Factores relacionados a la vulnerabilidad y fragilidad en ancianos: estudio transversal

estudio transversal, con 384 ancianos en Fortaleza, Ceará. Utilizó el Vulnerable Elders Survey e Índice de Vulnerabilidad Clínico-Funcional - 20. Emplearon testes chi-cuadrado y exacto de Fisher para relaciones. En el análisis de la influencia conjunta de los factores de riesgo, adoptó el método de regresión logística stepwise y multinomial stepwise.

Resultados:

251 (65,4%) no vulnerables y 133 (34,6%) vulnerables. De los vulnerables analizados, 42 (30,9%) hay alto riesgo para fragilidad. Factores relacionados a vulnerabilidad: edad, sexo, presencia de comorbilidades, hipertensión, diabetes, osteoporosis y uso de polifarmacia. Hay aumento de 30% en la chance de vulnerabilidad para cada medicamento adicional. La actividad física reduce en 60% la chance de vulnerabilidad. Factores relacionados a la fragilidad: escolaridad; autopercepción de salud; comorbilidades; polifarmacia.

Conclusiones:

Atentarse para la presencia en ancianos de hipertensión arterial, osteoporosis, polifarmacia e incentivar la práctica de actividad física.

Descriptores:
Vulnerabilidad en Salud; Fragilidad; Anciano; Atención Primaria de Salud; Enfermería

Variable	Vulnerability
	Non-vulnerable	Vulnerable	p value
Age			0.001^* * Chi-square and Fisher's exact test, considering p < 0.05.
60-79	234 (69.6%)	102 (30.4%)
80-100	17 (35.4%)	31 (64.6%)
Gender			0.010^* * Chi-square and Fisher's exact test, considering p < 0.05.
Female	158 (61%)	101 (39%)
Male	93 (74.4%)	32 (25.6%)
Educational level			0.008^* * Chi-square and Fisher's exact test, considering p < 0.05.
More than 6 years	122 (69.7%)	53 (30.3%)
1 to 5 years	112 (65.9%)	58 (34.1%)
Illiterate	17 (43.6%)	22 (56.4%)
Marital status			0.004^* * Chi-square and Fisher's exact test, considering p < 0.05.
Married	82 (65.1%)	44 (34.9%)
Single	69 (78.4%)	19 (21.6%)
Widow	58 (55.8%)	46 (44.2%)
Divorced	40 (67.8%)	19 (32.2%)
Stable union	2 (28.6%)	5 (71.4%)
Skin color			0.003^* * Chi-square and Fisher's exact test, considering p < 0.05.
White	70 (77.8%)	20 (22.2%)
Brown	139 (64.1%)	78 (35.9%)
Indigenous	0	2 (100%)
Black	39 (54.2%)	33 (45.8%)
Yellow	3 (100%)	0
Physical activity			0.002^* * Chi-square and Fisher's exact test, considering p < 0.05.
Yes	132 (73.7%)	47 (26.3%)
No	119 (58.0%)	86 (42%)
Comorbidities			0.007^* * Chi-square and Fisher's exact test, considering p < 0.05.
Yes	209 (62.8%)	124 (37.2%)
No	42 (82.4%)	9 (17.6%)
Hypertension			0.001^* * Chi-square and Fisher's exact test, considering p < 0.05.
Yes	140 (56.2%)	109 (43.8%)
No	111 (82.2%)	24 (17.8%)
Diabetes			0.001^* * Chi-square and Fisher's exact test, considering p < 0.05.
Yes	82 (53.6%)	71 (46.4%)
No	169 (73.2%)	62 (26.8%)
Osteoarthritis			0.008^* * Chi-square and Fisher's exact test, considering p < 0.05.
Yes	48 (53.3%)	42 (46.7%)
No	203 (69%)	91 (31%)
Osteoporosis			0.003^* * Chi-square and Fisher's exact test, considering p < 0.05.
Yes	50 (69.6%)	45 (47.4%)
No	201 (52.6%)	88 (30.4%)
Medications			0.001^* * Chi-square and Fisher's exact test, considering p < 0.05.
0-4	216 (74.5%)	74 (25.5%)
5 or more	35 (37.2%)	59 (62.8%)
Physical activity			0.002^* * Chi-square and Fisher's exact test, considering p < 0.05.
Yes	132 (73.7%)	47 (26.3%)
No	119 (58.0%)	86 (42%)

