Vol.5, No.12A, 49-57 (2013) Health
http://dx.doi.org/10.4236/health.2013.512A007
Falls and health-related quality of life (SF-36) in
elderly people—ISACAMP 2008
Iara Guimarães Rodrigues*, Margareth Guimarães Lima, Marilisa Berti de Azevedo Barros
Faculty of Medical Sciences, Department of Public Health, State University of Campinas, Campinas, Brazil;
*Corresponding Author: iaraguimar@gmail.com
Received 23 October 2013; revised 25 November 2013; accepted 2 December 2013
Copyright © 2013 Iara Guimarães Rodrigues et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Falls are accidental events and harmful to the
healthy elderly. Its consequence can lead to the
disability and the death. Accordingly, it becomes
important to assess the relation between falls
and quality of life. This theme is little studied in
Brazil and internationally, especially in areas
with large population bases. Objective: To iden-
tify the association between occurrence of fall
and health-related quality of life (HRQL) using
the SF-36 according to gender, age and school-
ing, among the elderly population of Campi-
nas/Brazil. Methods: A cross-sectional, popula-
tion-based study, using data from ISACAMP 2008.
The present study analyzed only the population
with 60 years old or more, totaling 1432 elderly
individuals. The dependent variables were the
eight SF-36 scale, version 2. The main inde-
pendent variables were the falls occurred in the
last 12 months and the limitation in activities
daily living due to the falls. Analysis were car-
ried out with the simple and multiple linear re-
gression model in order to determine the asso-
ciations between the dependent and main inde-
pendent variables, using svy commands of
STATA 11.0. Results: The prevalence of falls in
the last year was 6.3%. The elderly individuals
who referred to fall in the last 12 months exhib-
ited the lowest score in seven of eight SF-36
scales, comparing with non-fallers. The asso-
ciation between fall and HRQL was greater in the
male population. The elderly individuals who are
older (75 or more) and located in the lower
schooling stratum, and experienced falls also
exhibited the lowest SF-36 scale scores, in
physical and social functioning. Stratifying falls,
considering those who cause limitations and
those who do not, can be observed with the
lowest scores in physical functioning, role
physical, role emotion and social functioning,
and only in the stratum of people who have
limitations in daily living. Conclusion: The oc-
currence of falls can cause important limitations
in the elderly individuals, and the limitations are
associated with the worst health condition and
quality of life. It is important to consider that the
fragile elderly, especially in physical, social
functioning, with pain, and role physical, are
most vulnerable to experience falls, principally
those who cause limitation.
Keywords: Falls; Elderly; Quality of Life
1. INTRODUCTION
According to the projections from the WHO (World
Health Organization), the period from 1975 to 2025 will
be the ageing era. The elderly population in Brazil, fol-
lowing the worldwide population ageing trend, will grow
16 times. Thereby, the country will have the sixth elderly
largest population of the world in absolute terms [1], that
is, in the next decades a deep change will be generated in
the configuration of the Brazilian population.
The elderly are facing problems such as the con-
comitant ageing process and the increasing health prob-
lems, including the incidence of falls, which can cause
declines in mental and social health of the elderly, serious
injury, functional disability, dependence for carrying out
usual activities, hospitalization and death [2].
The fall is an accidental event, which occurs due to the
loss of postural balance, probably due to the sudden fail-
ure of neural and osteoarticular mechanisms involved in
the maintenance of posture [3]. Researches have revealed
that the occurrence of falls is higher among older women,
older aged widowed individuals with low education and
those who use many medications [4,5]. Elderly people
with visual alterations, gait and balance disorders, as well
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I. G. Rodrigues et al. / Health 5 (2013) 49-57
50
as those having a higher number of associated diseases,
are also most affected by falls [6,7].
It is known that besides causing various impacts on the
life of an elderly person, the consequences of falls generate
an increase of costs due to a greater need for use of spe-
cialized services and an increase in hospital admissions [4].
In 2011, the falls represented 38.4% of the total external
causes that had taken to hospitalization, reaching almost
20 hospital admissions by 10 thousand inhabitants [8].
Less serious falls that do not lead to death and institu-
tionalization may, however, affect the health-related qua-
lity of life (HRQL) of the elderly person. The quality of
life can be understood under two aspects: overall quality
of life, where more objective factors of life are considered,
such as income and housing conditions, and health-related
quality of life (HRQL), where the impact that illness or
health disorders have on people’s lives are considered
[9,10].
