Frailty Syndrome: A Risk Factor Associated With Violence in Older Adults

Abstract

Objective The objective of this study was to analyze the association between frailty syndrome as a risk factor associated with violence in older adults. Method A cross-sectional study, carried out with older adults, in an emergency care unit of a northeastern Brazilian city was conducted. Three instruments were used: a form for sample characterization (i.e., demographics) and two more scales, namely, the Edmonton Frail Scale and the Hwalek–Sengstock Elder Abuse Screening Test. The results were analyzed through descriptive and inferential statistics, using chi-square or Fisher's exact tests, Spearman's correlation test, and simple logistic regression. Results The sample included 146 older adults who were over 70 years old (56.6%), male (56.2%), and at risk of violence (69.86%). Among the categorical variables, there was an association between risk and being of a higher age (80.7%, p < 0.001), unemployed (73.7%, p < 0.05), having more than six children (80.8%, p < 0.05), and frail older adults (88.1%, p < 0.001). There was a correlation (p < 0.05) between the numerical variables of the scales of violence and frailty, with a coefficient of 0.40. The simple logistic regression model showed that frailty syndrome increases the risk of violence among older adults. Conclusions It was concluded that frailty is a factor that increases the occurrence of risk of violence and provides information to guide nursing action in the field of forensic sciences.

Risk of violence and frailty syndrome among older adults treated at a hospital service

“…Data related to marital status and work activity demonstrate that there is a predominance of risk of violence in older adults without a relationship and without working in paid work, where the lack of a partner and social relationships can bring a feeling of isolation, which impacts on individuals’ mental health, and older adults who do not remain active are more frail and vulnerable to risk of violence ( 21 , 25 - 26 ) . In terms of income, there was a greater risk among those who received more than 1 salary, which leads us to one of the most frequent types of violence, financial violence, where aggressors tend to abuse older adults with higher incomes ( 8 , 23 ) .…”

“…The aggressor, in most cases, takes advantage of older adults’ frailty to impose their will. It should also be noted that violence itself can be a factor that determines older adults’ frailty ( 7 - 8 ) .…”

“…Frailty is classified based on axes that generally take into account older adults’ physical, psychological and social status; therefore, the decrease in these aspects can bring older adults closer to a state considered frail. This state leads to vulnerability and, consequently, greater exposure to risk of violence, which can be seen as an aggravating factor to the frailty syndrome, as the risk or even the act has psychological consequences, which may reflect on the physical part ( 2 , 8 - 9 ) .…”

Risco de violência, doenças autorreferidas e fragilidade em pessoas idosas hospitalizadas

“…Todos esses aspectos ligados à síndrome da fragilidade fazem com que a pessoa idosa seja mais suscetível ao risco de violência. (26,27) Além da associação da síndrome da fragilidade com o risco para violência contra a pessoa idosa, neste estudo evidenciou-se correlação diretamente proporcional positiva entre a síndrome da fragilidade e as doenças autorreferidas, isto é, quanto mais a pessoa idosa é acometida por morbidades mais frágil ele se apresenta. Essa correlação é complexa, uma vez que compartilham dos mesmos fatores de risco e podendo haver a coexistência dessas, favorecendo o declínio da saúde da pessoa idosa em seus diversos aspectos, seja físico, mental e/ou emocional, bem como a perda da autonomia e diminuição da qualidade de vida.…”

“…Estudos mostraram que pessoas idosas internadas são mais suscetíveis a sofrer abusos dos diversos tipos, visto o estado de vulnerabilidade e de maior dependência, não só do acompanhante, que geralmente é um familiar ou cuidador, mas também da equipe de saúde como um todo, inclusive da equipe de enfermagem, por lidar diretamente com o paciente. (4,27,31) Nesse ínterim, acredita-se na criação de vínculo da equipe de enfermagem com a pessoa idosa e maior facilidade de detectar diversos sinais, entre esses, o risco de violência. Entretanto, estudos mostram que há limitações desde a graduação do profissional de enfermagem, em que essa temática não é devidamente abordada, o que dificulta a prestação de uma assistência integral, bem como atender adequadamente a pessoa idosa que esteja em risco, corroborando para a subnotificação e, consequentemente, a concretização da violência.…”