Home fall of elderly people: implications of stressors and representations in the COVID-19 context

Santos, Jéssica de Castro; Arreguy-Senna, Cristina; Pinto, Paulo Ferreira; Paiva, Elenir Pereira de; Parreira, Pedro Miguel dos Santos Dinis; Brandão, Marcos Antônio Gomes

doi:10.1590/1983-1447.2021.20200221

Jéssica de Castro Santos

Universidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery. Rio de Janeiro, Rio de Janeiro, Brasil.

https://orcid.org/0000-0002-8336-156X

Cristina Arreguy-Senna

Universidade Federal de Juiz de Fora (UFJF), Faculdade de Enfermagem. Juiz de Fora, Minas Gerais, Brasil.

https://orcid.org/0000-0002-5928-0495

Paulo Ferreira Pinto

Universidade Federal de Juiz de Fora (UFJF), Faculdade de Educação Física e Desportes. Juiz de Fora, Minas Gerais, Brasil.

https://orcid.org/0000-0001-7321-3160

Elenir Pereira de Paiva

Universidade Federal de Juiz de Fora (UFJF), Faculdade de Enfermagem. Juiz de Fora, Minas Gerais, Brasil.

https://orcid.org/0000-0001-6893-1221

Pedro Miguel dos Santos Dinis Parreira

Universidade de Coimbra (UC), Escola Superior de Enfermagem de Coimbra. Coimbra, Portugal.

https://orcid.org/0000-0002-3880-6590

Marcos Antônio Gomes Brandão

Universidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery. Rio de Janeiro, Rio de Janeiro, Brasil.

https://orcid.org/0000-0001-9829-4235

Corresponding author
Jéssica de Castro Santos Email jessicacastroenf@gmail.com

Authorship contribution

Conceptualization: Jéssica de Castro Santos; Cristina Arreguy-Senna; Marcos Antônio Gomes Brandão. Data curation: Jéssica de Castro Santos; Cristina Arreguy-Senna; Marcos Antônio Gomes Brandão. Formal analysis: Jéssica de Castro Santos; Cristina Arreguy-Senna; Paulo Ferreira Pinto; Marcos Antônio Gomes Brandão. Investigation: Jéssica de Castro Santos; Cristina Arreguy-Senna. Methodology: Jéssica de Castro Santos; Cristina Arreguy-Senna. Visualization: Jéssica de Castro Santos; Cristina Arreguy-Senna; Paulo Ferreira Pinto; Elenir Pereira de Paiva; Pedro Miguel dos Santos Dinis Parreira; Marcos Antônio Gomes Brandão. Writing-original draft: Jéssica de Castro Santos; Cristina Arreguy-Senna; Paulo Ferreira Pinto; Pedro Miguel dos Santos Dinis Parreira; Marcos Antônio Gomes Brandão. Writing-review & editing: Jéssica de Castro Santos; Cristina Arreguy-Senna; Paulo Ferreira Pinto; Elenir Pereira de Paiva; Pedro Miguel dos Santos Dinis Parreira; Marcos Antônio Gomes Brandão.

Associate editor

Dagmar Elaine Kaiser

Editor-in-chief

Maria da Graça Oliveira Crossetti

Mixed Method with Concomitant Triangulation
Study design	Qualitative	Quantitative
Study design	Structural and procedural approach of SRT	Sectional study
Objectives	Describe the content, structure and origin of social representations about falling at home by elderly people	Describe personal and home structure conditions that predispose the elderly to the risk of falling, in the perspective of Neuman’s stressors
Objectives	Conjecture the implications of this empirical evidence on the daily life of the elderly in the context of the pandemic caused by COVID-19.
Participants Data collect	190 participants - sample group of the structural approach 50 participants - sample group of the procedural approach	190 elderly people
Participants Data collect	TFAWTI Semi-structured interview with audio recording	Sociodemographic characterization Application of the Snellen and Jaeger scales for visual acuity Application of the FES-I scale Self-perceived risk of falls
Data analysis	Semantic and lexicographic analysis followed by prototypical analysis Content analysis EVOC 2000®. NVIVO pro11®	Descriptive and correlational statistics (univariate analysis) SPSS®, version 22

Variables	N	%		Variables	N	%	µ±SD (max-min)
Gender				Age
Male	41	21.5		65---69	50	26.3	µ75.01 ±7.109 (65-96)
Female	149	78.5		70---74	54	28.5
Total	190	100		75---79	30	15.7
				80---84	33	17.3
Skin Color				≥85	23	12.2
White	132	69.4		Total	190	100
Black	11	5.6
Brown	46	24.5		Marital Status
Not mentioned	1	0.5		Single	10	5.2
Total	190	100		Married	126	66.3
				Separated	9	4.7
Schooling			µ4.85 ± 4.63 (0-18)	Widower	41	21.5
0I-5 years	155	81.5		Stable union	4	2.3
5 I-8 years	14	7.5		Total	190	100
8 I-12 years	7	3.7
≥12 years	14	7.3		Personal income
Total	190	100		0	4	2.1	µ 1.91± 2.519 (0-18)
				1I-------3	92	48.4
				3I--------5	12	6.3
Have children				≥5	7	3.1
Yes	98	51.7		Did not answer	76	40
No	92	48.3		Total	190	100
Total	190	100
			µ 3.56± 1.814 (1-10)	Family income
Number of children				0	-	-	µ 3.20± 2.629 (1-18)
0	92	48.3		1I-------3	62	32.6
1I-------3	28	14.9		3I--------5	31	16.4
3I--------5	41	21.5		≥5	20	10.5
≥5	29	15.3		Did not answer	77	40.5
Total	190	100		Total	190	100

