Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia

@#Objective: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians. Methods: Tis cross-sectional study was conducted July–August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. Tey responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk. Results: In the year immediately preceding the study, 29.0% of participants had sufered a fall. Approximately one-third of women (31.1%) and one-ffth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. Te overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratifed analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting. Conclusion: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identifed for the population overall and for specifc populations in the home care and community setting that could help in designing fall-prevention strategies.

Calidad de la asistencia social en ancianos solos con atención domiciliaria / Quality of the social care in old men living alone under home care

Introducción: La calidad de la atención geriátrica en Cuba constituye una realidad impostergable. Objetivo: Evaluar la calidad de la asistencia social de salud en ancianos solos con atención domiciliaria. Método: Se realizó una investigación cualitativa, que incluyó a 4 838 ancianos, controlados por los departamentos de Trabajo Social del municipio de Santiago de Cuba, desde enero hasta diciembre del 2015, para lo cual se efectuó un muestreo por conglomerados bietápico, constituido por 387 gerontes. Se utilizó la metodología de la Escuela Nacional de Salud Pública de Cuba para evaluar las dimensiones: estructura, proceso y resultados. Resultados: Se encontró inadecuado el indicador recursos humanos y materiales. En el proceso resultaron adecuados la confección de la historia social y los registros administrativos. Conclusiones: La calidad de la asistencia social en ancianos solos con atención domiciliaria resultó inadecuada en los componentes estructura, proceso y resultados.

Introduction: The quality of geriatric care in Cuba constitutes an inevitable reality. Objective: To evaluate the quality of health social care in geriatric patients living under home care. Method: A qualitative investigation that included 4 838 old men, controlled by the departments of Social Work of Santiago de Cuba municipality was carried out from January to December, 2015, for which a sample through two-stage conglomerate constituted by 387 aged persons was made. The Cuban National School of Public Health methodology was used to evaluate the dimensions: structure, procedure and results. Results: The indicator human resources and materials resulted inadequate. Making the social history and the administrative registrations were appropriate. Conclusions: The quality of the social care in elderly living alone under home care was inadequate in the components structure, procedure and results.

Atenção ao idoso com demência: as ações dos terapeutas ocupacionais inseridos nas instituições de longa permanência de Curitiba­Paraná, Brasil / Atención para personas mayores con demencia: las acciones de los terapeutas ocupacionales insertados en hogares para ancianos de Curitiba-Paraná, Brasil / Attention to older adults with dementia: the actions of the occupational therapists placed in long-term care institutions of Curitiba-Paraná, Brazil

O objetivo desse estudo era compreender o processo de trabalho de terapeutas ocupacionais brasileiros que atuam em instituições de longa permanência, no município de Curitiba, Paraná - Brasil, junto à clientela de idosos com demência. Foi realizado um estudo descritivo transversal, com profissionais que atuam há mais de seis meses nestes estabelecimentos. A coleta de dados foi realizada por meio de um questionário on-line, para identificação do perfil profissional, demandas dos idosos, ações avaliativas e interventivas. Verificou-se que os idosos atendidos são, em sua maioria, do gênero feminino e com o diagnóstico de doença de Alzheimer. As avaliações mais utilizadas foram o Mini Exame do Estado Mental e o Montreal Cognitive Assessment, e as intervenções mais citadas foram as atividades expressivas, artesanais, recreativas e de lazer. Destacam-se também as inúmeras intervenções cognitivas. Como resultado, foram apontadas melhorias nas funções cognitivas, principalmente nos aspectos da atenção, orientação temporal e iniciativa, além de diminuição da apatia, melhora na autoestima, participação e interação social. No entanto, muitas intervenções identificadas na pesquisa ainda possuem modestas ou baixas evidências científicas e esses estudos precisam ser aprofundados. Na atenção aos cuidadores, poucas ações são realizadas. Conclui-se que, neste estudo, a atuação do terapeuta ocupacional mostrou seguir uma linha singular de atuação, com repercussões que apontam para melhorias nos aspectos cognitivos e comportamentais e/ou melhor desempenho ocupacional do idoso demenciado.

El objetivo de este estudio fue comprender el proceso de trabajo de los terapeutas ocupacionales brasileños que actúan en instituciones de larga permanencia, en el municipio de Curitiba, Paraná - Brasil, junto a la clientela de ancianos con demencia. Se realizó un estudio descriptivo transversal, con profesionales que actúan desde hace más de seis meses en estos establecimientos. La recolección de datos fue realizada por medio de un cuestionario on-line, para identificación del perfil profesional, demandas de los ancianos, acciones evaluativas e intervencionistas. Se verificó que los ancianos atendidos son, en su mayoría, del género femenino y con el diagnóstico de enfermedad de Alzheimer. La evaluación más utilizada fue el Mini Examen del Estado Mental y la Montreal Cognitive Assessment, y las intervenciones más citadas fueron las actividades expresivas, artesanales, recreativas y de entretenimiento. Se destacan también las innumerables intervenciones cognitivas. Como resultado, se señalaron mejoras en las funciones cognitivas, principalmente en los aspectos de la atención, orientación temporal e iniciativa, además de disminución de la apatía, mejora en la autoestima, participación e interacción social. Sin embargo, muchas intervenciones identificadas en la investigación todavía tienen modestas o bajas evidencias científicas y estos estudios necesitan ser profundizados. Se concluye que, en este estudio, la actuación del terapeuta ocupacional reveló seguir una línea singular de actuación, con resultados que apuntan hacia el mejor desempeño ocupacional del anciano demenciado o para mejoras en los aspectos cognitivos y comportamentales.

