Gestão do risco de queda em equipamentos para idosos

Abstract

Falls in the elderly are a major public health problem through the consequences on the decline in functionality, increased morbidity, social isolation and mortality, contributing or being the single cause for the decision to be institutionalized in equipment for the elderly, where incidence is higher than in the community. The increasing number or elderly and longevity makes this focus for nursing practice in a challenge difficult to resolve. Although there is evidence on the risk fators and preventive measures, the results of the studies are not sufficient to understand the complexity of this phenomenon, especially in institutionalized elderly, where apart from multiplicity of risk factors (intrinsic and extrinsic). the practices and behaviors of the elderly and their caregivers increase the variables in the genesis of the fall. This investigation had the following general objectives: determine the prevalence and characteristics of falls in equipment for the elderly; construct and validate tools to assess management practices and behaviors or falls by seniors and direct action helpers; evaluate the practices and behaviors of risk management; study some variables and garner the nurses contributions about what should be done to manage fall risk in equipments for the elderly. With the studies’ results a proposal of protocol intervention was defined for the fall risk management in equipment for the elderly.The samples included direct action helpers, elderly, nurses and records made by the professional from the equipments for the elderly where the studies were held. The instruments of data collection were interviews. questionnaires and observation/ registration grids. The results indicate that falls in equipments for the elderly have a high prevalence, are recurrent, occur all day long and take place predominantly in the bedroom and bathroom. After the fall the elderly calls for help more often and restricts actively or that is restricted to him. Physical restraint of mobility is used as a preventive measure. The scales of practices and behaviors of risk management by the elderly and direct action helpers have good psychometric characteristics allowing them to be used in clinical practice, education and research. The risk fators that are most frequently identified by the elderly as contributing to falls are changes in walking, decreased muscle strength and balance changes. Female elderly value information of the risk fators and the male elderly value the practices and safety behaviors. The direct action helpers decide prevention measures alter identifying risk, they know and use the prevention resources of the institution, but their practices and behaviors are not always kept in the course of care for the elderly. The indicators that had lower average are selecting the proper shoes, schedule regular trips to the bathroom in incontinent persons and put on closed and non-slip soles shoes. Practices related to the physical environment, are generally good. Not always the team discusses and decides preventive measures to apply to each elderly. There is a statistically significant relation between the Scale of Practice and Team Behaviors for Prevention of Falls and other scales applied to direct action helpers, which reinforces the teams' need to invest in maintaining practices and safety behaviors. Nurses consider important the existence of a protocol of intervention for management of fall risk in UPI, to control incidents and allow the therapeutic action. The results allowed the design of a protocol for managing fall risk. ln this model the nurse functions are: Prepare institutionalization; Assess individual fall risk; Manage fall risk over time of institutionalization; Evaluate practices and behaviors in managing the fall risk; Educate the multidisciplinary team; Decide on fall preventive actions to be implemented; Implement evidence-based nursing therapies; Manage institutionalized elderly self-care; Select support items that promote a secure self-care; Clarify task delegation process to ensure safety; Monitor the occurrence of falls; Assess the impact of fall in the elderly functionality; implement strategies to control the consequences of fall and prevent the decline of functionality post fall; Assess the impact of implemented interventions and conduct epidemiological studies. Suggestions for practice, research and training emerge.

Date of Award	28 Nov 2014
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Maria dos Anjos Coelho Rodrigues Dixe (Supervisor)