Variables	B	Wald	gl	Sig.	OR	CI95% for OR
Age	0.069	15.93	1	< 0.001	1.07	1.04	1.11
Physical activity	-0.857	11.76	1	0.001	0.42	0.26	0.69
Hypertension	0.832	7.70	1	0.006	2.30	1.28	4.13
Osteoporosis	0.711	6.57	1	0.010	2.04	1.18	3.51
Medication	0.271	20.51	1	< 0.001	1.31	1.17	1.47
Model adjustment: Omnibus test: x² = 92.2; gl = 5; p < 0.001		Hosmer-Lemeshow: x² = 2.90; gl = 8; p = 0.941				R² = 0.295

Domain	Clinical-Functional Vulnerability Index - 20			p value
Domain	Robust	Frailty risk	Frail	p value
Age				0.143
Did not score	22 (26.5%)	29 (34.9%)	32 (38.6%)
Scored	13(28.2%)	27 (51.3%)	10 (20.5%)
Self-Perception of Health				0.018^* * Chi-square and FisherS exact test, considering p < 0.05.
Did not score	24 (23.1%)	41 (39.4%) 15	39 (37.5%)
Scored	11 (37.9%)	(51.7%)	3(10.3%)
Daily Living Activities				*< 0.001^ * Chi-square and FisherS exact test, considering p < 0.05.**
Did not score	27 (42.2%)	30 (46.9%)	7 (10.9%)
Scored	8(11.8%)	25 (36.8%)	35 (51.5%)
Cognition				*< 0.001^ * Chi-square and FisherS exact test, considering p < 0.05.**
Did not score	22 (43.1%)	21 (41.2%)	8 (15.7%)
Scored	13 (16%)	34 (42%)	34 (42%)
Mood				0.001^* * Chi-square and FisherS exact test, considering p < 0.05.
Did not score	15 (16.7%)	39 (43.3%)	6 (14.6%)
Scored	20 (48.8%)	15 (36.6%)	36 (40%)
Mobility				*< 0.001^ * Chi-square and FisherS exact test, considering p < 0.05.**
Did not score	23 (67.7%)	9 (26.5%)	2 (5.9%)
Scored	12 (12.1%)	47 (47.5%)	40 (40.4%)
Communication				0.106
Did not score	13 (27.1%)	25 (52.1%)	10 (20.8%)
Scored	22 (26.5%)	30 (36.1%)	31 (37.3%)
Multiple comorbidities				*< 0.001^ * Chi-square and FisherS exact test, considering p < 0.05.**
Did not score	28 (43.1%)	32 (34.8%)	5 (77%)
Scored	7 (10.6%)	23 (34.8%)	36 (54.4%)

