Relação entre massa muscular e função física como indicadores de risco de quedas em idosos ambulatoriais de unidades básicas de saúde

Abstract

Introduction: Falls in older people are considered a significant public health problem due to their high prevalence and the severity of their biopsychosocial impacts. Among the main risk factors for falls are factors related to muscular health. However, correlational evidence between muscle mass and physical performance in older adults at risk of falls is inconsistent. Furthermore, there needs to be a consensus on the most appropriate approach with the most significant predictive value to identify individuals with muscle weakness and risk of falls. Objective: To analyze independent and combined associations between different components of lean mass and measures of physical function on the risk of falling in outpatient older adults. Methods: The research uses a quantitative approach characterized as descriptive and correlational. Sixty-six older people participated, men and women aged 60 or over, living independently in the community and registered in the Basic Health Centers. Sociodemographic and health status data were obtained to characterize the sample, and the Clinical-Functional Vulnerability Index (IVCF-20) was applied to identify the level of frailty. To analyze body composition, DXA was performed, and the measurements included total lean mass, appendicular lean mass adjusted for height, appendicular lean mass adjusted for BMI, and lean mass of the lower limbs. Physical function was assessed using the Short Physical Performance Battery, handgrip strength, and chair sit-stand test (5x). Fall risk screening was performed by analyzing gait speed (<0.8 m/s). The statistical analysis used descriptive analysis, the Mann-Whitney U test for independent samples, the Spemann Correlation, and binary logistic regression analysis to obtain the odds ratio (OR). Results: The group at risk of falls had lower muscle mass values and worse physical performance. However, the measurements that demonstrated a statistically significant difference were HGS (p=0.001), lower limb muscle mass (p=0.025), ALM/H² (p=0.047), and SPPB (p=0.000). When analyzing the combined variables, HGS moderately correlated with all muscle mass measurements. However, no measure of muscle mass has been able to predict falls alone. Better performance on the SPPB corresponded to a 76% lower chance of falls; for individuals with better HGS, the chance of falls was 18.6% lower. Conclusion: In this study, HGS and SPPB were protective factors against falls. Therefore, it is suggested that measures based on physical performance be used to identify older people in the community at risk of falls. Furthermore, a combined approach of lean mass variables and handgrip strength may be more effective than the isolated assessment of lean mass in predicting the risk of falls.