Implantación de una unidad de prevención de caídas y fracturas en un área sanitaria

Résumé

Introduction: Falls syndrome has multiple aetiology and it is highly prevalent in the elderly, impairing their functional capacity. The annual incidence rate is 25% in patients aged 65-75, and it is increased to 45% in cases aged older than 75. Prevention Falls and Fractures Units are the resources in charge of the multidisciplinary evaluation and intervention in subjects with the highest signs of falling risk. Methodology: The study was conducted in two levels. Level 1: Quasi-experimental study with educational intervention for medical assistants and further impact on the population evaluation. In this level, intervention was done in three Primary Care Centers (PCC) and in three Nursing Homes (NH). Level 2: Quasi-experimental study with multidisciplinary intervention in frailty patients with high risk of falling referred by the medical specialists from PCCs and NHs. In this level, clinical and analytical parameters associated with physical and mental functionality were studied. Results: From the 149 patients referred to the prevention falls and fracture unit, 86 were eligible for the study. The average age was 85 years and the percentage of females was higher. All the patients were invited to participate in a group and guided multicomponent exercise intervention as part of the multidisciplinary intervention. The 59 cases that completed the training experienced an improvement both in physical and mental capability, with decreased risk of falling and subsequent less necessity to be taken care in the emergency rooms. After finishing this exercise, physical exercise was individually prescribed to all of them. After three months, 41 out of 59 patients have followed the prescription. After six months, 34 out of 59 still were adhered to the prescription. Patients adhered to the prescribed exercise endure the improved physical and mental capacity with the reduced risk of falling. Nevertheless, patients that interrupted the prescribed exercise lost the improvement achieved. Regardless the communal intervention, proximal femur fractures were reduced in PCCs of intervention, whereas in PCCs where the intervention was not realised, the fractures increased. Importantly, falls were reduced in NHs of intervention. Conclusion: The establishment of prevention falls and fractures units developing interventions like the one described in this work would allow the improvement of mental and physical functionality in the elderly. Moreover, the risk of falling and fractures would be decreased. Further research is needed to confirm the results regarding the incidence in proximal femur fractures after intervention