Influence of Nutritional Deficit, Cognitive and Functional Impairment, Frailty, and Quality of Life on Fall Risk in Community-Dwelling Older Adults: A Cross-Sectional Study Conducted in Brazil

Introduction/Objective
Falls among older adults are a global health concern, affecting approximately 30% of the elderly and leading to physical and psychological harm. In Brazil, falls affect 13.6% of older adults, with a severe impact on 7.5% of cases, emphasizing the need for preventive actions, especially within Primary Health Care (PHC). Although mobility issues, medication use, and environmental factors are established fall risks, the roles of nutrition, cognitive and functional status, frailty, and quality of life (QoL) are less examined. This study aimed to assess the influence of these multifactorial health aspects on fall risk among older adults enrolled in a Brazilian PHC program.

Method
This cross-sectional study involved 257 older adults (≥60 years) registered in PHC in Santa Cruz, Rio Grande do Norte, from June 2023 to March 2024. Data were collected through structured interviews, using validated instruments to measure fall risk, nutritional and cognitive status, frailty, functionality, and QoL. Data analysis included Chi-square and Mann-Whitney tests for categorical and scalar data, respectively, with Odds Ratios (OR) calculated to identify risk factors. A significance level of 5% (p<0.05) was applied.

Results
Among participants, 39.7% were at risk of falling, with risk factors including nutritional deficits, frailty, and impaired cognition. Notably, preserved cognitive function (OR=5.27), the absence of frailty (OR=4.49), and good nutritional status were associated with lower fall risk. Functional independence and higher QoL in physical and functional domains also correlated with reduced fall risk.

Conclusion
Adequate nutrition, cognitive preservation, low frailty, and functional independence are protective factors against falls in older adults. Interventions targeting these areas could reduce fall risk, underscoring the value of a multidimensional approach in PHC. These findings support preventive strategies focusing on nutrition, cognitive monitoring, and functional training to enhance elderly well-being and safety in community settings.

引言/目标
老年人跌倒问题已成为全球性的公共卫生关注焦点，影响着约30%的老年人，并导致身体和心理上的伤害。在巴西，跌倒问题影响着13.6%的老年人，其中7.5%的病例影响严重，这凸显了预防措施的重要性，尤其是在初级卫生保健（PHC）领域。尽管移动障碍、药物使用和环境因素被确认为跌倒风险因素，但营养、认知和功能状态、虚弱以及生活质量（QoL）的作用则研究不足。本研究旨在评估这些多因素健康因素对巴西PHC项目中注册的老年人的跌倒风险的影响。

方法
这是一项横断面研究，涉及257名（≥60岁）在里约热内卢北部的圣克鲁斯注册的PHC老年人，研究时间为2023年6月至2024年3月。数据通过结构化访谈收集，使用经过验证的工具来测量跌倒风险、营养和认知状态、虚弱、功能性和QoL。数据分析包括卡方检验和Mann-Whitney检验，分别用于分类数据和标量数据，并计算了优势比（OR）以确定风险因素。应用了5%的显著性水平（p<0.05）。

结果
在参与者中，39.7%存在跌倒风险，风险因素包括营养不足、虚弱和认知障碍。值得注意的是，保持的认知功能（OR=5.27）、无虚弱状态（OR=4.49）和良好的营养状况与较低的跌倒风险相关。在物理和功能领域中的功能独立性和更高的生活质量也与降低跌倒风险相关。

结论
适当的营养、认知的保持、低虚弱状态和功能独立性是预防老年人跌倒的保护因素。针对这些领域的干预措施可以降低跌倒风险，这强调了在初级卫生保健中采用多维方法的价值。这些发现支持了以营养、认知监测和功能性训练为重点的预防策略，以增强社区环境中老年人的福祉和安全。