Mortalidade e fatores prognósticos em idosos residentes em Instituições de Longa Permanência

Abstract

Population aging is a global phenomenon. In Brazil, the increase in the proportion of elderly in the population has been accompanied by changes in the epidemiological profile, which are prevalent noncommunicable chronic diseases, which are the leading causes of morbidity, disability and mortality, especially in the elderly residing in nursing homes. The shortage of studies involving the situation of health and mortality in institutionalized elderly motivated this research, which aims to determine the mortality and its prognostic factors in institutionalized elderly in the city of Natal-RN. This is a prognostic study with dynamic population, started in October 2013 with duration of 18 months follow-up to all elderly residents (n = 345) in nursing homes, with and without profit. During this period, were realized seven assessment waves, where the following anthropometric variables were measured: weight (kg), height (cm), brachial perimeters (cm) and calf (cm). The nutritional screening was performed using the Mini Nutritional Assessment. Information about the food consumption and serum albumin concentration were obtained from the data analysis of a survey which this study is part. As for the information about morbidities, hospitalizations, diet type and number of medications they were obtained through medical records. Socioeconomic, demographic and sociocultural data were collected through structured interviews with questionnaires assistance. The information on mortality was obtained after analysis of death certificate. The statistical analysis was carried out through the analysis of survival by the Kaplan-Meier method, and then Cox regression at multivariate analysis, with the respective hazards ratios (HR). Thes 345 elderly evaluated presented mean age equal to 81.2 (9.3) years, with the largest proportion of the population ≥ 75 years (74,8%). Most institutionalized are female (76.5%), are single (45.8%) and have some degree of schooling (61.4%). A total of 179 elderly (51.9%) have mobility restriction, 89.0% were diagnosed with chronic diseases, 54% with malnutrition and 45.2% use more than five drugs a day. Chronic diseases such as hypertension (45.5%) and diabetes (25.0%) are the most frequent. During follow-up, 70 elderly (20.3%, CI 95%:16.25%- 25.00%) died, in which respiratory diseases (44.3%) and circulatory (30.0%) were the its main causes. The probability of overall survival of institutionalized elderly was 78.7% (CI: 0.74-0.83) at the end of the cohort, where the main prognostic factors identified in the Cox analysis were age ≥ 75 years (HR = 3 85), calf perimeter less than 31cm (HR = 2.58), tube feeding (HR = 2.59), doughy food (HR = 2.23), with mobility restrictions (HR = 1, 76), male (HR = 1.75) and polypharmacy (HR = 1.55). In this way, improvements in health, with actions directed to prevention of cardiovascular and respiratory diseases, as well as the recovery of nutritional status and fitness on prescription food and medications can result in reducing the risk of early mortality.