FATORES EXTRÍNSECOS PARA RISCO DE QUEDAS DE IDOSOS HOSPITALIZADOS EXTRINSIC FACTORS FOR THE RISK OF FALLS IN HOSPITALIZED ELDERLY

Objective: to identify the extrinsic factors favorable to the occurrence of falls in hospitalized elderly patients. Method: quantitative, documental, retrospective and descriptive study carried out from the collection of records in the admission and discharge book of the patients hospitalized in the unit of surgical clinic of a University Hospital. The sample consisted of 424 elderly hospitalized from January to December 2015. The data were entered in Excel and analyzed in the SPSS Program, version 2.0., And the results, presented in tables. Results: the profile of the elderly showed a majority of females 227 (54%), mean age 71.6 years, with higher admission numbers in February 55 (13%), mean time of 4.8 days and motive of exit 351 (83%) due to hospital discharge. Eight (62%) wards were considered safe environments, although four (31%) wards had excess furniture. Conclusion: knowing the profile of the elderly and the extrinsic factors will enable health professionals to identify the risks and provide safe care for the elderly. Descriptors: Aged; Hospitalizacion; Accidental Falls; Nursing Care; Aging; Risk Factors, RESUMEN Objetivo: identificar los factores extrínsecos favorables a la ocurrencia de caídas de pacientes ancianos hospitalizados. Método: estudio cuantitativo, documental, retrospectivo y descriptivo realizado a partir de la recolección de registros en el libro de admisión y alta de los pacientes internados en la unidad de clínica quirúrgica de un Hospital Universitario. La muestra se reunió 424 ancianos internados en el período de enero a diciembre de 2015. Los datos fueron digitados en Excel y analizados en el Programa SPSS, versión 2.0, y los resultados, presentados en tablas. Resultados: el perfil de los ancianos mostró la mayoría para el sexo femenino 227 (54%), una media de edad 71,6 años, con mayores números de internamiento en febrero 55 (13%), y media de tiempo de 4,8 días y motivo de la salida 351 (83%) por alta hospitalaria. Se consideraron ocho (62%) enfermeras como ambientes seguros, aunque cuatro (31%) de las enfermerías tenían exceso de muebles. Conclusión: conocer el perfil de los ancianos y los factores extrínsecos, posibilitar, a los profesionales de salud, identificar los riesgos y proveer la asistencia segura al anciano. Descriptores: Anciano; Hospitalizaciòn; Accidentes por Caídas; Atencion de Enfermarìa; Envejecimiento; Factores de Riesgo. Doutora, Universidade Federal da Paraíba/UFPB. João Pessoa (PB), Brasil. E-mail: jacirasantosoliveira@gmail.com ORCID iD: https://orcid.org/0000-0002-3863-3917; Doutoranda em Enfermagem, Universidade Federal da Paraíba/UFPB. João Pessoa (PB), Brasil. E-mail: mayara_muniz_@hotmail.com ORCID iD: https://orcid.org/0000-0002-0578-8146; Mestranda em Enfermagem, Universidade Federal da Paraíba/UFPB. João Pessoa (PB), Brasil. E-mail: renata_maia@hotmail.com ORCID iD: https://orcid.org/0000-0001-7595-2573; Especialista em Enfermagem do Trabalho, Hospital Universitário Lauro Wanderley. João Pessoa (PB), Brasil. E-mail: barbichaves@hotmail.com ORCID iD: https://orcid.org/0000-0003-2555-6593; Especialista em Saúde Coletiva, Hospital Universitário Lauro Wanderley. João Pessoa (PB), Brasil. E-mail: suzannajpb@gmail.com ORCID iD: https://orcid.org/0000-0002-2601-932X; Graduanda em Medicina, Universidade Federal da Paraíba/UFPB. João Pessoa (PB), Brasil. E-mail: amanda_motiva@hotmail.com ORCID iD: https://orcid.org/0000-0001-7572-7982; Especialisata em Urgência e Emergência, Hospital Universitário Lauro Wanderley. João Pessoa (PB), Brasil. E-mail: emanuellaabrantes@mns.com ORCID iD: http://orcid.org/0000-0002-1700-7079; Especialista em Saúde Pública, Hospital Universitário Lauro Wanderley. João Pessoa (PB), Brasil. E-mail: suzcris@hotmail.com ORCID iD: http://orcid.org/0000-00018195-4321 ARTIGO ORIGINAL Oliveira JS, Diniz MMP, Falcão RMM et al. Fatores extrínsecos para risco de quedas... Português/Inglês Rev enferm UFPE on line., Recife, 12(7):1835-40, jul., 2018 1836 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i7a231271p1835-1840-2018 O envelhecimento da