The aim of this study was to understand the work process of Brazilian occupational therapists who work in long-term care institutions in the city of Curitiba, Paraná - Brazil, with elderly people with dementia. A cross - sectional descriptive study was carried out, with professionals who have been working for more than six months in these institutions. Data collection was by means of an online questionnaire, to identify the professional profile, demands of the elderly, assessment and intervention actions. It was verified that the elderly patients are mostly female and diagnosed with Alzheimer's disease. The most used assessment was the Mini Mental State Examination and the Montreal Cognitive Assessment, and the most cited interventions were expressive, artisan, recreational and leisure activities. Also the numerous cognitive interventions are highlighted. As a result, improvements in cognitive functions were pointed out, especially in aspects of attention, temporal orientation and initiative, as well as a decrease in apathy, improvement in self-esteem, participation and social interaction. However, many interventions identified in the research still have modest or low scientific evidence and these studies need to be further developed. In caring for caregivers, few actions are taken. It is concluded that, in this study, the occupational therapist's performance showed a unique line of action, with repercussions that point to the better occupational performance of the deferred elderly or to improvements in cognitive and behavioral aspects.

Actividades recreativas en adultos mayores internos en un hogar de ancianos / Recreational activities for institutionalized older adults at an elderly home

Introducción: la recreación para mejorar la calidad de vida en las personas de la tercera edad ofrece al anciano un buen uso del tiempo libre. Objetivo: valorar la realización de actividades recreativas en un hogar geriátrico, las preferidas y razones para ello. Métodos: estudio cualitativo y correlacional realizado en adultos mayores internos en el hogar Santa Marta en la ciudad de Mendoza, Argentina, durante los meses de agosto y septiembre de 2013. El universo lo constituían 105 adultos y la muestra quedó conformada por 99 que aceptaron participar. Se aplicó un cuestionario y entrevista individual y las pruebas de Pearson y de Fisher para analizar las actividades recreativas en relación con la edad, el sexo y el tiempo de estadía en la institución. Resultados: se realizaban actividades recreativas que se clasificaron en intramuros y extramuros. Estas últimas, que se concretaban los fines de semana y coincidían con las visitas familiares, fueron las preferidas, especialmente entre aquellos con menor tiempo de estadía en la institución. Conclusiones: las actividades recreativas internas y externas se realizan en la institución con la colaboración de especialistas y voluntarios según una estrategia adecuada y optimizada. La preferencia de los adultos mayores por las actividades externas se apoya en su necesidad de interactuar y socializar con sus familiares y otros ancianos, lo que los aleja de experimentar estados vivenciales negativos. Es importante prever la inclusión de los ancianos con más tiempo de estadía en las actividades recreativas externas y estimular la concurrencia de los familiares con periodicidad(AU)

Introduction: recreation for the improvement of the quality of life of the older people offers them a good use of their leisure time. Objective: to assess the celebration of recreational activities at an elderly home, the favorite activities and the reasons for it. Methods: correlational qualitative study conducted in institutionalized older adults at Santa Marta home for the elderly located in Mendoza, Argentina from August to September, 2013. The universe of study was 105 older adults and the final sample was 99 who accepted to participate. Data were collected from survey, individual interview and Pearson's and Fisher's test for the analysis of recreational variants. Results: outdoor activities carried out on weekend were the favorite; since they were held during the family visits, particularly by those older people who had not been for long at the institution. Conclusions: the recreational activities take place at the institution with the cooperation of professors, specialists and voluntaries pursuant to an adequate optimized strategy. The elderly prefer the outdoor activities because they need to interact and socialize with their relatives and with other aged persons, which do not let them feel negative experiences. It is important to include those elderly people who have been longer at the home in these outdoor recreational activities and to encourage the systematic participation of the families(AU)

Idosos e seus fazeres na Instituição de Longa Permanência / Seniors and their activities in the Long Term Institution

Este artigo fala dos resultados de em um estudo feito numa instituição de longa permanência partindo de sua realidade cotidiana, ao verificar de que maneira esta pode interferir no fazer de seus residentes. Foi possível diagnosticar os empecilhos que entravam o trabalho com atividades nessas instituições, empurrando os residentes ao não fazer, a uma "ociosidade" aparente. Um (re)pensar sobre o idoso institucionalizado e o seu fazer.

This articule discusses the results of a study done in a long term institution based on their everyday reality, to see how that can influence the making of its residents. It was possible to diagnose the obstacles which hinder the work with activities in these contexts, leading the residents to not doing anything, to an apparent "idleness". It is a rethinking about the elderly residential home and their activity level.