Medo de cair e o risco de queda: revisão sistemática e metanálise

Pena, Silvana Barbosa; Guimarães, Heloísa Cristina Quatrini Carvalho Passos; Lopes, José Maria de Andrade; Guandalini, Lidia Santiago; Taminato, Mônica; Barbosa, Dulce Aparecida; Barros, Alba Lúcia Bottura Leite de

doi:10.1590/1982-0194201900062

Cited by 40 publications

(32 citation statements)

References 35 publications

(108 reference statements)

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“…There is a low quality of evidence from two small studies showing a slight but signi cant increase of fear of falling in the intervention group when compared to usual care. This is in contrast to existing literature, which assumes that an increased fear of falling contributes to an increased risk of falling [45]. Our ndings might be explained by the fact that an element of PDHA is to increase patients' awareness of potential risk of falling at home, which might also result in an increased fear of falling.…”

Section: Integrative Synthesiscontrasting

confidence: 99%

Effects, Barriers and Facilitators in Predischarge Home Assessments to Improve the Transition of Care from the Inpatient Care to Home in Adult Patients: An Integrative Review

Kirchner-Heklau

Krause

Saal

2020

Preprint

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Background: Predischarge home assessments (PDHA) aim to ensure safe discharge from hospital or rehabilitation. There is insufficient evidence on the effectiveness of PDHA. For adults with any diagnosis, we aimed to determine (1) the effects of PDHA on outcomes associated with the successful return to community living (e.g., Activities of Daily Living falls) and (2) the associated barriers and facilitators to derive recommendations for clinical practice.Methods: We searched Medline, EMBASE, CINAHL, five additional databases and other sources. We included individual and cluster randomized (RCT/cRCT) and controlled clinical trials comparing PDHA versus usual care/other intervention, as well as qualitative/mixed methods studies dealing with PDHA. Critical appraisal was performed according to the Cochrane risk-of-bias tool in quantitative studies and the Critical Appraisal Skills Programme (CASP) for qualitative studies and data extraction. Meta-analysis, thematic synthesis and integrative synthesis were performed.Results: Seven RCTs (n = 1072) and ten qualitative studies (n = 245) met the inclusion criteria. RCTs reported a variety of outcomes (n = 17). There is moderate to very low evidence for missing effects on (instrumental) Activities of Daily Living, quality of life, risk of falling and risk of readmission, mobility and fear of falling. The qualitative studies revealed the following topics related to patient education, patient information, patients’ acceptance of modifications and aids, involvement of patient goals and meaningful activities in functional assessment, as well as relevant social- and diagnosis-related patient conditions in PDHA. Seven implications for interventions were derived from these topics. Six of the included RCTs each addressed at least one and at most three of the seven identified meaningful implications for implementation.Conclusion: There is no evidence from the meta-analysis for the effectiveness of PDHA. Further robust studies are needed to adapt and evaluate PDHA interventions, taking the identified implications from stakeholders’ views into account, and should follow the current recommendations for the development and evaluation of complex interventions.Trial registration: The review was registered and methods were reported on PROSPERO on 18th July 2018 (https://www.crd.york.ac.uk/PROSPERO. CRD42018100636).

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Section: Integrative Synthesiscontrasting

confidence: 99%

Effects, Barriers and Facilitators in Predischarge Home Assessments to Improve the Transition of Care from the Inpatient Care to Home in Adult Patients: An Integrative Review

Kirchner-Heklau

Krause

Saal

2020

Preprint

View full text Add to dashboard Cite

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“…However, there is only low quality of evidence from two small studies showing a slight but signi cant increase of fear of falling in the intervention group when compared to usual care. This is in contrast to existing literature, which assumes that an increased fear of falling contributes to an increased risk of falling [53]. Our ndings might be explained by the fact that an element of PDHA is to increase patients' awareness of the potential risk of falling at home, which might also result in an increased fear of falling.…”

Section: Improving Patient Outcomes With Pdhacontrasting

confidence: 99%

Effects, barriers and facilitators in predischarge home assessments to improve the transition of care from the inpatient care to home in adult patients: An integrative review

