trajetória entre M0 e M3 e entre M1 e M2. O nível considerado significativo foi p<0,05. Resultados: foram avaliados 99 idosos com média de idade 74 + 7,35 anos, sendo 59,6% do sexo masculino. Referiram independência funcional no M0 81,8% dos idosos, 45,5% no M1, 57,6% no M2 e 72,8% no M3. As trajetórias prevalentes da CF dos idosos foram 31,4/% nos quais os idosos perderam função entre M0 e M1 e recuperaram em M2 e M3 e 25,3% na qual eram independentes em M0, perderam a CF no M1, mantiveram a perda em M2 e recuperaram em M3. Foram considerados eutróficos 39,4% e com baixo peso 38,4% dos idosos. Foram considerados robustos 8% e frágeis 38% dos idosos pelos dois índices. Não foram observadas diferenças estatisticamente significativas entre as médias do tempo de internação e da idade em relação às trajetórias da CF. A piora da CF entre M0 e M3 foi associada naanálise univariada com o idoso ser frágil (RR: 2,27 IC 95%: 1,30 – 3,97) e ter IMC < 22,9 kg/m2 (RR: 1,79 IC 95%: 1,10 – 2,91) e na multivariada ação com o idoso ser frágil (RR: 4,99 IC 95%: 1,59 – 16,35). A piora da CF entre M1 e M2 mostrou associação com valor de albumina menor que 3,5g/dl (RR: 1,14 IC 95%: 0,38 – 3,40). Conclusão: Dos idosos avaliados 9% perderam CF entre a M0 e M3. As trajetórias funcionais mais frequentes foram as quais os idosos perderam CF durante a internação. A SF foi detectada em 38% dos idosos no momento da internação. Perda da CF entre M0 e M3 foi associada com idoso ser frágil e entre M1 e M2 ter albumina < 3,5 g/dl.
Introduction: During the elderly hospitalization, it is possible for there to be a lost in the functional capacity, since the patient is removed from his / her family context and subjected to various procedures that may compromise the performance of his or her usual activities. Objective: verify the impact that hospitalization has on elderly’s functional capacity. Method: A descriptive, prospective cohort study conducted between 2015 and 2016. Hospitalized elderly were evaluated at Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP, regarding functional capacity by means of scales of assessment of basic activities of daily living (ADL) by the Katz scale, nutritional status with calculation of body mass index (BMI) and the presence of Fragility Syndrome (Study of Osteoporotic Fractures – SOF; Fried Frailty Phenotype) . A description of the trajectory of the functional capacity according to functional performance was performed 15 days before the hospital admission (M0), on admission (M1), on discharge from hospital (M2) and 30 days after discharge (M3). A descriptive analysis of the quantitative variables was performed with means and standard deviation and for the qualitative variables with frequencies and percentages; comparative analysis between the means of the age groups and time of hospitalization and the type of trajectory of the functional capacity (chi-square test, Anova and Tukey) and univariate and multivariate analyses (chi-square test and relative risk calculator (RR)) with a worsening outcome between M0 and M3 and also M1 and M2. The level considered significant was p<0.05. Results: 99 elderly with the average age of 74 + 7.35 years were evaluated, being 59.6% male. 81.8% of elderly presented functional independence at M0, 45.5% at M1, 57.6% at m2 and 72.8% at M3. The prevalent trajectories of functional capacity of elderly were 31.4% in which elderly lost function between M0 and M1 and regained it at M2 and M3 and 25.3% in which they were independent at M0, lost functional capacity at M1, maintained the loss at M2 and regained it at M3. By the two indices, 8% of the elderly were considered robust and 38% fragile. No statistically significant differences were found between the means of hospitalization time and the age in relation to the functional capacity trajectories. The worsening in the functional capacity between M0 and M3 was associated in the Abstract 6 univariate analysis with the elderly’s fragility (RR: 2.27, IC 95%: 1.30 – 3.97) and have BMI < 22.9 kg/m2 (RR: 1.79, IC 95%: 1.10 – 2.91) and the multivariate action of the elderly being fragile (RR: 4.99, IC 95%: 1.59 – 16.35). Worsening in the functional capacity between M1 and M2 showed association with the albumin value lower than 3.5g/dL (RR: 1.14, IC 95%: 0.38 – 3.40). Conclusion: Of the elderly evaluated 9% lost functional capacity between M0 and M3. The most frequent functional trajectories were those in which the elderly lost functional capacity during hospitalization. The SF was detected in 38% of the elderly at the moment of hospitalization. Loss of functional capacity between M0 and M3 was associated with the elderly being fragile and between M1 and M2 albumin < 3,5 g/dL.
Introduction: During the elderly hospitalization, it is possible for there to be a lost in the functional capacity, since the patient is removed from his / her family context and subjected to various procedures that may compromise the performance of his or her usual activities. Objective: verify the impact that hospitalization has on elderly’s functional capacity. Method: A descriptive, prospective cohort study conducted between 2015 and 2016. Hospitalized elderly were evaluated at Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP, regarding functional capacity by means of scales of assessment of basic activities of daily living (ADL) by the Katz scale, nutritional status with calculation of body mass index (BMI) and the presence of Fragility Syndrome (Study of Osteoporotic Fractures – SOF; Fried Frailty Phenotype) . A description of the trajectory of the functional capacity according to functional performance was performed 15 days before the hospital admission (M0), on admission (M1), on discharge from hospital (M2) and 30 days after discharge (M3). A descriptive analysis of the quantitative variables was performed with means and standard deviation and for the qualitative variables with frequencies and percentages; comparative analysis between the means of the age groups and time of hospitalization and the type of trajectory of the functional capacity (chi-square test, Anova and Tukey) and univariate and multivariate analyses (chi-square test and relative risk calculator (RR)) with a worsening outcome between M0 and M3 and also M1 and M2. The level considered significant was p<0.05. Results: 99 elderly with the average age of 74 + 7.35 years were evaluated, being 59.6% male. 81.8% of elderly presented functional independence at M0, 45.5% at M1, 57.6% at m2 and 72.8% at M3. The prevalent trajectories of functional capacity of elderly were 31.4% in which elderly lost function between M0 and M1 and regained it at M2 and M3 and 25.3% in which they were independent at M0, lost functional capacity at M1, maintained the loss at M2 and regained it at M3. By the two indices, 8% of the elderly were considered robust and 38% fragile. No statistically significant differences were found between the means of hospitalization time and the age in relation to the functional capacity trajectories. The worsening in the functional capacity between M0 and M3 was associated in the Abstract 6 univariate analysis with the elderly’s fragility (RR: 2.27, IC 95%: 1.30 – 3.97) and have BMI < 22.9 kg/m2 (RR: 1.79, IC 95%: 1.10 – 2.91) and the multivariate action of the elderly being fragile (RR: 4.99, IC 95%: 1.59 – 16.35). Worsening in the functional capacity between M1 and M2 showed association with the albumin value lower than 3.5g/dL (RR: 1.14, IC 95%: 0.38 – 3.40). Conclusion: Of the elderly evaluated 9% lost functional capacity between M0 and M3. The most frequent functional trajectories were those in which the elderly lost functional capacity during hospitalization. The SF was detected in 38% of the elderly at the moment of hospitalization. Loss of functional capacity between M0 and M3 was associated with the elderly being fragile and between M1 and M2 albumin < 3,5 g/dL.
Descrição
Palavras-chave
Idoso, Capacidade funcional, Nutrição, Hospitalização, Síndrome da fragilidade