An important instrument for measuring the HRQL and
the self-referred health status is The Medical Outcomes
Study 36-Item Short-Form Health Survey (SF-36), much
used internationally, consisting of 36 items, divided into
eight domains: functional capacity, physical aspects, pain,
general state of health, vitality, social aspects, emotional
aspects and mental health [11].
Studies indicate that the HRQL differs according to
gender, age, socioeconomic factors, the number of chro-
nic diseases and health problems [12-14]. However, it is
unknown if there are population-based surveys, on the im-
pact of falls in the several dimensions of the quality of life
in elderly people’ health, using SF-36 in Brazil.
Internationally, the studies are also scarce. A few of
them use data from institutionalized subjects or specific to
a group. In Oklahoma (USA), researchers studied the im-
pact of falls in obese adults and found the lowest scores of
the SF-36 in social aspects, pain, functional capacity and
physical aspects for those individuals with reported re-
current falls in the past year [15]. Another study carried
out in Canada, which evaluated the impact of falls through
the SF-36 in elderly patients with chronic obstructive pul-
monary disease (COPD), has found that those who had
experienced one or more falls in the previous year had
lower scores in all domains of the instrument [16].
In Brazil, Ribeiro et al. [2], using the WHOQOL-Bref
(abbreviated Quality of Life Scale of the Worldwide
Health Organization), studied 72 elderly of a low-income
community in Rio de Janeiro city, who had suffered one or
more falls in the last 12 months preceding the survey and
found a reduction in the average of all scale domains.
The increase of healthy life years and quality of life is
currently considered one of the main challenges for health
promotion for elderly [17]. Thus, it is necessary to know
the impact of health problems on the functional ability, in
the social life and in the well-being of the elderly.
The study aims to identify the association between the
occurrence of falls in last year and the domains of HRQL,
assessed by the SF-36, by gender, age and education, in
the elderly in Campinas/SP.
2. MATERIALS AND METHODS
It is a cross-sectional population-based study, where
data from 1.432 elderly were analyzed (60 years old and
over) non-institutionalized, residents in Campinas city
urban areas. Data are from the Health Survey (ISACAMP
2008) aimed to obtain information from various health
dimensions, from three age groups: adolescents (10-19
years), adults (20 - 59 years) and elderly (+ 60 years).
The number of people to comprise the sample of each
domain was established considering 50% of proportion
estimate with a confidence interval of 95%, sampling
error between 4 and 5 percentage points and a design
effect of 2. Thus, a minimum number of 1.000 interviews
were established for each age domain.
The survey sample was obtained by probability sam-
pling procedures, by cluster in two stages: census tracts
and households. In the first stage, 50 census tracts were
drawn with probability proportional to size (number of
households). In the second stage, to achieve the required
sample size, were drawn independently 2.150, 700 and
3.900 households to obtain the desired minimum number
of adolescents, adults and elderly, respectively.
The information was obtained through a structured
questionnaire, applied by trained and supervised inter-
viewers. In this study, only the survey data relating to per-
sons aged 60 or more were used.
The dependent variables of the study were the SF-36,
version 2 eight scales (Physical functioning, Role physi-
cal, Body pain, General Health, Vitality, Role emotion,
Social Functioning and Mental Health). The result of the
scales is presented as a final score ranging from 0 through
100, where 0 (zero) is the worst and 100 is the best state of
health [11,18,19].
The SF-36 was translated and validated into the Por-
tuguese language by Ciconelli et al. (1999) [20]. The
construction of scales scores and components of the SF-36
was conducted according to guidelines from the instruc-
tions manual of the instrument [19].
The main independent variables of the study were:
occurrence of fall reported as main accident in the last 12
months, and reference of this fall with or without limita-
tion of usual activities. Gender, age group (60 to 74 years
and 75 years or more) and education (schooling average),
were the covariates of the study and together with the
referred number of comorbidities (0, 1 - 2, 3 or more)
were also used in the analyzes adjustments.
The survey data were entered into a database developed
using the software EpiData 3.1 (Epidata Association,
Odense, Denmark) and submitted for consistency evalua-
Copyright © 2013 SciRes. OPEN ACCESS
I. G. Rodrigues et al. / Health 5 (2013) 49-57 51
tion. The means and confidence intervals of 95% of the
scales’ scores and from the two components of the SF-36
were estimated, according to the occurrence of falls and
according to falls which caused or not limitation of the
usual activities.
