The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-reviewed research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
3. The PICOT question will provide a framework for your capstone project.
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 

This assignment 

763

THEMATIC ISSUE:

HEALTH OF THE ELDERLY

Rev Bras Enferm [Internet]. 2018;71(suppl 2)763-9. http://dx.doi.org/10.1590/0034-7167-2017-0069

RESEARCH

Adriana Remião LuzardoI, Newton Ferreira de Paula JúniorI, Marcelo MedeirosII,
Paula Carolina Bejo WolkersIII, Silvia Maria Azevedo dos SantosI

I Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.
II Universidade Federal de Goiás, Nursing Faculty. Goiânia, Goiás, Brazil.

III Universidade Federal de Uberlândia, Hospital de Clínicas. Uberlândia, Minas Gerais, Brazil.

How to cite this article:
Luzardo AR, Paula Júnior NF, Medeiros M, Wolkers PCB, Santos SMA. Repercussions of hospitalization

due to fall of the elderly: health care and prevention. Rev Bras Enferm [Internet]. 2018;71(suppl 2):763-9.
[Issue Edition: Health of the Elderly] DOI: http://dx.doi.org/10.1590/0034-7167-2017-0069

Submission: 03-16-2017 Approval: 11-18-2017

ABSTRACT
Objective: To know the repercussions of the fall reported by the elderly and their caregiver during hospitalization in a public hospital
in Florianópolis city from October to December 2014. Method: Exploratory research with a qualitative approach, conducted by depth
interviews with 16 participants, the eight elderly were hospitalized for falls and eight elderly caregivers. Data analysis were performed
through the Thematic Content Analysis. Results: It was evidenced the thematic axis: Faller Elderly supported by four thematic categories:
Changes caused by Falls, I am a faller, I take care of me and Prevention of the Fall. The repercussions of the fall were evidenced in the
impairment of the health condition, self-care and functional capacity. We observed the naturalization of the phenomenon and the passivity
with the harmful consequences of the event. Final Considerations: The fall is valued the more negative its repercussion, such as the need
for hospitalization and surgery. Managing the vulnerability of the elderly, especially in primary care, evaluating their comorbidities and their
internal and external environment, will minimize unfavorable consequences and the social and fi nancial cost of hospitalizations.
Descriptors: Health of the Elderly; Vulnerability in Health; Accidents by Falls; Accident Prevention; Caregivers.

RESUMO
Objetivo: Conhecer as repercussões da queda relatadas pelo idoso e seu cuidador, durante internação em um hospital público de
Florianópolis, no período de outubro a dezembro de 2014. Método: Pesquisa exploratória com abordagem qualitativa, realizada
por entrevistas em profundidade com 16 participantes, dos quais oito foram idosos internados por quedas e oito cuidadores
de idosos. A análise dos dados foi realizada por meio da Análise de Conteúdo Temática. Resultados: Foi evidenciado o eixo
temático: Idoso Caidor sustentado por quatro categorias temáticas: Mudanças Provocadas pela Queda, Eu sou caideira, Eu me
cuido e Prevenção da Queda. As repercussões da queda foram evidenciadas no prejuízo à condição de saúde, ao autocuidado
e à capacidade funcional. Observou-se a naturalização do fenômeno e a passividade com as consequências danosas do evento.
Considerações Finais: A queda passa a ser valorizada quanto mais negativa for sua repercussão, a exemplo da necessidade de
internação e cirurgia. Gerenciar a vulnerabilidade do idoso, em especial na atenção primária, avaliando suas comorbidades
e seu ambiente interno e externo, minimizará consequências desfavoráveis e o custo social e fi nanceiro das hospitalizações.
Descritores: Saúde do Idoso; Vulnerabilidade em Saúde; Acidentes por Queda; Prevenção de Acidentes; Cuidadores.