população é um fenômeno na sociedade mundial e vem tomando proporções significativas especialmente nos países em desenvolvimento. Percebe-se que, desde 1940, as taxas de mortalidade têm diminuído, em especial, entre as pessoas mais jovens. Assim, a expectativa de vida passou de 50 para 73 anos refletindo no aumento da população idosa. Estima-se que 25% da população seja composta de idosos em 2050. De acordo com dados do Instituto Brasileiro de Geografia e Estatística, o IBGE, em 2012, o Brasil tinha 21 milhões de pessoas com idade igual ou superior a 60 anos. A Organização Mundial da Saúde, a OMS, estima que o país seja o sexto em número de idosos em 2025 quando deve chegar a 32 milhões de pessoas nessa faixa etária. O Sistema de Informações Hospitalares do SUS do Ministério da Saúde (SIH/SUS) mostra que, de janeiro de 2011 a janeiro de 2012, no município do Rio de janeiro, o índice de internação de idosos caracterizou-se por estar em torno de 12 mil a quase 14 mil internações por mês. Ainda pelo Sistema de Informações Hospitalares, em 2013, foram registradas 11.197.160 internações hospitalares no SUS das quais 23,4% correspondem a internações de idosos. Essas são mais incidentes entre os homens na faixa etária entre 60 e 79 anos com uma maior incidência para as mulheres a partir de 80 anos. As quedas podem ocasionar diferentes consequências, desde lesões leves, até fraturas e morte, e causam impacto nas instituições de saúde ao aumentar o uso de recursos pessoais e materiais devido aos atendimentos médicos e de Enfermagem. Dessa forma, as quedas são consideradas a lesão de maior custo entre os idosos. Entre as principais causas de morbidade e mortalidade na população idosa encontram-se as quedas. Aproximadamente 30% das pessoas com mais de 65 anos e metade das com mais de 80 anos sofrem uma queda a cada ano. Em estudo realizado no Brasil, de 1996 a 2005, as mortes por causas externas levaram a óbito 41.054 idosos. Dessas, 9.249 (22,5%) foram codificadas como quedas. A etiologia das quedas pode ser variada. Os fatores podem estar relacionados à pessoa, como o uso de fármacos, o medo de cair, distúrbios na caminhada, redução das atividades da vida diária ou a fatores relacionados ao ambiente como tapetes soltos, diferenças de nível e pisos escorregadiços. Acredita-se ser essencial também identificar os fatores de risco extrínsecos de quedas em pacientes idosos com a finalidade de reconhecer precocemente os riscos existentes e, de imediato, eliminá-los ou diminuí-los utilizando medidas adequadas para a prevenção do incidente. Logo, a relevância deste estudo está na contribuição para a eficiência na qualidade de atendimento e o conforto ao paciente idoso hospitalizado.  Identificar os fatores extrínsecos favoráveis à ocorrência de quedas de pacientes idosos hospitalizados. Estudo quantitativo, documental, retrospectivo e descritivo realizado na unidade de clínica cirúrgica de um Hospital Universitário no Estado da Paraíba, região Nordeste do Brasil. A clínica cirúrgica funciona com 13 enfermarias e, pelo menos, 37 leitos ativos, sendo uma para pacientes com necessidade de isolamento. Alguns dados foram resgatados por meio do livro de registro de admissão e alta da unidade, no período de janeiro a dezembro de 2015, assim como a posterior avaliação, por parte dos pesquisadores, das condições ambientais para o risco de quedas encontradas nas referidas enfermarias. O universo foi constituído por todas as pessoas, com 60 anos ou mais, admitidas na clínica cirúrgica, independente da motivação, no ano referido. Para isso, foram fatores de inclusão na amostra: ter idade igual ou superior a 60 anos, de ambos o sexo e ser admitido no período antes mencionado. Foram excluídos os pacientes com idade menor que 60 anos. Para a coleta de dados, elaborou-se um instrumento para facilitar a busca dos dados contendo as informações dos idosos (idade, sexo, data da admissão e alta, motivo da saída) e outros dados envolvendo as condições relevantes para a prevenção de risco de quedas para idosos hospitalizados tais como: o uso de material antiderrapante; o piso seco (no momento da coleta de dados); barras de segurança nos boxes dos banheiros; grades nas camas; iluminação