Associação entre fragilidade cognitiva e motora e o risco de quedas em idosos institucionalizados na cidade de Colombo

Abstract

Introduction: Falls among older adults represent an important public health issue, particularly in the context of long-term care facilities, due to their high incidence and the physical, functional, psychological, and financial repercussions they entail. In institutionalized residents, falls are associated with increased morbidity and mortality rates, greater functional dependence, and frequent use of health services. Several factors have been identified as determinants of falls, including cognitive and motor frailty, reduced muscle strength, and postural balance impairments. Despite research in this area, limitations remain regarding standardized indicators and practical instruments adapted to the specificities of this context, which hinder the early identification of older adults at higher risk. Objective: To analyze the association between the degree of cognitive and motor frailty and the risk of falls in institutionalized older adults. Methods: This study employed a quantitative approach and is characterized as descriptive and correlational. A total of 43 older adults, men and women aged 60 years or older, residing in long-term care facilities in the municipality of Colombo, participated. Sociodemographic and clinical data were collected to characterize the sample. Motor frailty was assessed through tests of strength, balance, and functionality. Handgrip strength was measured using a manual dynamometer. Balance was assessed using the Tinetti test and the Short Physical Performance Battery (SPPB). Functional autonomy in basic activities of daily living was measured using the Katz Index, while cognitive frailty was assessed through the Mini-Mental State Examination (MMSE). In the statistical analysis, descriptive analyses were performed, as well as the application of the Mann-Whitney U test for independent samples and Spearman’s correlation. Results: Older adults with a history of falls showed poorer performance on the Tinetti test and lower handgrip strength compared to those without falls (p < 0.05). The Tinetti test and handgrip strength both demonstrated a significant negative correlation with the occurrence of falls (rs = -0.327; p < 0.05). Although moderate (r = -0.435 to -0.566), the Katz scale was the instrument that showed correlations with most of the other measures. Nevertheless, it was not able to distinguish participants who experienced falls from those who did not. No significant associations were observed between falls and MMSE scores, SPPB, or the Katz Index. Conclusion: Motor frailty was associated with the risk of falls in institutionalized older adults, especially through handgrip strength and performance on the Tinetti test. In contrast, cognitive frailty did not show a direct association with the occurrence of falls in this sample. Among the physical performance instruments evaluated, the Tinetti test demonstrated greater ability to discriminate older adults with a history of falls compared to the SPPB, suggesting higher applicability for fall risk screening in this population. Thus, handgrip strength and the Tinetti test proved to be promising tools for identifying institutionalized older adults at greater vulnerability to falls.