Analyzes were conducted for the elderly population
overall and stratified by gender, age group and education.
For each scale and each component of the SF-36, and in
each category of stratification a model of simple and mul-
tiple linear regression was carried through. All analyses
had been conducted using software Stata 11.0 (Stata Corp,
Station College, United States of America) using the svy
commands incorporating the weightings resulting from
the sample design.
The project of this study was approved by the Ethics
Committee of the Faculty of Medical Sciences of the State
University of Campinas, Brazil, in addendum to process
no. 079/2007.
3. RESULTS
Among the households selected to obtain the sample of
elderly persons there was a loss of 14.2% due to the im-
possibility of knowing whether there was an elderly resi-
dent or not. Among the elderly identified in the selected
households, there was 5.5% of refusal and 6.9% that were
lost for other reasons. The elderly who were unable to
directly respond the interview (96 elderly persons) due
disability or dementia and whose information was given
by family members or caregivers, were excluded from this
study.
Although the survey addressed adolescents, adults and
elderly, this study assessed only the information of indi-
viduals 60 years and older (60 to 74 years and 75 years
or more). Thus 1.431 elderly persons were analyzed in
this research.
From the studied sample 59.5% were female, with av-
erage age of 69.9 years (CI 95% 69.5 - 70.3). 69.6% with
less than eight years of education. 33.1% of the elderly
reported having three or more chronic morbidities. 6.3%
reported the occurrence of falls in the last year, and out of
these, 3.6% reported having limitation of the habitual
activities due to this fall (Table 1).
The mean scores of the SF-36 considering the total
population (Table 2) were higher in the role emotional
(87.3) and social functioning (83.3) and lower in vitality
(72.1) and general health (72.1).
In relation to the total sample of elderly victims of fall
in the last year, all SF-36 domains, except for the general
health, showed significant associations (p 0.05) after
adjustment by gender and age. It is observed that the total
population of elderly male shows higher scores than fe-
males on all SF-36 scales. However, when analyzing the
scores from men who had experienced fall they appear
lower than females. When analyzing the difference in the
scores of those who have experienced fall compared to
those who did not, it is observed the largest differences in
men than in women, showing the most affected domains,
after adjustment with age and comorbidities: physical
functioning, role physical, body pain and social func-
tioning (Table 2).
In terms of age group (Ta ble 3) it is observed that the
elderly with 75 years or older, show lower scores on all
SF-36 scales when compared to the elderly with 60 to 74
years. When analyzing the difference in the scores be-
tween those who experienced falls compared to those who
did not, it is noted that the scales of role physical and
social functioning, after adjustment with gender and co-
morbidities, remained with β 10 and p 0.05 in those
aged 75 years and over, while there was no association
observed (p 0.05) after this same adjustment, in the
younger elderly group.
According to schooling years (Ta b l e 4) it is observed
that those with less schooling (0 to 7 years), in the total
sample, and those who had experienced fall showed lower
scores on all SF-36 scales and significant association (p
0.05) after adjustment by gender, age and comorbidities,
in role physical and social functioning. When analyzing
the difference of association among those who had ex-
perienced fall compared to those who had not, the scale of
social functioning was the most affected (β 10) in the
less schooling group.
In the Table 5, it is observed that in the total elderly
sample, those who reported limitation of usual activities
due to the fall, showed lower scores on all SF-36 scales
compared to those who did not experienced falls. The
scales of physical functioning, role physical, body pain
and social functioning were the most affected, even after
adjustment by gender, age and comorbidities. No differ-
ences were found between those who reported falls with-
out limitation and those who did not fall.
4. DISCUSSION
The study shows that the elderly who had experienced
falls in the year prior to the interview showed significantly
lower scores compared to those who did not fall, with
seven of the eight SF-36 scales, after the adjustment by
gender and age. It must be observed that the male popu-
lation who had experienced falls last year and reported
limitation of usual activities due to falls, showed worse
HRQL, through lower SF-36 scores compared to females.
The older elderly, aged 75 and more and the less schooled
who had fallen last year, also showed lower SF-36 scores
when compared to younger elderly and with higher
schooling.