e móveis em distribuição adequada. Para a análise da pesquisa, as informações foram digitadas no Excel e, posteriormente, no Programa SPSS, versão 2.0, para a configuração dos dados, que tiveram as apresentações ilustradas em tabelas. MÉTODO OBJETIVO INTRODUÇÃO Oliveira JS, Diniz MMP, Falcão RMM et al. Fatores extrínsecos para risco de quedas... Português/Inglês Rev enferm UFPE on line., Recife, 12(7):1835-40, jul., 2018 1837 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i7a231271p1835-1840-2018 Este estudo obedeceu à Resolução 466/2012 do Conselho Nacional de Saúde (BRASIL, 2012) e foi aprovado pelo Comitê de Ética em Pesquisa com o CAAE 4574615.0.0000.5183. Os participantes do estudo foram 424 idosos internados na unidade de clínica cirúrgica do Hospital Universitário no ano de 2015. Desses, 227 (54%) eram do sexo feminino e 197 (46%), do masculino. No que se refere à faixa etária, os idosos tinham entre 60 e 103 anos de idade, com prevalência de idade na faixa etária de 65 a 69 anos (122=29%), como apresentado na tabela 1. Tabela 1. Distribuição dos idosos internados em unidade de clínica cirúrgica de Hospital Universitário de acordo com faixa etária. João Pessoa (PB), Brasil, 2016. Faixa Etária n % 60 a 64 anos 120 28 65 a 69 anos 122 29 70 a 74 anos 72 17 75 a 79 anos 53 13 80 a 84 anos 31 7 85 a 89 anos 18 4 90 a 94 anos 7 2 95 a 99 anos 0 0 100 anos ou mais 1 0 Total 424 100 Quanto aos meses de internação, observouse que janeiro e fevereiro lideram o quantitativo de idosos internados na unidade de clínica cirúrgica com 53 (12%) e 55 (13%) internos, respectivamente. Os meses de agosto (16=4%) e setembro (19=4%) obtiveram os menores números d

English/Portuguese J Nurs UFPE online., Recife, 12 (7):1835-40, July., 2018  1836  Population aging is a phenomenon in world society and has been taking on significant proportions, especially in developing countries.It has been noted that, since 1940, mortality rates have declined, especially among younger people.2] It is estimated that 25% of the population is composed of the elderly in 2050. 3ccording to data from the Brazilian Institute of Geography and Statistics, IBGE, in 2012, Brazil had 21 million people aged 60 or over.The World Health Organization, WHO, estimates that the country is the sixth largest number of the elderly in 2025 when it is expected to reach 32 million people in this age group. 4he Hospital Information System of the UHS of the Ministry of Health (HIS / UHS) shows that, from January 2011 to January 2012, in the city of Rio de Janeiro, the rate of hospitalization of the elderly was characterized by being around 12 thousand to almost 14,000 admissions per month. 5lso in the Hospital Information System, in 2013, 11,197,160 hospital admissions were registered in the UHS, of which 23.4% corresponded to hospitalizations of the elderly.These are more incidents among men in the age group between 60 and 79 years with a higher incidence for women from 80 years. 6alls can have different consequences, from minor injuries to fractures and death, and impact health institutions by increasing the use of personal and material resources due to medical and nursing care.Thus, falls are considered the most costly injury among the elderly. 7mong the main causes of morbidity and mortality in the elderly population are falls.Approximately 30% of people over 65 and half of those over 80 suffer a fall each year.In a study conducted in Brazil, from 1996 to 2005, deaths from external causes led to death 41,054 elderly.Of these, 9,249 (22.5%) were coded as falls. 8he etiology of falls can be varied.Factors may be related to the person, such as drug use, fear of falling, walking disturbances, reduced activities of daily living or to environmental factors such as loose rugs, level differences and slippery floors. 9t is also believed to be essential to identify the extrinsic risk factors for falls in elderly patients in order to recognize the existing risks early and to immediately eliminate or reduce them using appropriate measures to prevent the incident.Therefore, the relevance of this study is the contribution to the efficiency in the quality of care and comfort to the hospitalized elderly patient.