	B	Wald	df	Sig.	Exp(B)	CI95%
Moderate risk
Age
Did not score	-4.19	6.28	1	0.012	0.015	0.001	0.401
Scored	-3.99	5.12	1	0.024	0.018	0.001	0.586
Self-Perception of Health
Poor (scored)	5.80	6.10	1	0.014	329.4	3.306	32810.9
Regular (scored)	4.67	5.78	1	0.016	107.1	2.369	4845.1
Good (did not scored)	4.33	4.60	1	0.032	75.64	1.451	3944.2
Very goof (did not scored)	4.57	4.67	1	0.031	96.63	1.531	6098.4
Daily Living Activities
Did not score	-2.86	5.24	1	0.022	0.057	0.005	0.662
Cognition
Did not score	-1.15	1.73	1	0.188	0.317	0.057	1.753
Mood
Did not score	-16.16	0.00	1	0.994	9.6e-8	0.000	--
Scored	-12.45	0.00	1	0.995	3.9e-6	0.000	--
Mobility
Did not score	-5.90	13.74	1	< 0.001	0.003	0.000	0.062
Multiple comorbidities
Did not score	-4.53	9.76	1	0.002	0.011	0.001	0.185
High risk
Age
Did not score	-5.03	5.18	1	0.023	0.007	8.6e-5	0.496
Scored	-7.02	7.93	1	0.005	0.001	6.7e-6	0.118
Self-Perception of Health
Scored (Poor)	4.72	3.19	1	0.074	112.2	0.631	19955.1
Scored (Regular)	4.01	3.18	1	0.075	55.23	0.670	4552.5
Did not Scored (Good)	3.59	2.00	1	0.157	36.19	0.251	5216.2
Did not scored (Very Good)	4.29	1.50	1	0.221	73.23	0.075	71037.1
Daily Living Activities
Did not score	-5.48	13.29	1	0.000*	0.004	0.000	0.080
Cognition
Did not score	-3.16	6.29	1	0.012	0.042	0.004	0.501
Mood
Did not score	-9.68	37.90	1	0.000*	6.3e-5	2.9e-6	0.001
Scored	-3.67	--	1	--	0.026	0.026	0.026
Mobility
Did not score	-9.03	20.69	1	0.000*	0.000	2.4e-6	0.006
Multiple comorbidities
Did not score	-9.28	26.10	1	0.000*	9.3e-5	2.6e-6	0.003
Model adjustment:
Likelihood Ratio Test: χ² = 172.3; gl = 26; p < 0.001	Adjustment test: χ² = 130.5; gl = 142; p = 0.746					R² = 0.829

Variable	Clinical-Functional Vulnerability Index - 20			p value
Variable	Robust	Frailty risk	Frail	p value
Age				0.96
60-79	32 (28.3%)	42 (37.2%) 15 (57.7%)	39 (34.5%)
80-100	7 (26.9%)	42 (37.2%) 15 (57.7%)	4 (14.4%)
Gender				0.187
Female	27 (25%)	44 (40.7%)	37 (34.3%)
Male	12 (38.7)	13 (41.9%)	6 (19.4%)
Educational level				0.008^* * Chi-square and Fisher's exact test, considering p < 0.05.
llliterate	5 (22.7%)	10 (45.5%)	7 (31.8%)
1 to 5 years	17 (27%)	28 (44.4%)	18 (28.6%)
More than 6 years	17 (31.5%)	19 (35.2%)	18 (33.3%)
Marital status				0.424
Single	7 (29.2%)	7 (29.2%)	10 (41.7%)
Married	14 (31.8%)	16 (36.4%)	14 (31.8%)
Stable union	0	4 (80%)	1 (20%)
Widow	12 (25.5%)	23 (48.9%)	12 (25.5%)
Divorced	6 (31.6%)	7 (36.8%)	6 (31.6%)
Skin color				0.222
White	4 (19%)	6 (28.6%)	11 (52.4%)
Brown	26 (31.7%)	32 (39%)	24 (29.3%)
Indigenous	1	1	0
Black	8 (23.5%)	57 (41%)	8 (23.5%)
Yellow	0	0	0
Physical activity				0.063
Yes	20(40%)	17 (34%)	13 (26%)
No	19(21.3%)	40 (44.9%)	30 (33.7%)
Comorbidities				0.020^* * Chi-square and Fisher's exact test, considering p < 0.05.
Yes	34 (26.2%)	53 (40.8%)	43 (33.1%)
No	5 (55.6%)	4 (44.4%)	0
Medications				0.001^* * Chi-square and Fisher's exact test, considering p < 0.05.
0-4	33 (41.8%)	35 (44.3%)	11 (13.9%)
5 or more	6 (10%)	22 (36.7%)	32 (53.3%)

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[1] Corresponding author: Caroline Ribeiro de Sousa E-mail: carolineribeiro7@hotmail.com