The scales that were more affected in the elderly who
had experienced falls in the last 12 months prior to the
survey were physical functioning, role physical and body
pain. Results of a previously mentioned study, involving
the population of obese adults in Oklahoma (USA), also
Copyright © 2013 SciRes. OPEN ACCESS
I. G. Rodrigues et al. / Health 5 (2013) 49-57
Copyright © 2013 SciRes. OPEN ACCESS
52
Table1. Description of the study population second occurrence of falls in individuals 60 years and older. ISACAMP 2008.
Variables n (%) Occurrence of Fall Prevalence
Ratio (CI 95%) Prevalence Ratio adjusted
(gender/age)
Gender 0,0002*
Male 579 (40.5) 3.3(2.1 - 5.1) 1 1
Female 852 (59.5) 8.4(6.8 - 10.5) 2.54(1.55 - 4 .15) 2.39(1.48 - 3 .86)
Total 1431 (100) 6.3(5.1 - 7.6)
Age 0.0000*
60 -74 1067 (74.6) 4.6(3.5 - 5.9) 1 1
75 and over 364 (25.4) 11.2(8.2 - 14.9) 2.42(1.64 - 3.56) 2.30(1.60 - 3.3 2)
Education (years) 0.2519*
0 - 7 996 (69.6) 6.8(5.4 - 8.6) 1 1
8 and over 434 (30.4) 5.0(3.1 - 8.0) 0.73(0.42 - 1.28) 0.97(0.58 - 1.62)
Number of chronic morbidities 0.0120*
0 278 (19.7) 2.0(0.9 - 4.6) 1 1
1 - 2 666 (47.2) 5.9(4.1 - 8.3) 2.86(1.07 - 7.61) 2.46(0.97 - 6.23)
3 or more 467 (33.1) 8.5(5.9 - 12.1) 4.12(1.55 - 1 0.94) 2.93(1.15 - 7 .47)
*P value in the chi-square test
Table 2. Mean scores of the SF-36 seconds occurrence of fall and sex stratification in the elderly. ISACAMP 2008.
Mean Scores and CI(95%) Analysis
Adjusted** Analysis Adjusted***
Total Falls
Domains
n = 1431 Yes (n = 91) No (n = 1340) β p β p
Total
Physical functioning 75.1(72.9 - 77.3) 61.9(56.2 - 67.6) 76.0(73.7 - 78.2) 8.7 0.003 6.5 0.031
Role physical 78.6(76.4 - 80.9) 66.4(59.6 - 73.2) 79.4(77.2 - 81.7) 9.4 0.004 6.7 0.027
Body Pain 75.4(73.7 - 77.1) 64.1(56.6 - 71.6) 76.2(74.6 - 77.8) 8.7 0.031 6.7 0.096
General Health 72.1(70.1 - 74.1) 70.3(65.3 - 75.3) 72.2(70.3 - 74.1) 0.90.659 1.1 0.574
Vitality 72.1(69.5 - 74.8) 64.8(60.1 - 69.6) 72.6(69.9 - 75.4) 5.8 0.016 3.8 0.106
Role Emotion 87.3(85.6 - 88.9) 79.1(73.1 - 85.0) 87.8(86.2 - 89.5) 6.1 0.046 3.7 0.130
Social Functioning 83.3(81.1 - 85.5) 72.5(66.8 - 78.3) 84.0(81.7 - 86.2) 8.9 0.002 7.9 0.004
Mental Health 77.6(75.6 - 79.6) 71.5(67.0 - 76.1) 78.1(76.1 - 80.1) 5.3 0.029 3.7 0.151
Male
n = 579 n = 19 n = 560
Physical functioning 80.1(77.1 - 83.0) 51.8(36.7 - 66.9) 81.0(78.2 - 83.9) 26.1 0.000 22.4 0.000
Role physical 81.1(78.1 - 84.1) 52.7(35.6 - 69.8) 82.1(79.1 - 85.0) 26.8 0.001 23.2 0.001
Body Pain 80.6(78.4 - 82.8) 59.1(40.5 - 77.6) 81.4(79.4 - 83.4) 20.6 0.013 19.3 0.029
General Health 73.2(71.0 - 75.4) 66.0(57.2 - 74.9) 73.5(71.3 - 75.6) 6.70.094 4.2 0.253
Vitality 75.4(72.5 - 78.4) 67.3(54.9 - 79.7) 75.7(72.8 - 78.6) 7.40.163 4.9 0.349
Role Emotion 89.9(87.8 - 92.0) 76.5(59.6 - 93.4) 90.3(88.3 - 92.4) 12.80.095 8.0 0.175
Social Functioning 85.5(82.7 - 88.2) 60.1(43.8 - 76.4) 86.4(83.8 - 88.9) 24.9 0.001 21.8 0.002
Mental Health 80.2(78.0 - 82.4) 70.6(59.9 - 81.2) 80.6(78.4 - 82.8) 9.20.054 7.8 0.122