 To identify the extrinsic factors favoring the occurrence of falls in hospitalized elderly patients.
Quantitative, documental, retrospective and descriptive study performed at the surgical clinic unit of a University Hospital in the State of Paraíba, Northeastern region of Brazil.The surgical clinic operates with 13 wards and at least 37 active beds, one for patients in need of isolation.
Some data was retrieved through the admission and discharge register of the unit, from January to December 2015, as well as the subsequent evaluation by the researchers of the environmental conditions for the risk of falls found in said wards.
The universe was constituted by all people, aged 60 and over, admitted to the surgical clinic, regardless of the motivation, in the referred year.For this purpose, inclusion factors were included in the sample: being 60 years of age or older, of both sexes and admitted to the aforementioned period.Patients younger than 60 years were excluded.
For data collection, an instrument was developed to facilitate the search of data containing the information of the elderly (age, sex, date of admission and discharge, reason for leaving) and other data involving the relevant conditions for the prevention of risk of falls for hospitalized elderly people such as: the use of non-slip material; dry floor (at the time of data collection); security bars in the bathrooms; crates in beds; lighting and furniture in proper distribution.For the analysis of the research, the information was entered in Excel and later in the SPSS Program, version 2.0, for the configuration of the data, which had the presentations shown in tables.
This As for the months of hospitalization, it was observed that January and February lead the number of elderly hospitalized in the surgical clinic unit with 53 (12%) and 55 (13%) internal, respectively.The months of August (16 = 4%) and September (19 = 4%) obtained the lowest numbers of hospitalizations, according to table 2. Regarding the hospitalization time of the hospitalized elderly, 381 (90%) occupied the beds from one to ten days; 28 (7%), from 11 to 20 days and 13 (3%) for more than 20 days.Two patients had no record of the date of exit.It was verified that the length of stay varied from one to 52 days of hospitalization, with a mean of 4.86 days and standard deviation 7,12.The majority of exits were due to discharge (351 = 83%), internal transfer (66 = 16%), death (5 = 1%) and two of them were not informed.
Regarding the extrinsic factors and environmental conditions, it was verified that 30% of the infirmaries had excess of furniture, as pointed out in table 3. The study demonstrated the predominance of the female sex in the elderly hospitalized in the clinic.The finding corroborates another, carried out with 103 elderly people from University Hospital in Pará, showing that 73.7% of hospitalizations were from women.This fact can be explained by countless researches that affirm that the female population is the most susceptible to the development of comorbidities, as well as the very fragility to which sex is related. 10n addition, women are more prone to cardiovascular disease from menopause, indicating a restricted relationship between blood pressure and female hormones, which increases the predisposition to the occurrence of pathologies. 11Another interesting factor may be related to the greater longevity of women who, with the predominance of the greater cognitive deficit, end up needing more health care than men. 12he predominant age range between 65 and 69 years corroborates studies that are the most common balance alterations in the elderly over 65 years of age, and this prevalence can reach 85% in this population. 11till on these data, approximately 30% of the elderly population, increasing to 40% in those older than eighty years,  tended to decrease the efficiency of sensory systems (vestibular, visual, somatosensory). Thisalteration, associated to the lack of capacity to select sensory information of great importance, may be responsible for the increase of the body oscillation and of imbalances in the elderly contributing to the occurrence of falls.6 Thus, the predominant age group indicates the constant risk of falls to which the elderly were exposed during the hospitalization process in the referred clinic.Although the increase in age reflects the number of hospitalizations, showing a downward trend, this information can not be mischaracterized and, rather, used as an alert for the need for preventive measures in this regard.
