PREVIEW NOTES

Evaluation of fragility and nursing interventions in the case of the elderly: a transversal study

Graciela Maria Carneiro Maciel¹, Rejane Maria Paiva de Menezes¹, Thaís Moreira dos Santos¹, Heloiza Talita Adriano da Silva¹, Maria Edjailma Silva Sousa¹, Gleyce Any Freire de Lima¹

¹Rio Grande do Norte Federal University

ABSTRACT
Introduction: Fragility is a multidimensional syndrome that involves biological, psychological and social factors. The risk to fragility in the elderly is associated with the state of vulnerability of these people leading to the development of incapacitating conditions, loss of autonomy, and functional dependency.
Aims: To evaluate and ascertain the nursing interventions for the elderly at risk of fragility; to identify the level of such patients by using Edmonton’s Frail Scale; to verify the association of the domains described in the Scale with the levels of fragility; to indicate the nursing interventions for the elderly at risk of fragility according to the Protocol of Interventions. 
Method: This is a transversal study, which adopts a quantitative approach.
Expected results: The indication of nursing interventions for the elderly at risk of fragility.
Implications to health: This present study will be a positive addition to gerontology clinical practice, in terms of avoiding or reducing the effect of fragility. 
Descriptors: Geriatric Nursing; Frail Elderly; Nursing Care.

PROBLEM SITUATION AND ITS MEANING

The prevalence of non-communicable diseases (NCD) and functional incapacities, together with the natural process of aging, makes the elderly more inclined to develop a frail condition. This is a syndrome that includes the biological, physical, cognitive, and social aspects throughout the life of the person⁽¹⁾.

Individuals who present three or more of the following characteristics are considered to be fragile: 1) non-intentional weight loss (5 kilograms in the last year); 2) self-reported fatigue; 3) reduced gripping force; 4) reduction in gait speed; and 5) reduced physical activity⁽²⁾. The nurse has an important role to play in preventing and promoting health, especially for a population that uses the Basic Health Units (BHU), one of the main gates to the Brazilian Unified Health System (SUS, in Portuguese). Hence, the evaluation of fragility of the elderly that have a preferential relationship with the BHU, enables the nurse to plan and perform nursing interventions, with the goal of preventing and reducing NCDs, and the accompanying incapacities, besides motivating the habit of self-care, the autonomous role of the elder, and his independence⁽³⁾.  Based on this, the importance of the evaluation of fragility and of the work of the nurse in a preventive role will be understood.

GUIDING QUESTIONS

What is the level of fragility of the elderly in terms of the application of Edmonton’s Frail Scale? What is the association of the domains of the Scale with the levels of fragility? What are the nursing interventions for the elderly at risk of fragility?

AIMS

General
To evaluate and indicate nursing interventions for the the elderly at risk of fragility.

Specific
To identify the level of fragility from the application of Edmonton’s Frail Scale;
To verify the association of the domains of the Scale with levels of fragility;
To indicate the nursing interventions for the elderly at risk of fragility according to the Protocol of Interventions.

METHOD

This is transversal study, which will adopt a quantitative approach. The research will be performed in three Family Health Units (FHU) located in the municipality of Natal, Brazil. The sample will be convenient, composed of the number of the elderly that use the services of the FHU during the months of April to July 2014. The defined criteria for inclusion are people who are 60 years old or more, who are registered and who frequently use the services of the chosen FHU. As a criterion of exclusion, people who suffer acute cognitive and sensorial deficits that compromise the communication between the researcher and the interviewee are excluded.

Two instruments will be used to collect the information:  one deals with the socio-demographic and health aspects of the interviewees, and the other is Edmonton’s Frail Scale. This last is composed of nine domains which evaluate cognition, general health state, functional independence, social support, use of medication, nutrition, humor, continence, and functional performance of the elderly individual. To analyze the data, simple and inferential descriptive statistics, with the support of suitable software, will be used. The nursing interventions will be indicated according to the most prevalent and meaningful data collected, based on each domain of Edmonton’s Frail Scale, as described by the protocol of interventions already built in a doctoral thesis⁽³⁾. The protocol is an instrument composed of 26 interventions as described by the Nursing Interventions Classification (NIC), destined to the nurses of FHU to be used in the elderly under risk of frailty.

This study was approved by the Committee of Ethics in Research of Rio Grande do Norte Federal University, under protocol #562.327, according to the Brazilian National Health Council Resolution 466/2012.

REFERENCES

1. Fabrício-Wehbe SCC, Schiaveto FV, Vendrusculo TRP, Haas VJ, Dantas RAS, Rodrigues RAP. Cross-Cultural Adaptation and Validity of the “Edmonton Frail Scale – EFS” In a Brazilian Elderly Sample. Rev Latino-Am Enfermagem. [ Internet ]. 2009 [ cited 2014 Ago 13 ] 17(6). Avaibable from: http://www.scielo.br/pdf/rlae/v17n6/18.pdf

2. Fabrício-Wehbe SCC, Cruz IR, Haas VJ, Diniz MA, Dantas RAS, Rodrigues RAP. Reproducibility of the Brazilian version of the Edmonton Frail Scale for elderly living in the community. Rev Latino-Am Enfermagem. [ Internet ]. 2013 [ cited 2014 Jun 3 ] 21(6). Avaibable from: http://www.scielo.br/pdf/rlae/v21n6/0104-1169-rlae-0104-1169-2933-2371.pdf

3. Bessa MEP. Elaboração e Validação de Conteúdo do Protocolo de Intervenções de Enfermagem para Idosos com Risco Fragilidade [ Thesis ]. Fortaleza: Universidade Federal do Ceará, Programa de Pós-Graduação em Enfermagem da Faculdade de Farmácia, Odontologia e Enfermagem; 2012.

All authors participated in the phases of this publication in one or more of the following steps, in According to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the versión submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf

Received: 08/05/2014
Revised: 08/26/2014
Approved: 08/26/2014