Female
n = 852 n = 72 n = 780
Physical functioning 71.4(68.6 - 74.2) 64.9(58.5 - 71.3) 72.0(69.0 - 75.0) 3.10.349 1.5 0.680
Role physical 76.8(74.0 - 79.6) 70.4(63.3 - 77.6) 77.4(74.5 - 80.3) 3.80.272 1.6 0.665
Body Pain 71.5(69.3 - 73.8) 65.6(58.2 - 73.0) 72.1(69.8 - 74.4) 4.90.204 2.4 0.521
General Health 71.3(69.2 - 73.4) 71.6(66.1 - 77.1) 71.2(69.1 - 73.3) 0.8 0.736 2.6 0.278
Vitality 69.7(66.8 - 72.6) 64.1(58.8 - 69.3) 70.2(67.2 - 73.2) 5.4 0.040 3.4 0.175
Role Emotion 85.4(83.2 - 87.6) 79.8(73.7 - 86.0) 85.9(83.6 - 88.2) 3.80.243 2.3 0.439
Social Functioning 81.6(78.9 - 84.3) 76.2(70.7 - 81.7) 82.1(79.3 - 85.0) 3.80.208 3.4 0.227
Mental Health 75.7(73.5 - 78.0) 71.8(67.0 - 76.6) 76.1(73.8 - 78.4) 4.30.085 2.5 0.334
**Beta coefficients: estimated by multiple linear regression, with adjustment for age and/or gender; ***Beta coefficients estimated by multiple linear regression,
with adjustment for age and / or gender and comorbidities.
I. G. Rodrigues et al. / Health 5 (2013) 49-57 53
Table 3. Mean scores of the SF-36 according to the occurrence of falls and stratification by age in the elderly. ISACAMP 2008.
Mean Scores and CI(95%)
Total Falls
Analysis Adjusted** Analysis Adjusted***
Domains
n = 1431 Yes (n = 91) No (n = 1340) β p β p
60 - 74
N = 1067 Yes (n = 50) No (n = 1017)
Physical functioning 79.2(76.9 - 81.4) 69.8(61.9 - 77.8)79.6(77.5 - 81.8) 8.4 0.033 4.6 0.244
Role physical 81.9(79.6 - 84.1) 74.2(66.3 - 82.2)82.3(80.0 - 84.5) 7.6 0.048 3.4 0.334
Body Pain 77.1(75.3 - 78.8) 64.2(54.9 - 73.5)77.7(75.9 - 79.4) 11.8 0.018 7.8 0.116
General Health 72.5(70.4 - 74.6) 71.7(65.3 - 78.2)72.5(70.5 - 74.5) 0.4 0.891 3.5 0.216
Vitality 73.1(70.3 - 75.8) 66.2(59.6 - 72.6)73.4(70.6 - 76.2) 6.1 0.070 2.7 0.343
Role Emotion 89.2(87.5 - 90.9) 84.3(77.1 - 91.6)89.5(87.8 - 91.2) 4.7 0.185 0.5 0.830
Social Functioning 85.5(83.2 - 87.8) 80.5(73.3 - 87.7)85.7(83.5 - 88.0) 4.8 0.142 2.7 0.365
Mental Health 77.9(75.1 - 80.1) 70.7(64.7 - 76.8)78.2(76.0 - 80.4) 6.5 0.032 3.3 0.273
75 or older
n = 364 Yes (n = 41) No (n = 323)
Physical functioning 63.3(59.5 - 67.1) 52.4(44.1 - 60.8)64.6(60.7 - 68.6) 10.2 0.028 9.2 0.066
Role physical 69.2(65.3 - 73.1) 57.0(46.7 - 67.3)70.7(66.8 - 74.6) 12.4 0.019 10.8 0.038
Body Pain 70.6(67.4 - 73.9) 64.1(52.7 - 75.4)71.5(68.1 - 74.8) 5.6 0.334 5.6 0.351
General Health 70.9(67.9 - 73.8) 68.6(61.8 - 75.4)71.2(68.4 - 73.9) 2.3 0.415 2.0 0.481
Vitality 69.5(66.0 - 73.0) 63.2(56.9 - 69.5)70.3(66.8 - 73.7) 6.3 0.044 5.5 0.111
Role Emotion 81.6(78.6 - 84.7) 72.7(64.0 - 81.4)82.8(79.7 - 85.9) 8.1 0.087 7.5 0.121
Social Functioning 76.7(72.9 - 80.5) 62.9(53.7 - 72.2)78.5(74.7 - 82.2) 14.2 0.004 14.1 0.006
Mental Health 76.9(74.1 - 79.7) 72.5(65.6 - 79.4)77.5(74.6 - 80.3) 4.5 0.225 4.5 0.240
**Beta coefficients estimated by the multiple linear regression, with adjustment for gender. ***Beta coefficients estimated by the multiple linear regression, with
adjustment for gender and comorbidities.