As for the months of hospitalization, the month of January and February were much more than the others leading the occupations of the beds.On the other hand, August and September were the lowest numbers of hospitalizations.
The hospitalization time of the elderly varied, for the most part, from one to ten days, presenting an average of 4.68 days.This result disagrees with a study carried out in a large university hospital in the South of Brazil, in 2011, in which the majority of hospitalizations lasted from ten to 24 days, for a median time of 20 days.This number represents a fairly high average for a clinical and surgical unit. 13Hospital discharges accounted for 82% of reasons for exits.
Associated with the profile found of hospitalized elderly, the environmental characteristics became relevant to complement this study.Although the study clinic does not have an instrument for registering falls in the environment, the environmental factors are in accordance with those cited in a study carried out in a University Hospital of Rio Grande do Sul, which proved to be slippery or wet floors, carpets scattered on the floor and Irregular floors Considerable factors for the occurrence of episodes. 14he environmental obstacles that may predispose the elderly to the occurrence of fall accidents are places where it is possible to locate scattered personal objects, wet ground or other physical obstacles characterizing the risk.There are also risks such as sitting or standing up from inappropriate places such as beds and chairs. 9egarding the non-slip material in the bathrooms, in 11 (85%) infirmaries he was absent.The absence of non-slip materials in the wards, associated with wet floors, indicates an increased risk of falls, since the existence of these devices can act as preventive measures.These obstacles, associated with elderly age or some pathology, may increase the risk of falls to hospitalized elderly people. 15ata from a study carried out at the University Hospital of Natal-RN indicate that the absence of anti-slip material in the shower is a conditioning factor for the

DISCUSSION
English/Portuguese J Nurs UFPE online., Recife, 12(7):1835-40, July., 2018 1839 occurrence of falls due to the conformation of the hospital environment, especially the infirmaries, where patients are the largest part of the time during hospitalization.When analyzing the protection offered in the bathrooms, it is pointed out that 11 (85%) wards of hospitalized elderly did not have security bars.Thus, the adoption of adaptations in the environment such as the installation of safety bars, adequate lighting and ventilation, the removal of objects that become obstacles during the elderly walk, the use of lower beds and side rails raised in the beds are very relevant actions for the protection of the hospitalized elderly. 17razilian research has shown great emphasis on physical environmental elements that may be related to falls in the elderly.Thus, these studies may support the adoption of fall prevention measures in this risk group, in order to promote the necessary safety, minimizing the risk of falls and their consequences. 18Thus, the presented results reinforce the need for continuous investigations on the risks of falls in the hospital environment, as well as the need for preventive measures.This is because, in the clinic researched, preventive measures are based on the observation and judgment of the professionals who watch it.
Although the difficulties of the study were unclear records in the admission books of the surgical clinic, it is expected that the research will foster the importance of nursing care as critical and transformative professionals, planning care with care for the elderly and promoting quality care.
Knowing the profile of hospitalizations of the elderly of the clinic studied, besides the extrinsic factors favorable to occurrences of falls, awakens to the need to intensify attention in preventive actions, with specificity in the hospital environment, thus contributing to the economy in public health.
Therefore, the results can favor actions in the environment such as adherence to the use of anti-skid utilities for floors, the adoption of lamps with presence sensors in the bathrooms, the improvement of lighting, the educational approach for the prevention of falls (with the elderly and companions), the training of care teams and the adoption of an instrument for the recording of falls and injuries, in order to prevent these types of accidents and to guarantee a harmless assistance.

Table 1 . Distribution of the elderly hospitalized in a surgical hospital unit of University Hospital, according to age group. João Pessoa (PB), Brazil, 2016.
study obeyed Resolution 466/2012 of the National Health Council (BRAZIL, 2012) and was approved by the Research Ethics Committee with CAAE 4574615.0.0000.5183.