RESUMEN
Objetivo: Conocer las repercusiones de caídas relatadas por el anciano y su cuidador, durante hospitalización en un hospital público de
la ciudad de Florianópolis, en el período de octubre a diciembre de 2014. Método: Investigación exploratoria con abordaje cualitativo,
realizada por entrevistas en profundidad con 16 participantes, de los cuales ocho fueron ancianos hospitalizados por caídas y ocho
cuidadores de ancianos. El análisis de los datos fue realizado por medio del Análisis de Contenido Temático. Resultados: Se evidenció
el eje temático: Anciano Caidor sostenido por cuatro categorías temáticas: Cambios Provocados por la Caída, Yo soy la caída, Me
cuido y Prevención de la Caída. Las repercusiones de la caída se evidenciaron en el perjuicio a la condición de salud, al autocuidado

Repercussions of hospitalization due to fall of the elderly:
health care and prevention

Repercussões da hospitalização por queda de idosos: cuidado e prevenção em saúde

Repercusiones de la hospitalización por caída de ancianos: cuidado y prevención en salud

Rev Bras Enferm [Internet]. 2018;71(suppl 2)763-9. 764764

Repercussions of hospitalization due to fall of the elderly: health care and preventionLuzardo AR, Paula Júnior NF, Medeiros M, Wolkers PCB, Santos SMA.

Governador Celso Ramos Hospital (CEP/HGCR), which fol-
lowed the standards of Resolution 466/2012 from the Nation-
al Health Council for research on human beings(7).

In order to preserve the anonymity of the participants,
codes consisting of letters and numbers were used, identifying
the elderly with the letter “I” and numbers 1 to 8 (I1, I2, I3 …
I8), as in the same way “C “For caregiver, following the same
numbering (C1, C2, C3 … C8).

Type of study
This is a descriptive study with a qualitative approach.

Methodological procedures

Study scenario
The chosen scenario was the Governador Celso Ramos

Hospital, in Florianópolis/SC and the data collection period
was from October to December 2014.

Data source
The study population consisted of the elderly and their

caregivers. The choice of sample was intentional, by conve-
nience method. Thirty-two patients aged 60 years and over
were hospitalized due to a fall in the collection period at the
medical and surgical clinics. Inclusion criteria for the care-
giver involved the situations in which the elderly person was
not a good respondent, considering their cognitive ability
through routine evaluations of the medical staff of the service
described in the medical records. In addition, the caregiver
should declare himself as the primary caregiver of the elderly
for at least six months. Thus, they accepted to be part of the
research, signing the Free and Clarified Consent Term (FCCT),
eight elderly and eight caregivers.

Data collection and organization
In all, 16 interviews were conducted with semi-structured

script. The interviews were recorded and transcribed in full to
compose the analysis corpus.

The Consolidated Criteria for Reporting Qualitative Re-
search (COREQ) was used as a criterion for data organization.

Data analysis
After the data collection was completed, the organization

of the transcribed material was followed to begin the analysis,
which observed the three chronological poles of the Thematic
Content Analysis process proposed by Bardin(8), namely: 1)
pre-analysis; 2) material exploration; and 3) treatment of re-
sults, inference and interpretation.

INTRODUCTION

Population aging is a reality in the world and in develop-
ing countries such as Brazil, where the growth of the elderly
population has been accelerating. The multiplicity of chronic
diseases is a frequent feature in old age and has an influence
on functional capacity and quality of life(1).

Increasing the longevity of the population raises biologi-
cal, socioeconomic, socio-cultural and psychosocial risks and
vulnerabilities(2). In situations of vulnerability in which the el-
derly are exposed falls as an important health problem for the
elderly and threatens to maintain their functional capacity, as
it is associated with restriction in mobility, fractures, hospital-
ization, depression, loss of autonomy, institutionalization, de-
cline in health and death(3). Thus, the presence of elements of
vulnerability strongly influences the quality of life, especially
when more than one of these elements are present, reaching
the different areas of the life of the elderly.

In this sense, the risk of falling increases with the number
of risk factors and in one year the risk of falling folds for each
additional vulnerability factor(4-5). According to the study by
the American Geriatrics Society and the British Geriatrics So-
ciety(6), the percentage of community-dwelling elderly expe-
riencing falls has increased by 27% for those with up to one
vulnerability factor and to 78% among the elderly with four
or more factors.

