Clinical and functional vulnerability of elderly people from a day center

Cross-sectional study carried out with 216 elderly people of a day center in Teresina, state of Piauí, Brazil. Data collection took place between April and August 2018 by means of a questionnaire for sociodemographic and clinical characterization, the clock drawing test (CDT), the Timed up and Go Test (TUG) and the Clinical and Functional Vulnerability Index (IVCF-20). Linear regression with a forward selection was applied to identify the predictive variables of individual vulnerability.

Results

It was observed that 37% of the elderly people were identified as showing medium risk with regard to clinical and functional vulnerability and 11.1% of them had a high risk. Sociodemographic (individual and family income) and clinical characteristics (self-declared comorbidities, polypharmacy, urinary incontinence, BADL-dependence, falls, hospitalization, frequency of physical activities, health self-perception, frequent sadness and depression, cognition, oblivion of drug therapy and functional mobility) were associated with clinical and functional vulnerability (p<0.05).

Conclusion

The findings of our study enable the operationalization of public policies and strategies for early detection of clinical and functional vulnerability in elderly people and intervention measures aimed at promoting health and preventing illness based on comprehensive care.

Aging; Aged; Health vulnerability; Geriatric nursing; Primary health care

Variables	n(%)
Comorbidities (self-declared)
Presence	182(84.3)
Absence	34(15.7)
Regular use of five or more prescribed drugs
Yes	64(29.6)
No	152(70.4)
Non-intentional weight loss (3 kg over the last month)
Yes	34(15.7)
No	182(84.3)
Urinary incontinence (self-reported)
Yes	52(24.1)
No	164(75.9)
Dependence on Basic Activities of Daily Life (BADL)
Up to 1 activity	197(91.2)
More than 2 activities	19(8.8)
Walking or visual aid
Yes	189(87.5)
No	27(12.5)
Falls over the past year
Yes	76(35.2)
No	140(64.8)
Hospitalization over the past year
Yes	23(10.6)
No	193(89.4)
Physical activity (at least once a week)
Yes	215(99.5)
No	1(0.5)
Physical activity frequency
Up to twice a week	24(11.1)
More than twice a week	192(88.9)
Alcoholism
Yes	23(10.6)
No	193(89.4)
Smoking
Yes	3(1.4)
No	213(98.6)
Health self-perception
Excellent, very good, good	144(66.7)
Fair, poor	72(33.3)
Frequent sadness and depression over the last month
Yes	56(25.9)
No	160(74.1)
Clock drawing test (CDT)
Approved	44(20.4)
Disapproved with minor errors	49(22.7)
Disapproved with major errors	123(56.9)
Oblivion of drug therapy 3 times a week
Yes	82(38.0)
No	134(62.0)
Timed Up and Go Test (TUG) time
0 – 10 seconds	35(16.2)
11- 20 seconds	154(71.3)
Above 20 seconds	27(12.5)
TOTAL	216(100.0)

Variables	Statistics	p-value
Gender	2710.500¹	0.997
With a partner	5487.000¹	0.548
Literacy	2665.000¹	0.092
Individual income	-0.145²	0.033*
Family income	-0.219²	0.001**
Comorbidities (self-declared)	2345.000¹	0.025*
Regular use of five or more prescribed drugs	1741.000¹	0.000*
Weight loss	2467.500¹	0.060
Urinary incontinence	2684.500¹	0.000*
BADL-dependence	613.000¹	0.000*
Walking or visual aid	2227.000¹	0.284
Falls	3381.000¹	0.000*
Hospitalization	1208.000¹	0.000*
Physical activity (at least once a week)	55.500¹	0.519
Physical activity frequency	1611.500¹	0.016*
Alcoholism	1993.000¹	0.422
Smoking	309.000¹	0.922
Health self-perception	3283.500¹	0.000*
Frequent sadness and depression (at least 3x/week)	1734.000¹	0.000*
Clock drawing test	2605.000¹	0.001*
Oblivion of drug therapy 2 times a week	3591.500¹	0.000*
Timed Up and Go Test (TUG) time	2143.000¹	0.002*

Variables	β coefficient	Standard error	t	p-value
Falls over the past year	-1.391	0.509	-2.736	0.007
Hospitalization over the past year	-2.040	0.762	-2.678	0.008
Health self-perception	1.568	0.506	3.096	0.002
Memory loss perceived by close people	-1.624	0.529	-3.068	0.002
Memory loss prevents the performance of a daily activity	-5.557	0.985	-5.642	0.000
Loss of interest of pleasure in pleasant activities	-3.469	0.881	-3.936	0.000
Presence of physical weakness criteria (non-intentional weight loss, BMI below 22 kg/m²), calf circumference below 31 cm, time spent in the walking speed test (4m) > 5 seconds	-2.940	0.873	-3.366	0.001
Polypharmacy	-3.577	0.521	-6.864	0.000
Frequent sadness and depression (3x/week)	-1.707	0.629	-2.713	0.007
Urinary incontinence	-2.254	0.569	-3.959	0.000
BADL-dependence	3.482	0.862	4.039	0.000

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Cynthia Roberta Dias Torres da Silva E-mail: cynthiarobertatorres@gmail.com