Fragilidade e desempenho físico de idosos de instituições de longa permanência: uma análise de sobrevida de cinco anos

Abstract

Introduction: Population growth and aging is a global phenomenon that affects all countries in the world and has repercussions on social assistance and protection, in addition to the organization of health systems. Population aging, the epidemiological transition, the reduction in mortality rates, especially among the older adults over 80 years of age, changes in family structures and the increase in functionally dependent older adults demand the need to establish long-term care for the elderly. In this scenario, there is a growing demand for Nursing Homes - NHs, which have a high prevalence of physical frailty and mortality. Objectives: to verify whether physical frailty and physical performance are predictors of mortality in the older adults in NHs through a five-year survival analysis. Methods: this is a five-year longitudinal study with the initial baseline collection of 133 elderly residents of 15 ILPI in the State of Paraiba - Brazil. The study started in 2014 and data collection ended in 2019. In addition to data on physical frailty (Fried Frailty Syndrome) and physical performance (Short Physical Performance Battery), sociodemographic information and health conditions were collected. The relationship between physical frailty and physical performance with mortality was evaluated using Kaplan-Meier Survival Curves and Cox Proportional Risk Regression models. A confidence interval (CI) of 95% and a pvalue < 0.05 was considered. Results: Of the 133 participants at baseline, 114 were evaluated during the follow-up of the study. Of these, 41.22% died by the end of the cohort. The main results of Article 1, entitled “How does the physical frailty phenotype predict mortality in older adults in nursing homes? A 5-year survival study” showed that life expectancy among the non-frail older adults was significantly higher, with a mean survival of 7.5 months longer compared to the frail older adults (49.1%) (p = 0.01). There was a 36% increase in the risk of dying (adjusted HR 1.36; 95% CI 1.02 - 1.68; p=0.03) for each additional point on the Fried frailty count, and frail subjects had a 2.1- fold increased risk of dying. compared with non-frail subjects (adjusted HR 2.01; 95% CI 1.11 - 3.62; p=0.02). The main results of Article 2, entitled “Physical performance as a predictor of mortality in nursing home residents: A five-year survival analysis”, found that 61.40% of the participants had low physical performance. Low physical performance increased the chance of dying by 2.77 times (adjusted HR 2.77; 95% CI 1.38 – 4.83; p < 0.001). Low performance on the gait speed test also represented a 2.58-fold increased risk of dying (adjusted HR 2.58; 95% CI 1.38 - 4.83; p < 0.01). The survival time of the older adults with low physical performance was significantly shorter, with a mean survival of less than 12 months in relation to the mean survival time of the older adults with better physical performance (p < 0.01). Conclusion: The results of this study showed that both physical frailty and low physical performance can predict the mortality of older adults in nursing home residents over five years.