It is shown that undesirable unfolding affects morbidity and
mortality. The high family and individual costs due to the inju-
ries caused by the fall event are subject to intervention, which
is why preventive actions must be implemented to minimize
the impacts caused by the event.

Thus, the objective of this study was to know the repercus-
sions of the fall for the elderly and their caregiver, reported
during hospitalization, in a public hospital in Florianópolis
city, from October to December 2014.

OBJECTIVE

To know the repercussions of the fall reported by the elder-
ly and their caregiver during hospitalization in a public hos-
pital in Florianópolis city, from October to December 2014.

METHOD

Ethical aspects
The study was approved by the Human Research Ethics

Committee of the Universidade Federal de Santa Catarina
(CEPSH/UFSC) and by the Research Ethics Committee of the

Paula Carolina Bejo Wolkers E-mail: paulawolkers@yahoo.com.brCORRESPONDING AUTHOR

y a la capacidad funcional. Se observó la naturalización del fenómeno y la pasividad con las consecuencias dañinas del evento.
Consideraciones Finales: La caída pasa a ser valorada cuanto más negativas es su repercusión, a ejemplo de la necesidad de internación
y cirugía. La gestión de la vulnerabilidad del anciano, en especial en la atención primaria, evaluando sus comorbilidades y su ambiente
interno y externo, minimizará consecuencias desfavorables y el costo social y financiero de las hospitalizaciones.
Descriptores: Salud del Anciano; Vulnerabilidad en Salud; Acidentes por Caída; Prevención de Acidentes; Cuidadores.

Rev Bras Enferm [Internet]. 2018;71(suppl 2)763-9. 765765

Repercussions of hospitalization due to fall of the elderly: health care and preventionLuzardo AR, Paula Júnior NF, Medeiros M, Wolkers PCB, Santos SMA.

RESULTS

Eight elderly and eight caregivers were interviewed. The el-
derly respondents presented ages ranging from 60 to 84 years.
The majority of the elderly participants were female (six). Half
of the elderly group was married and the other half was wid-
owed. Six elderly people were retired, two due to disability,
one of whom was wheelchair-bound. One of the old women
was from home and the other worked at home as a carpenter.
The group of caregivers was all made up of women and only
one was single. Caregivers were between the ages of 28 and
65 years. Most caregivers maintained occupations related to
nursing home and care activity. Two caregivers maintained
out-of-home activities with employment, one as an auditor,
and the other was a caregiver for the elderly in a Long-Stay
Institutions for the Elderly.

From the contents manifested by the elderly and caregivers
of the elderly the Elderly theme Faller appeared that added
four categories, which are: a) Changes caused by falls; b) I am
a faller; c) I take care of me and d) Fall Prevention.

Changes caused by falls
The category Changes caused by falls emerged from the

testimonies when they related to the activities that the elderly
could accomplish before the fall in perspective to the changes
perceived after the event:

[…] I used to walk around the yard, water the plants …
sweep the house, clean the floor … […] I used to go out
every morning to walk … I walked more on the edge of the
beach. (I3)

He used to help me at home, in the kitchen. […] he won’t
do anymore. His dependence increased .. He had the au-
tonomy of eating by himself, doing the dishes […] that made
him very happy. (C5)

She used to do the dishes, bath, do all her things by herself,
hygiene, she used to change clothes … She never asked me
to do anything for her! Even though she’s not good. […] she
made the bed … she didn’t complain … […] only if she was
in a lot of pain did she ask for help … She was always a very
active person … (C2)

The perceived changes after the fall were reflected in the
finding of serious damages to the health condition and func-
tional capacity of the elderly, provoking reflection about the
future, as can be evidenced in the following reports:

[…] I only hope I have the strength to raise him and put him
at least to walk! Walk, stammer something. I know it’s no
longer the man who left home on the 14th, but it doesn’t
hurt because it’s my husband who’s there, he’s the father of
my children. He’s the one over there … (C1)

