Falls in the elderly of the Family Health Program

Abstract

This study aims to determine the factors that may be related to falls in the elderly assisted by the Family Health Program (FHP). Elderly individuals aged 60 years or over, who were assisted by the FHP primary care system (n = 2209), responded to a sociodemographic and health questionnaire. Mental health was evaluated using the Geriatric Depression Scale (GDS) and quality of life was assessed by the Medical Outcome Study Short-Form Health Survey (SF-36). In order to verify which independent variables affected the occurrence of falls, logistic regression analysis was performed. 27.1% of the sample reported one fall during the previous year, and 8.7% were recurrent fallers over the same period. The factors considered in the final model for falls were: age over 80 years-old, female gender, the presence of more than eight associated diseases, need for hospitalization during the previous year and appointments outside the FHP routine, hearing complaints, GDS score over 11 points, and emotional problems SF-36 score between 25 and 74 points. The factors included in the final model for falls can be easily identified and properly overcome by FHP strategy. Patient falling history investigation should thus form part of the FHP team routine. This concern should be reinforced when it comes to women aged 80 years and over.

Introduction

The elderly are currently considered the fastest growing age group worldwide. According to the US Census Bureau (2004), the population aged 65 years-old and over comprises almost 440 million people, i.e., 7.0% of the planet's inhabitants. It is well known that this age group is more susceptible to chronic diseases and disabilities that require long-term care. This picture indicates the importance of community care provided by the FHP, which is responsible for the execution of effective low-cost actions, focused on prevention, recovery and rehabilitation in this population (Silvestre and Costa Neto, 2003).

Among all negative outcomes derived from elderly health conditions, falling is considered one of the main causes of functional impairment. Falling frequency increases significantly with age and statistics reveals that one in three elderly individuals falls annually (Tinetti et al., 1988). Among those who fall, around 20% present injuries which predispose them to mobility restriction, dependence and premature death risk (Alexander et al., 1992). Therefore, prevention should be considered one of the key points in elderly primary health care.

The literature (Lopes et al., 2002) suggests that health-care teams that include members belonging to the community, as the FHP does, are more likely to succeed during treatment. This accomplishment could also be considered as a consequence of the global approach adopted by this model, which considers the interaction of biological, social, and environmental factors. Such a comprehensive approach may improve the understanding of the falling events.

Most studies that report data concerning falls are performed in hospitals, nursing homes and community environments (Perracini and Ramos, 2002, Silvestre and Costa Neto, 2003, Estévez, 2004, Fabrício et al., 2004). Therefore, they do not permit the proper identification of risk factors for elderly individuals who are assisted by the FHP. A better description of this group may allow for appropriate planning of public health policies in relation to the factors associated with falling.

The present study was designed in order to determine isolated and combined factors that may be related to the occurrence of falls in the elderly assisted by the FHP.