Orientações quanto à prevenção de quedas de pessoas idosas caidoras da comunidade submetidos à gestão de casos: ensaio clínico randomizado

Abstract

Some conditions can be detrimental to the health of the older people, such as falls. The importance of research and interventions for clinical practice to prevent falls is well known. However, the results of studies on the applicability of different fall screening methods in developing countries are still inconclusive. Objectives: To verify the effects of a remote intervention, based on an individual case management plan, on falls and their consequences for community-dwelling older people with a history of falls; to verify adherence and applicability to filling in and following up the falls calendar and responding to monthly phone calls by older people fallers and what factors influence them to adopt these practices in their daily lives. Methods: This is a randomized clinical trial carried out remotely between 2021 and 2022. Older people fallers included in the Multidisciplinary and Assistance Program for the Management of Falls for Older People Fallers (MAGIC) at the Federal University of São Carlos (UFSCar) took part in the study. The participants were divided into two groups: The Control Group and the Intervention Group. The Intervention Group underwent a 16-week case management program, which included a multidimensional assessment, a proposed intervention according to the risks identified, the development of an individualized care plan, as well as follow-up and monitoring. There was an initial assessment with sociodemographic, health and functional data, a re-evalu- ation after 16 weeks on falls and a 12-month follow-up on falls, starting from the beginning of the first assessment. To assess falls, the data collected during the monthly telephone calls and from the records in the falls calendar were used, based on the following aspects: "number of falls", "number of fallers", "number of falls per person", "when was the first fall (month)?", "when was the second fall (month)?", "consequences", "injurious falls", "falls resulting in medical expenses/hospitalizations", "fractures", "mortality". From this data, adherence to the falls calendar was measured, as to whether it was filled in properly, and how important the monthly phone calls were, as well as quantifying the data from these screening tools. Results: The total sample consisted of 56 older people, 27 from the CG and 29 from the IG. There was no significant interaction between groups and time points in terms of falls data. The CG had a higher number of falls and consequences compared to the IG, at all three assessment times. There was no satisfactory adherence to the falls calendar in either group. As for sensitivity and specificity, a value of 21.2% was obtained for sensitivity and 18.75% for specificity. In addition, clinical and sociodemographic factors did not influence the sample to adhere to the falls calendar. Conclusion: As for the falls data, there was no effectiveness of a remote intervention based on case management for older people fallers compared to the control group.

There was no adherence to the falls calendar and clinical and sociodemographic factors did not influence the sample to adhere to the screening tool for falls and their consequences. It is suggested that more randomized clinical trials with similar methodologies be carried out, using monthly phone calls to screen for falls, in order to prove the findings and improve the effectiveness of intervention protocols in case management for older people fallers.