For all that has happened … in the same thing she is not
going to stay, things are already changing … I notice that
her memory is much worse since the fall, she used to forget
some things, but I notice she is even slower. (C3)

With this fall, I see that his situation has totally changed.
I see the consequences of this. As he has Alzheimer’s dis-
ease, he became much disoriented … I think that is why all
these complications arose. (C5)

… I hope for a much greater dependence. She’s going to
have to be fed, she’s not going to be able to take a bath
herself, get dressed, she’s going to stay in bed longer, she’ll
need a lot of physical therapy … all the care not to create
those “bedsores”… She’ll need to be cared, a device that
you didn’t need before. (C6)

After the evidences defined by the repercussions of the
falls, expectations arise that the elderly will return to do what
he used to do before the fall, thought expressed in several
manifestations, as participants I8 and C7, for example:

My expectation is to continue to do the things I’ve always
done. … improve the leg … improving I can walk with the
Canadian [crutch]. … to fix my arm too … that is out of place
… Then I’ll be able to drive again … (I8)

I expect her to do the crafts again, to see her walking; be-
cause otherwise it will be very difficult … otherwise she
would be very dependent. (C7)

In the speeches of participants C2, I6 and C1 the expecta-
tions were expressed sometimes with a sense of doubt, some-
times as alert and learning and sometimes as resignation be-
fore the consequence of the fall:

… after this fall and the surgery … it will be worse, I will
have to pay more attention, I cannot leave her alone any-
more … I don’t know if she will recover … if she can walk
again! …. I have expectations but at the same time doubt
whether she will be able to walk, to do her personal hy-
giene. (C2)

This fall … is serving as a warning to me … so I can stop and
take better care of myself and my life! It’s like those “STOP”
signs of traffic … it’s as if life were coming … and saying:
now stop and take care of yourself! (I6)

My husband will come completely vegetative. I’m going to
take a baby home. (C1)

A space of reflection was created so that the participants
had the freedom to externalize their beliefs about the fall
event. It was possible to show in the testimonies of I6 and
C1 that the fall represented a fact that generated changes in
people’s lives.

I am a faller
Supported by the free expression of the participants ap-

peared the category I am a faller as a self-definition of the
elderly in relation to the action of falling being incorporated
as an adjective. The category I am a faller brings the idea that
the fall event seems to be something natural, as if it were part
of people’s lives or even as if kept hereditary determination,
like the speech of the elderly I5:

Rev Bras Enferm [Internet]. 2018;71(suppl 2)763-9. 766766

Repercussions of hospitalization due to fall of the elderly: health care and preventionLuzardo AR, Paula Júnior NF, Medeiros M, Wolkers PCB, Santos SMA.

I’ve fallen several times, but I’ve never been hurt like this! I
am a “faller”. Just like my mother … she was like that. Since
I was a kid, I fell … I am like this! (I5)

I’ve fallen other times, i used to stumble and fall, but no
serious, just scratches or small bruises … but now … I even
had surgery. (I4)

There are many falls. The feeling is terrible! I had another
fall … 4 months ago … in the home service area. […] I fall
on my back. It didn’t have a more serious consequence …
but I got my whole body aching … Six months ago … I had
another fall … between the gate and the car door. It was the
same thing, I went to close the door … and fell. […] I already
know that, more or less, every 2 months I fall… (I2)

It was evidenced in this group that the fall gains more atten-
tion from the elderly and their relatives when more complex con-
sequences arise, such as the need for hospitalization and surgery.
Otherwise, the elderly will coexist with pain, excoriations, bruis-
ing, exposure to the risk of further falls and not realizing their
vulnerability will be exposed to increasingly severe outcomes.

The fall gains more visibility, often, by the marks it leaves.
The message: “I am a faller”, or “I am like this”, refers to the
self-identification of the faller elderly and to the acceptance of
the circumstances surrounding the event.

I take care of me
Despite the context of determination and naturalization

present in the idea of “being a faller”, the study also revealed
manifestations of the elderly about self-care, which was evi-
denced by the category I take care of me.

