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Master's Dissertation
DOI
Document
Author
Full name
Deise Ferreira da Silva
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Tanaka, Clarice (President)
Curiati, José Antonio Esper
Fló, Claudia Marina
Pompeu, José Eduardo
Title in Portuguese
O uso do Mini-BESTest e da Morse Fall Scale na avaliação do risco de quedas durante a internação e no pós alta de pessoas idosas
Keywords in Portuguese
Acidente por quedas
Escala de Risco de Morse
Hospitalização
Idoso
Medição de risco
Mini-BESTest
Abstract in Portuguese
Introdução: As quedas hospitalares interferem na funcionalidade do paciente durante e após a hospitalização. Nosso objetivo foi verificar se uma escala de identificação do risco de quedas (Morse Fall Scale) e um teste de avaliação de equilíbrio dinâmico (Mini-BESTest) identificam os idosos caidores durante e após hospitalização. Método: Trata-se de um estudo coorte prospectivo com análise retrospectiva. Participaram 154 idosos (>=65 anos) internados em duas enfermarias não cirúrgicas de Clínica Médica e Geriatria de um Hospital Universitário de porte extra. Foram realizadas avaliações do Mini-BESTest e da Morse Fall Scale (MFS) na admissão e na alta hospitalar. O acompanhamento das quedas foi feito por telefone em 1, 3 e 6 meses após alta hospitalar. Resultados: Os idosos foram divididos em: caidores (Grupo Q, n=5) e não caidores (Grupo NQ, n=149) na hospitalização. Na admissão não houve diferença significativa entre os Grupos Q e NQ nas ferramentas avaliadas (Mini-BESTest Q=23, NQ=20, p=0.85; MFS Q=25, NQ=15, p=0,87) e na alta hospitalar apenas na MFS (Mini-BESTest Q=20, NQ=22, p=0,22; MFS Q=50, NQ=25, p=0,01). Nos domínios "Respostas Posturais" do Mini- BESTest e nos domínios "Histórico de Quedas" e "Tipo de Marcha" da MFS houve diferença entre Q e NQ na alta (respectivamente, =0,02; p=0,01; p=0,02). Foi realizada uma subanálise com pareamento de dados por gênero, idade e comorbidades e também não foram encontradas diferenças clínicas, demográficas e nos escores das escalas entre os grupos Q (n=5) e NQp (n=10) (p > 0,05). Na predição de quedas pós-alta o Mini-BESTest apresentou AUC=0,53, p=0,50, sensibilidade 48,8% e especificidade 59,5%, já a MFS apresentou AUC=0,56, p=0,20, sensibilidade 44,2% e especificidade 72%. Houve um aumento de caidores nos 6 meses de Follow-up (11,2%, 15,6% e 17,1%;), e os pacientes com baixo risco de queda pela MFS tiveram mais quedas no Follow-up do que os pacientes de alto risco. Conclusão: Mini-BESTest e a Morse Fall Scale não identificaram os idosos caidores durante e após a hospitalização, apesar de alterações nos domínios na alta hospitalar e do aumento de quedas no Follow-up
Title in English
The use of the Morse Fall Scale and Mini-BESTest to evaluate risk identification of falls during hospitalization and post-hospital discharge in elderly
Keywords in English
Aged
Hospitalization
Mini-BESTest
Morse Fall Scale
Risk assessment
Sccidental falls
Abstract in English
Introduction: Hospital falls interfere with the patient's functionality during and after hospitalization. This study aimed to identify whether the Morse Fall Scale and Mini-BESTest can identify fall risk in elderly patients during and after hospitalization. Method: This is a prospective cohort study with retrospective analysis. A total of 154 consecutive elderly patients (>=65 years old) who were hospitalized at two clinical wards in a tertiary Hospital were included in the study. Mini-BESTest and Morse Fall Scale (MFS) assessments were carried out at hospital admission and discharge. The occurrence of falls was evaluated by phone calls 1, 3 and 6 months after hospital discharge. Results: Patients were divided in two groups, those who had falls (F group, n=5) and those who did not fall (NF group, n=149) during hospitalization. At hospital admission, no differences were observed between the F and NF groups in the Mini-BESTest (F=23 vs. NF=20; p=0.85) and MFS (F=25 vs. NF=15; p=0.87) scores. At hospital discharge, the F and NF groups had similar scores in the Mini-BESTest (F=20 vs. NF=22; p=0.22) but differences in the MFS (F=50 vs. NF=25; p=0.01). The domain assessments for "postural responses" of the Mini-BESTest and "history of falls" and "type of gait" of the MFS were different between the F and NF groups at hospital discharge (p=0.02, p=0.01 and p=0.02, respectively). A sub analysis was performed with data matching by gender, age and comorbidities and no clinical, demographic and scales differences were observed between the group F (n=5) and group NFm (n=10) (p > 0.05). In the prediction of post-discharge falls, the Mini-BESTest presented AUC = 0.53, p = 0.50, sensitivity 48.8% and specificity 59.5%, the MFS presented AUC=0.56, p=0. 20, sensitivity 44.2% and specificity 72%. There was an increase in the number of patients who fell from the 1st to the 6th month of follow-up (from 11.2% to 17.1%), and the patients with low and medium fall risk determined by the MFS had more falls in the follow-up period than those classified as high risk. Conclusion: Our results suggest that neither the Mini-BESTest nor the MFS identified elderly fall risk during and after hospitalization. In addition, we observed the need to supervise elderly patients after hospitalization
 
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Publishing Date
2019-08-07
 
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