Impacto da capacidade funcional e síndrome de fragilidade na mortalidade de idosos internados em Unidade de Terapia Intensiva: estudo prospectivo

• Ano de defesa: 2022
• Autor(a) principal: Ricci, Tainá Gabriela
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Estadual Paulista (Unesp)
• Palavras-chave em Português: Elderly; Fragility; Functionality; Intensive care unit; Unidades de terapia intensiva; Idosos; Mortalidade; Fragilidade; Pacientes internados
• Link de acesso: http://hdl.handle.net/11449/239262

Introduction: In Brazil we have 32.3 million elderly people in 2022, corresponding to 15.1% of the population. Aging promotes loss of physiological reserves and an increase in diseases, which can lead to loss of functional capacity and frailty syndrome. These conditions need to be assessed in hospitalized elderly people, as dependent and frail individuals may have worse outcomes. Objectives: To evaluate the association between the degree of severity, frailty and functional capacity of elderly people admitted to the Intensive Care Unit of the HCFMB and the outcomes presented after 180 days of hospital discharge. Materials and methods: It is a prospective observational study, carried out at HCFMB. Elderly patients admitted to the Intensive Care Units (ICU) of the HCFMB were included, and sociodemographic and clinical assessments, SOFA severity score, functionality by the Katz Index and frailty by the FRAIL Index were performed. Follow-up was carried out during the entire stay in the ICU and in the HCFMB, after 30 days and 180 days after hospital discharge, evaluating the outcomes (length of stay, post-discharge readmission and mortality) and reassessing functionality and frailty. Results: From January to November 2021, 153 elderly people with a mean age of 70.6 (± 7.2) years were evaluated. The number of diseases reported before hospitalization averaged 3.4 (± 1.9), the most prevalent being SAH (70.6%). The length of hospital stay was 19.0 (± 14.2) days, and for ICU stay 14.5 (± 12.6) days. 53.6% of individuals died in the hospital environment. In the period of 30 days after discharge, the total number of deaths was 54.2% and after 180 days, the total number of deaths was 60.1%. The SOFA had an average of 6.8 (± 5.0) points. 76.3% of participants had a score equal to or greater than 2. Dependent patients (score <4) totaled 8.5%. After 30 days, 22.7% were dependent and at 180 days, 18.7%. On admission, robust patients represented 26.1%, at 30 days 13.8% and 180 days 27.1%. Patients with SOFA >2 had longer ICU and hospital stays. In the association of functional capacity and frailty, an association was observed. An association was observed between SOFA score >2 and death within 180 days. In the bivariate analyses, an association was observed between SOFA >2, hospitalization for medical reasons and hospitalization for COVID-19 with mortality (p<0.05). In the multivariate analyses, SOFA > 2, hospitalization for medical reasons, hospitalization for COVID 19, and length of stay in the ICU and hospital were associated with the death event. Conclusion: A SOFA score > 2, reason for clinical and COVID-19 hospitalization, length of hospital and ICU stay were associated with mortality in this study.