Table 4. Mean scores of the SF-36 according to the occurrence of falls and educational stratification in the elderly. ISACAMP 2008.
Mean Scores and CI(95%)
Total Falls Analysis Adjusted***
Domains
n = 1430 Yes (n = 91) No (n = 1340) β p β p
0 - 7
n = 996 Yes (n = 69) No (n = 926)
Physical functioning 70.7(68.3 - 73.2) 59.4(52.3 - 66.5) 71.6(69.1 - 74.0) 7.5 0.041 7.1 0.069
Role physical 74.9(72.2 - 77.6) 64.2(55.8 - 72.6) 75.7(73.0 - 78.4) 8.8 0.023 7.8 0.045
Body Pain 72.4(70.3 - 74.5) 62.4(53.3 - 71.4) 73.2(71.1 - 75.2) 8.1 0.095 6.8 0.166
General Health 69.5(67.5 - 71.6) 67.9(61.7 - 74.1) 69.6(67.7 - 71.6) 1.6 0.575 0.3 0.889
Vitality 70.2(67.1 - 73.4) 64.5(59.2 - -69.9) 70.6(67.4 - 73.9) 4.2 0.132 2.6 0.351
Role Emotion 85.1(82.8 - 87.4) 78.8(72.2 - 85.5) 85.5(83.3 - 87.8) 4.2 0.193 3.2 0.317
Social Functioning 79.6(77.1 - 82.2) 68.6(61.2 - 76.1) 80.5(78.0 - 82.9) 10.0 0.006 10.5 0.004
Mental Health 75.9(73.5 - 78.4) 68.6(62.8 - 74.4) 76.5(73.9 - 79.0) 6.9 0.034 5.4 0.092
8 and over
n = 434 Yes (n = 22) No (n = 412)
Physical functioning 84.4(82.0 - 86.9) 69.2(55.4 - 83.0) 85.3(82.8 - 87.7) 12.1 0.044 4.6 0.443
Role physical 86.6(84.4 - 88.7) 72.6(59.4 - 85.9) 87.3(85.2 - 89.4) 11.1 0.062 -3.7 0.378
Body Pain 81.7(78.9 - 84.5) 69.2(57.5 - 81.0) 82.4(79.7 - 85.1) 10.2 0.063 6.4 0.199
General Health 77.6(75.7 - 79.4) 77.3(68.6 - 86.0) 77.6(75.8 - 79.3) 1.1 0.771 6.0 0.116
Vitality 76.3(73.6 - 78.9) 65.7(56.9 - 74.5) 76.8(74.2 - 79.5) 10.3 0.013 7.4 0.106
Role Emotion 92.0(90.1 - 93.8) 79.6(63.8 - 95.5) 92.6(91.1 - 94.3) 11.3 0.102 4.6 0.376
Social Functioning 90.9(88.8 - 93.1) 83.7(70.1 - 97.4) 91.3(89.3 - 93.4) 5.8 0.340 0.0 0.991
Mental Health 81.3(79.6 - 82.9) 80.0(74.2 - 85.7) 81.3(79.7 - 83.0) 0.9 0.745 1.6 0.388
***Beta coefficients estimated by multiple linear regression, with adjustment for gender, age and comorbidities.
Copyright © 2013 SciRes. OPEN ACCESS
I. G. Rodrigues et al. / Health 5 (2013) 49-57
Copyright © 2013 SciRes. OPEN ACCESS
54
Table 5. Mean scores of the SF-36 seconds occurrence of fall, with and without limitations of usual activities. ISACAMP 2008.