This category demonstrated that participants’ self-care was
related to the well-being that comes from eating and healthy
living habits. The health here was related to balanced, natural
and vegetarian food, as well as to the use of medicinal plants.
The recovery of the health status after the fall appears to be
associated with food, appearing as a central and important
element for the elderly I3 and I6:

I will continue with my natural food with whole products
… […] this food helps in the recovery of the person… (I3)

[…] I have been a vegetarian for 40 years … I drink natural
juice, I make wonderful salads. I eat various kinds of veg-
etables, fruits and vegetables. I know how to do wonderful
things in the kitchen. I believe this all gives health to us,
even to recover bones. (I6)

It is noticed in the statements of the participants of the pres-
ent study that the natural feeding is recognized as something
healthy, being a pleasant habit. This group identified subjective
aspects of the daily life lived from the practices and knowledge
of the elderly about their self-care. It is understood that the con-
text of the fall must be embedded in the practices and knowl-
edge to be incorporated by the elderly and their families.

The speeches in this category allowed us to understand that
self-care favors and is favored by empowerment, insofar as
the elderly person appropriates knowledge that they believe

are beneficial to their health. Thus, such knowledge can be
strengthened to work on fall prevention aspects.

Fall prevention
The Fall Prevention category emerged from the testimonies,

when the informants identified elements of prevention that
could have helped to prevent the illness, evidenced in the state-
ments of caregivers C6, C7 and the elderly I2, I6, I7 and I8.

[…] as she has Alzheimer’s all care of falling is important
… could have a preventive action in the hospital room, as
some restraint system […] could solve her not get out of
bed. […] create an atmosphere of peace and tranquility …
I closed the curtains, but now I think that curtain should
have been open … maybe she wouldn’t have fallen. (C6)

[…] safety bars in the bathroom, type of footwear, removal
of carpets, careful step, floor, stairs, this all I consider basic
and had already arranged well before she fell. […] I think
that chair in her case is something important. […] it has to
be a steady chair, because my mother is heavy. I had these
basic cares as she began to show more fragility. (C7)

“Ando devagar porque já tive pressa…” [freely translated ad
“I’m slow because I’ve been in a hurry …”], this song says
a lot about my life. Now is to walk slowly and look at the
landscape … and not to hurry. (I2)

I fell because I was anxious and hurried […] I am a carpenter.
I make dollhouses and I got a very large order […] and to take
care of the request I walked inside the house, going up and
down some steps that have from the kitchen to the area … (I6)

I could have prevented if I’d done things more calmly. The day
I fell I went very fast […] because I wanted to give the medi-
cine to my husband he has to take at 8:00 in the morning. (I7)

[…] as prevention of this fall on the street I should have
left the car with the help of someone …. In the house …
shouldn’t have facilitated … The wife has helped me, but
said … “lemme to try doing alone.” (I8)

Caregiver C6 linked her idea of fall prevention to the spe-
cific condition of her mother with Alzheimer’s disease who
fell during hospitalization, ending the coma and death. The
caregiver, somehow, expected the institution to have fall pre-
vention strategies for people with dementia, demonstrating
the presence of institutional vulnerability to which the elderly
woman was exposed.

For the caretaker C7 to prevent is to “provide what is neces-
sary” as a way to control the environmental risk factors, dem-
onstrating having knowledge of how to organize the domestic
structure in order to avoid falling.

The elderly I2 mentioned that prevention is “not being in a
hurry” and that hurry was a factor associated with the causes
of the various falls that had been in the last 2 years, reflecting
their current sense of preservation and self-care, but that did
not prevent the various falls occurred.

In the same way, it is also worth mentioning the speech
of the elderly woman, who fell between the kitchen and the

Rev Bras Enferm [Internet]. 2018;71(suppl 2)763-9. 767767

Repercussions of hospitalization due to fall of the elderly: health care and preventionLuzardo AR, Paula Júnior NF, Medeiros M, Wolkers PCB, Santos SMA.

yard, because she was in a hurry to finish her joinery work,
suffering from a femur fracture, hospitalization and surgery.