Variable of interest	Empirical research					Theoretical conjecture
	Activity measured for situation at home					Hypothesis of change in the context of the COVID-19 pandemic
	Non-falling people		Falling people		X²
	N	%	N	%	X²
Rug	46	48.4	49	51.6	0.365	YES
Security bar	12	36.4	21	63.6	0.530	YES
Good lighting	68	49.6	69	50.4	0.241	NO
Slippery floor	20	31.3	44	68.8	0.000	YES
Steps	72	51.1	69	48.9	0.848	NO
Stairs	29	39.2	45	60.8	0.04	NO
Handrail	11	28.2	28	71.8	0.001	YES
Many objects	79	51.3	75	48.7	0.848	NO
Low toilet	-	-	-	-	-	--

/*		Fragment of exemplary speeches according to representational dimensions
/*		Representation of the (in)adaptability of the home environment	Representation and overcoming limitations arising from weaknesses
Dimensions (40/266*)		Behavioral and attitudinal: I can fall at home; I even fell down P183. I'm afraid to raise my Arms P189. I am afraid of having a vertigo P189. I went to take off a skirt and stepped on it with a slipper on the smooth floor and slipped P178. COGNITIVE AND informative:But you have to be very careful at home too P165. [...]Slippery floor P142. I think the person has to be very attentive and careful P121. Sometimes you can slip, trip P149. Evaluative: ... I am very afraid of falling. P121. I think the person has to be very attentive and careful P121. Wet floor, I never fell P188. Objective: The boy [son] even fixed my bathroom. P111. I am very afraid of rug and stairs P111. I think it's dangerous to slip, to slip on the rug, in the bathroom. [...]The floor can slip, if there is a loose cloth on the floor, it will slip for nothing P180.	Behavioral and attitudinal: ... I've been grabbing to keep from turning [falling] P180. I clean the house and put everything in place very carefully P150. But I haven't fallen for a long time, I have more attention P148. Cognitive and informative: There is a certain amount of dust here, we can use a cloth, we can forget and use a little soap, washing powder or detergent and slip and fall P188. Here at home I think I can fall P120. It is not difficult. I can fall inside home P114. [...]Because of the rug and worn slipper P140. I have never fell inside home P166. EVALUATIVE: I walk very carefully P174. It's not even good to wear slippers, but in that heat, how do you do it? P140. Objectival: I already slipped in bathroom P131. To take a shower, you have to stop holding the bathroom (safety bar) P120. [...]The slipper doubled and I fell P140.
Stressors and origins	Intrapersonal (40/132*)	Own origin:I'm already ninety, it's not a day, right? P111. I am terrified of falling. P120 I bathe alone and never fall P114. Break something, hit your head on the floor and don't walk anynore P167. I think it can bring health problems, give a hip fracture, break a leg, displace something. I think if it falls it breaks, because the bones are no longer strong P177.	Own origin:I walk very carefully [...] P174. Because I don't trust that leg (left). P160 I joke about my fall that was my height. I didn't trip and I didn't slip. When you trip, you fall forward, when you slide, you fall back. Mine was like this: simply at my height, I didn't have dizziness or imbalance P181. We can grate the face. If you don't protect it when you fall, your nose is thin. I fell with my legs up, then they had to get me up P166.
	Interpersonal (35/64*)	Family origin:The boy (son) even fixed my bathroom P111. This one (husband) has already fallen many times P142. Colleagues origin:She fell into the box. She got up in the morning and went to the bathroom. Her husband was waiting for her to come back and she didn't. When he got there, she was debating P117. I haven't seen anyone fall for a long time P119.	Family origin:[...]I had to tell my granddaughter, because I am afraid not to speak and for me to be worse. P138 As soon as I lost my husband, I fell in the kitchen, but I didn't feel anything, just fell and lay on the cold floor P177 My husband was always falling P149. Colleagues/friends origin:This colleague of mine who was changing the lamp, made him dizzy P183. My girl's godfather, unbalanced and broke the femur, had the surgery, but gave pulmonary embolism and died P189.
	Transpersonal (40/69*)	Origin in household objects:I am afraid to climb a chair [...]I cannot clean the chandeliers anymore P189. Origin in the environment and home actions:Inside home is the easiest place for people to fall P127. The floor is wet [...]with an old slipper P155. Leaving a light environment and moving to a dark one, there is a drop in vision, so I think may fall P168. When I fell on the stairs that I had TBI, I had a skull fracture, I fractured three spine vertebrae. It was because I didn't hold the handrail. So stairs that don't have a handrail I don't go up and I don't go down at all P160.	Origin in household objects:think it is dangerous to slip, to slip on the rug, in the bathroom P080. Origin in personal objects:A slipper that is not suitable P154. Origin in the environment and home actions:This was to me never wash the kitchen again P147. But, inside my room, I don't want any rug on the floor P165.
Dendogram and Circle Graph

[1] Corresponding author
Jéssica de Castro Santos Email jessicacastroenf@gmail.com

Brasil

Brasil

Home fall of elderly people: implications of stressors and representations in the COVID-19 context

Caída de ancianos en casa: implicaciones de estresores y representaciones en el contexto de COVID-19

ABSTRACT

Objectives

Method

Results

Conclusion