Mean Scores and CI(95%) Analysis Adjusted** Analysis Adjusted***
Suffered falls (n = 91)
Domains Not suffered
falls
(0)
with limited
(2)
without limitation
(1)
β
(2-0) p β
(1-0) p β
(2-0) p β
(1-0) P
n = 1340 n = 52 n = 39
Physical functioning 76.3(74.0 - 78.5) 54.6(46.3 - 63.0)71.5(62.6 - 80.5) 15.1 0.000 0.70.862 11.7 0.007 0.0 0.987
Role physical 80.0(77.8 - 82.3) 58.0(50.2 - 65.8)77.5(68.3 - 86.7) 17.2 0.000 0.10.980 -13.5 0.000 1.4 0.728
Body Pain 76.8(75.1 - 78.4) 59.8(50.0 - 69.5)69.9(61.3 - 78.5) 12.4 0.016 4.00.329 10.0 0.059 2.6 0.540
General Health 72.2(70.3 - 74.2) 67.4(62.6 - 72.2)74.2(66.1 - 82.3) 3.60.1252.50.459 0.7 0.750 3.60.293
Vitality 72.7(70.0 - 75.4) 63.3(57.5 - 69.1)66.9(60.4 - 73.3) 7.1 0.018 4.30.156 5.0 0.104 2.30.445
Role Emotion 88.2(86.5 - 89.8) 71.9(63.4 - 80.5)88.4(82.4 - 94.4) 12.7 0.005 2.30.425 9.6 0.014 3.5 0.184
Social Functioning 84.5(82.2 - 86.8) 66.9(58.4 - 75.4)79.9(71.3 - 88.6) 14.0 0.002 2.80.466 12.3 0.006 2.6 0.493
Mental Health 78.2(76.2 - 80.2) 71.1(65.3 - 77.0)72.1(66.0 - 78.1) 5.6 0.064 5.10.084 3.8 0.238 3.6 0.222
**Beta coefficients estimated by the multiple linear regression, with adjustment for age and/or gender. ***Beta coefficients estimated by the multiple linear re-
gression, with adjustment for comorbidities, age and/or gender.
indicated the lowest scores of the SF-36 in physical and
social aspects, pain and functional capacity in individuals
with a history of falls [15]. Another study conducted in
Brazil with 120 elderly subjects, using the WHOQOL,
also found that the presence of falls in the past six months
was associated with the worst condition in the physical
domain assessed by the instrument [21]. Fabricio et al
(2004), in the study with elderly residents of Ribeirão
Preto/SP, confirmed that the consequences generated by
the falls lead to an increase in the functional dependence
for carrying out activities of daily life (ADLs) [22].
According to the International Classification of Func-
tioning, Disability and Health of the World Health Or-
ganization (ICF), the functional capacity can be under-
stood by the execution of tasks or actions under the
competence of the organism and environmental condi-
tions, i.e., there is a relationship between the ability of the
individual to adjust his needs to the environment in which
he lives [23]. The disabilities are worthy of attention be-
cause they cause the dependency for carrying out tasks
and decreased autonomy of the subjects [24], who tend to
live under the care of other people.
The body pain has also been associated with the oc-
currence of falls. This is another important issue con-
sidering the health and well-being of the elderly, since that
the pain can cause depression and decreased vitality and
compromise its physical functioning, generating loss of
autonomy and damages in the lives of individuals and
families [25].
In this study, despite the fact that the falls have occurred
more frequently in females, the damages related to this
occurrence were greater in males, being observed with a
strong association with the physical dimension of health,
especially in the scales of physical functioning, role
physical, body pain and social functioning. However, this
result differs from the work of Stel et al. (2004) who
analyzed the consequences of falls in a sub sample of
elderly of the study LASA (Longitudinal Aging Study
Amsterdam). The authors found that the impact of falls in
the decline of functionality had been greater for the fe-
males [26].
No studies that have addressed this finding of the
greater impact of falls for the males were found. However,
it may be noted that the elderly males who had experi-
enced falls are those who are in worse HRQL conditions,
especially in the physical aspects, although they have
made another assessment of their own health.
