Factors associated with fragility in elderly persons in the context of primary attention

This study aimed to analyze the factors associated with frailty in the elderly in the context of Primary Health Care (APS) in the city of Pombal, Paraíba. It is a cross-sectional, crosssectional analytical study, conducted in the quantitative approach, using spatial analysis, preceded by a tempor developed, with a secondary analysis of data from the System of Health Indicators and Follow-up of Policies of the Elderly, in a temporal cut, referring to the years 2000 to 2010, in the state of Paraíba. Then I study correlation analysis, conducted in the quantitative approach, was developed in Basic Health Units of the municipality of Pombal-Paraíba. The study population was 2,972 elderly (≥ 65 years old) enrolled in APS. The sample consisted of 307 elderly individuals selected by proportional stratified sampling. Data collection took place between January and March of 2017, in the homes of the elderly. A structured form was used to collect sociodemographic and clinical-behavioral data. To track the fragility, the Functional Clinical Vulnerability Index (IVCF-20) was used for the cognition of the Mini Mental State Examination, for the mood of the Geriatric Depression, for mobility the Timed Up and Go and for communication the Test of Whisper and the Snellen Sign Test. The data were analyzed in software R, based on descriptive analysis including relative and absolute frequency, central tendency and dispersion measurements, and multiple logistic regression (p<0.05), ANOVA, Kruskal-Wallis, Fisher tests and correlation of Pearson (p <0.05). After that, an analytical study was developed that used spatial analysis with fragile or fragile elderly individuals registered in the APS, distributed in 32 census tracts, between January and March of 2017. For geolocation, the software was used Google Earth Pro, the "app C7 GPS Data ", and for the elaboration of thematic and cadastral maps Qgis 2.16. The temporal analysis showed that between 2000 and 2010 in Paraíba, there was an increase in elderly women, aged 85 years or older, living in urban areas, living alone and not responsible for the household. It reduced illiteracy rates, with income of up to one minimum wage and in poverty. Relative to the functional state, the proportion of permanent, motor, visual and auditory deficiency increased. The analytical study showed that in the city of Pombal, the prevalence of fragility corresponded to 16.6%, while at risk of embrittlement it represented 43.0% and robust 40.4%. The factors associated with frailty were gender (0.0271), age range (<0.0001), marital status (0.0352), work (<0.0001), pension (0.0063), caregiver (<0, 0001), alcohol consumption (0.0001), health problems (<0.0001), drug treatment (<0.0001), respiratory diseases (0.0228), diabetes (0.0029), heart disease (<0.0001) and osteoarticular diseases (0.0005). In the regression, the variables: age, daily life activities, cognition, mood, mobility, caregiver of the elderly, osteoarticular diseases and dyslipidemia were positively associated with frailty. There was a significant association between fragility and MMSE, GDS-15 and TUG (<0.0001), Snellen Signal Test, for both the right eye (0.0157) and the left eye (0.0255) and the Whisper for right and left ear (˂0,0001). The spatial analysis allowed to know the distribution and concentration areas of the fragility, favoring the comparison of social vulnerability with the potential of health services, in order to support planning and management actions for the distribution of care units or of specific projects to visit those in need. The results point to the need for health interventions that favor good functional status, observing variables such as illiteracy, low income and disabilities, which contribute to the fragility of the elderly and need to be overcome. It is important, in the context of the fragility of the Paraíba hinterland, the evaluation of Functional Clinical Vulnerability applied in PHC, as a strategy for early detection of fragility that may contribute to interventions that minimize this condition and favor care interventions capable of guaranteeing autonomy and independence of the elderly. In this sense, the tools of geo-information technology are presented as potential to strengthen access to health services and better life and health conditions of the elderly, a fundamental aspect in a country context in a fast aging population, subsidizing care in the perspective of opportunism better quality of life.(AU)