Banca de DEFESA: KARLA VANESSA RODRIGUES SOARES MENEZES

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
DISCENTE : KARLA VANESSA RODRIGUES SOARES MENEZES
DATA : 13/07/2017
HORA: 14:00
LOCAL: Sala 05 - Departamento de Fisioterapia
TÍTULO:

Impact oh hospitalization in functional and mobility capacity o folder adults


PALAVRAS-CHAVES:

ity limitation, hospitalization, validity of testes, reproducibility of tests, functioning


PÁGINAS: 130
RESUMO:

Introduction As people get older remains a challenge maintaining functional
capacity. Functional capacity defined as the ability to perform self-care
activities (i.e. activities of daily living - ADLs) is classified inside the level of
“activity and participation” of the International Classification of Functioning,
Disability and Health (ICF). Previous studies have identified different risk
factors for worsening functional capacity during hospitalization, including older
age, sociodemographic characteristics, preexisting disability, comorbidity,
cognitive loss and depression. In-hospital mobility has received particular
attention due to its important relation to loss of functional capacity. Few
studies about hospitalization effects on older adults were done in Brazil and in
an attempt to fill this gap this study was developed. Identify older adults at risk
for loss in functional capacity during hospitalization will help researchers and
clinicians in order to make informed decisions. Objectives This study has
three objectives. First: to provide an updated review to identify and appraise
relevant instruments for the measurement of older adults’ mobility based on
the ICF conceptual framework in the context of an acute care or intensive
geriatric rehabilitation unit and to appraise and compare their measurement
properties. Second: to evaluate if in-hospital mobility assessed at admission is 

predictive of loss in functional capacity during hospitalization of older adults.
Third: to assess functional changes since pre admission (baseline) until
discharge of hospitalized older adults and identify predictors of loss in
functional capacity. Methods This cohort prospective study was conducted at
University Hospital Onofre Lopes (HUOL), Natal/RN, Brazil, between January
1, 2014 and April 30, 2015. The study enrolled all consecutive patients aged
60 years and older who were acutely admitted and fill the following inclusion
criteria: 1) ability to provide informed consent; 2) admitted directly from the
community; 3) screening for study eligibility performed in first 24 hours of
admission. Independent variables included personal characteristics, domestic
live activities (i.e. instrumental activities of daily living – IADL) evaluated by
Lawton and Brody´s scale, cognition evaluated by Leganés cognitive test,
depression assessed by Geriatric Depression Scale (GDS-15), in-hospital
mobility evaluated by Short Physical Performance Battery (SPPB). The
dependent variable functional capacity was assessed by Katz scale. Those
instruments were applied at two different times: at admission (within first 24
hours) and at discharge (12-24 hours before). Analysis included descriptive
statistics, bivariate and multivariate, by means of frequencies, means ±
standard error, receiver-operating characteristic (ROC), logistic binary
regression and Generalized Estimating Equation (GEE). Data were entered
into the Statistical Package for Social Sciences (SPSS) version 18.0 for
Windows. Results At discharge from the 1256 included 65 (5.1%) died during
the hospitalization and final sample consisted of 1191 older adults. The mean
age was 70.02 (±7.34), 684 (57.4%) participants were men and 790 were
married (66.3%). The mean length of hospital stay was 7.65 days (±9.94). Our
sample had a high prevalence of surgery (˃70%). Regarding to the best
instruments to assess mobility De Morton Mobility Index (DEMMI) and SPPB
presented the best balance between mobility coverage, measurement
properties and applicability to acute care and intensive geriatric rehabilitation
units. SPPB cutoff point of 6.5 (62% sensitivity, 54% specificity) identified 593
(49.8%) patients at risk for loss in functional capacity. In logistic regression
SPPB alone presented statistically significant prediction loss of functional
capacity between admission and discharge. Finally regarding to changes in
functional capacity 52.5% of the older adults were discharged with worse
functional capacity than baseline. Be dependent in domestic life activities,
presence of depressive symptons, low levels of cognition and in-hospital
mobility were risk factors for greater loss in functional capacity after a
hospitalization event. Conclusion We concluded that DEMMI and SPPB
were the best instruments to assess mobility in hospitalized older adults.

Regarding to functional capacity half of the sample presented loss in
functioning between baseline and discharge and in-hospital mobility evaluated
by SPPB can predict loss of function in hospitalized older adults. In addition to
in-hospital mobility, dependence for domestic life activities, low levels of
cognition and depression improve the detection of cases at risk of loss in
functional capacity.


MEMBROS DA BANCA:
Externo ao Programa - 1195933 - ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA
Externo à Instituição - ARMELE DE FATIMA DORNELAS DE ANDRADE - UFPE
Externo ao Programa - 3328273 - IRAMI ARAUJO FILHO
Externo à Instituição - MAYLE ANDRADE MOREIRA - UFC
Presidente - 350637 - RICARDO OLIVEIRA GUERRA
Notícia cadastrada em: 30/06/2017 09:52
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