Research results indicate that women consider them-
selves in worse health conditions than men [12,27]. This
could justify the absence of decline in the SF-36 scales in
this population. Fried et al. (2000) by means of a longi-
tudinal study of seven years, with the objective to develop
and put into operation a syndromic profile for frailty in
elderly people, show that the likelihood of becoming frail
is high among women. These authors argue that women
could offer an increased risk of fragility by the fact that
the amount of lean mass and muscle strength is lower than
men of the same age. In addition, women could also be
more exposed to extrinsic factors that cause sarcopenia,
such as the inadequate dietary intake compared to men
[28].
In relation to age, an attention is drawn to the problem
of falls as one becomes older. The biological aging proc-
ess involves structural and functional changes that ac-
cumulate progressively with increasing age [29]. As time
goes by in one’s life, there is a decrease of the muscle
strength and elasticity, loss of stability and joint dynamics,
alterations in the sensory, vestibular and somatosensory
and nervous system. These changes imply the commit-
ment of the postural control mechanisms, changing pos-
ture, gait and balance which may increase the predisposi-
tion to falls [3,19,29,30].
In relation to educational level, it was observed that the
I. G. Rodrigues et al. / Health 5 (2013) 49-57 55
falls are negatively associated with the HRQL for those
with low educational level. No studies have been found to
evaluate the association of falls with the HRQL using the
SF-36, according to age and level of education for com-
parison with these results. However, researches confirmed
that the prevalence of falls is greater in elderly with lower
schooling levels [5,31]. The physical and social role
functions were most affected in this population. It is worth
noting that the role physical assesses the impact of
physical health problems in daily activities and/or work.
These aspects should be carefully considered, given, for
example, the importance of work in elderly person’s life,
including helping to engage in social activities [32,33].
And in the case of elderly with lower socioeconomic
strata, the difficulties at work will also compromise the
elderly’s income.
Another negative association found was the limitation
of usual activities as a result of the falls and HRQL, being
the scales of physical function, role physical, role emo-
tional and social functioning the most affected. Lopes and
Dias (2010), in a literature review, mentioned some con-
sequences caused by falls, which in turn comes to solidify
the association found in this study. Among them are the
limitation of mobility and dependence in performing basic
and instrumental activities of daily life [34]. Studies on
this subject are scarce in Brazil and in other countries,
especially considering the association of the occurrence of
the falls with the SF-36 scales in population-based areas,
making it difficult to compare between researches.
One limitation of the study is that the cross-sectional
design does not allow inferences about causality of the
association. It is possible that the elderly who are in
poorer health conditions and quality of life are those who
are most vulnerable to falls. On the other hand, we must
emphasize that the quality of life has been jeopardized due
to the occurrence of falls, i.e., they can have negative
consequences for the life and health of the subject. In this
sense, it is important to consider that the results presented
indicate only associations.
The results of this study make a warning to caregivers
and health care programs for the elderly for two perspec-
tives in relation to the occurrence of falls: on the one hand,
they lead to important limitations to the elderly, which are
associated with worse health condition and quality of life,
through losses primarily in the domains of physical func-
tion, role physical and body pain. On the other hand, it is
worth considering that the impaired elderly, especially in
physical functioning, role physical, body pains and with
difficulty in normal social relationships, are more vul-
nerable to experiencing falls, including the most serious
falls, which cause limitations. The study also points out
that the elderly males, more advanced in age and less
schooled, deserve special attentions in relation to falls
because it is shown that they are more greatly damaged in
most scales assessed by the SF-36.
Given the scarcity of studies in this topic in non-in-
stitutionalized elderly in Brazil and internationally, the
study points to the need for the further research and con-
tributes to the advancement of knowledge, providing the
information for health policies directed to the elderly
population.
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ABREVIATIONS
HRQL: Health Related Quality of Life
SF-36: The Medical Outcomes Study 36-Item Short-
Form Health Survey
ISACAMP 2008: Campinas Health Survey—2008
WHO: World Health Organization
USA: United States of America
WHOQOL: Bref-Abbreviated Quality of Life Scale of
the Worldwide Health Organization
COPD: Chronic Obstructive Pulmonary Disease
CI 95%: Confidential Interval of 95%
ADLs: Activities of Daily Life
ICF: International Classification of Functioning
LASA: Longitudinal Aging Study Amsterdam
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