Kirchner-Heklau

Krause

Saal

2020

Preprint

View full text Add to dashboard Cite

Background: Predischarge home assessments (PDHA) aim to support safe discharge from hospital or rehabilitation. There is insufficient evidence on the effectiveness of PDHA. For adults with any diagnosis, we aimed to determine (1) the effects of PDHA on outcomes associated with the successful return to community living (e.g., Activities of Daily Living, falls) and (2) the associated barriers and facilitators in order to derive recommendations for clinical practice.Methods: We searched Medline, EMBASE, CINAHL, five additional databases and other sources. We included individual and cluster randomized (RCT/cRCT) and controlled clinical trials comparing PDHA versus usual care/other intervention, as well as qualitative/mixed methods studies dealing with PDHA. Critical appraisal was performed according to the Cochrane risk-of-bias tool in quantitative studies and the Critical Appraisal Skills Programme (CASP) as well as the McMaster University Guidelines for Critical Review Form for qualitative studies and data extraction. Meta-analysis, thematic synthesis and integrative synthesis were performed. Results: EightRCTs (n=1149) and eleven qualitative studies (n=346) met the inclusion criteria. RCTs reported a variety of outcomes (n=17). We are uncertain if PDHA has any effect on patient outcomes in Activities of Daily Living, quality of life, mobility and fear of falling, falls and hospital readmissions (with moderate to very low quality of the evidence). The qualitative studies revealed facilitators and barriers which should be considered by therapists when conducting PDHA. These were related to the following topics: patient safety education, patient information, patients’ acceptance of modifications and aids, functional assessment, standardization of procedures as well as the consideration of relevant patient conditions and contextual factors in PDHA. Conclusion: There is no evidence from the meta-analysis for the effectiveness of PDHA. Further robust studies are needed to adapt and evaluate PDHA interventions, taking the identified stakeholders’ views on PDHA into account and following the current recommendations for the development and evaluation of complex interventions. Trial registration:The review was registered and methods were reported on PROSPERO on 18th July 2018 (https://www.crd.york.ac.uk/PROSPERO. CRD42018100636).

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“…Esta muestra poblacional en especial no se comportó diferente a lo esperado; aquellos con tncm sufrieron 2 veces más caídas que aquellos que no lo tenían (or: 2.09; ic 95 %: 1.14-3.86; p: 0.001), y en la literatura, la relación es ampliamente documentada: se ha descrito que las personas ancianas con demencia tienen un riesgo de 2 a 3 veces mayor que los ancianos cognitivamente sanos; empero, no se ha identificado la influencia del tipo de demencia en la gravedad y el riesgo de caídas. Las medidas de ejecución física como la velocidad de la marcha o la variabilidad del tiempo de paso son marcadores de riesgo de caídas en pacientes con tncm (9).…”

Section: Discussionunclassified

Factores asociados a caídas en el servicio ambulatorio de geriatría de un hospital universitario en Bogotá, Colombia

et al. 2021

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Introducción: las caídas en el adulto mayor tienen un impacto negativo en el estado funcional y el riesgo de caídas se eleva progresivamente con la edad, por lo que es importante objetivar todos los factores de riesgo de cada paciente. Nuestro objetivo fue describir la prevalencia y los factores asociados con caídas en los pacientes del servicio ambulatorio de geriatría del Hospital Universitario San Ignacio en Bogotá, Colombia. Materiales y métodos: se realizó un estudio descriptivo con pacientes valorados en la consulta externa de geriatría del Hospital Universitario San Ignacio desde enero de 2017 hasta diciembre de 2018. Resultados: se incluyeron 233 pacientes, documentando una prevalencia de caídas del 44,5%. En el análisis bivariado las variables con asociación estadísticamente significativa fueron: la presencia de trastorno neurocognitivo mayor (TNCM) (OR 2.31 IC 95% 1.28-4.18 p 0.005), el miedo a caer (OR 2.27 IC 95% 1.24-4.18 p 0.008), un grado de dependencia moderado a total (OR 1.93 IC 95% 1.11-3.35 p 0.019) y a un mal estado nutricional (OR 1.18 IC 95% 1.099- 3.18 p 0.02); no obstante, en el análisis multivariado, las variables que mantuvieron la asociación fueron el TNCM (OR 2.09 IC 95% 1.14-3.86 p 0.001) y el miedo a caer (OR 2.27 IC 95% 1.19-4.32 p 0.001). Conclusión: las variables asociadas con caídas en nuestra población se relacionan con lo descrito en la literatura mundial; son necesarias intervenciones para corregir estos factores y evitar caídas en nuestra población, así como diseñar más estudios para detectar otros factores asociados.

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Medo de cair e o risco de queda: revisão sistemática e metanálise

Cited by 40 publications

References 35 publications

Effects, Barriers and Facilitators in Predischarge Home Assessments to Improve the Transition of Care from the Inpatient Care to Home in Adult Patients: An Integrative Review

Effects, Barriers and Facilitators in Predischarge Home Assessments to Improve the Transition of Care from the Inpatient Care to Home in Adult Patients: An Integrative Review

Effects, barriers and facilitators in predischarge home assessments to improve the transition of care from the inpatient care to home in adult patients: An integrative review

Factores asociados a caídas en el servicio ambulatorio de geriatría de un hospital universitario en Bogotá, Colombia

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