Carrying out routine activities calmly can prevent a fall in
the home environment, as the elderly woman says when she
hastily tripped on the carpet in the living room, not seeing that
it was an obstacle at that moment.

Prevention was associated with “having someone’s help”
for the elderly I8, both in terms of the fall he had on the street
and the fall he had in the house.

DISCUSSION

The accident by falls represents a negative impact on the
lives of older people and caregivers by causing increasing in-
juries, disabilities, treatment costs and death. Fall hospitaliza-
tion can be considered a factor for change. After the event, its
negative consequences provoked in the elderly and caregivers
visibility in relation to risk factors and reflection about care
and prevention.

In this context, the repercussions of injuries experienced
at a later age are more severe than among younger people,
requiring a long period of hospitalization, rehabilitation treat-
ment and a greater risk of dependence(9). Such a condition has
a direct impact on the family, especially on the next of kin, be-
ing those who take on new routines due to the necessary reha-
bilitation of the elderly person and often carry extraordinary
expenses to meet the need for special care. The occurrence
of immobility and dependence also represent a loss for the
family and the caregiver(10). The occurrence of falls can lead
to physical and psychological consequences that significantly
compromise the autonomy, independence and functionality
of the elderly person, representing a decrease in the quality of
life. Its occurrence can generate from small bruises, fractures,
reduction of physical capacity, greater dependence, decline in
health and reason for hospitalization or institutionalization to
psychological and social problems such as depression, isola-
tion, alteration in body image, low self-esteem, besides the
risk of developing the fear of falls syndrome(11). In the study by
Celich(12), it was possible to identify risk factors for falls in 104
elderly people living in the community in the southern region
of the country. The results revealed that 63.46% of the elderly
reported having fallen and 36.53% had suffered fractures. The
elderly showed that the fractures brought limitations to the
daily life, among which were related to walking injury, dif-
ficulty in carrying out personal hygiene and difficulty in carry-
ing out domestic activities.

Faced with the magnitude of the event, individuals’ lives,
the changes and reflections caused by them, it is necessary to
keep updated of the discussion about disabling events and the
need to preserve the autonomy and independence of the el-
derly, in the sense that he retakes the control over the accom-
plishment of the basic activities of the daily life and the instru-
mental ones, being independent in its functional capacity(11).
Functional capacity refers to the evaluation of the potential
that an elderly person has to perform daily activities, as well
as the need for assistance in the execution of these activities.
These activities are related to basic activities and instrumental

activities of daily living(13). The fall causes changes both for the
elderly and the caregiver, marking a new moment in the path
of health and sickness of each one. The post-fall can still arise
as a restrictive or propositional event of new experiences. The
emergence of fear of new falls, fear of dependency, negative
self-perception of health, adoption of a more preventive stance
and participation in the construction of support networks are
part of the scenario of outcomes and prevention(14).

In a population-based epidemiological study conducted
in the capital of Santa Catarina known as EpiFloripa, it was
observed that the majority of the elderly usually fall at home
(43.2%), in circumstances of stumbling and slipping and due
to hurry, by the hands and irregularities on the floor(15). Thus,
the risks and vulnerability of the fall occur as the elderly ex-
perience various levels of exposure to the event, increasingly
compounding the result of this vulnerable condition, in the
very process of living the elderly person. It should be stressed
that preventive strategies are loaded with interventions based
on the identification of exposure to risk factors, but it is not
a simple task to always be aware of all the possible risks that
threaten people’s lives(16). Vulnerability situations are not al-
ways recognized by the elderly, because often he himself does
not perceive the risks of being elderly and so little is perceived
elderly(17).

It is understood that situations of vulnerability and risks of
falling are not evident in the daily lives of the elderly and care-
givers, so that they can recognize them constantly. However,
it is understood that the elderly, family, health services and
community can adopt preventive strategies, which are incor-
porated into the daily life, through an educational process of
empowerment. In this context, knowledge will instrumental-
ize the various actors to levels of daily management of healthy
practices that include the interpretation of the dynamics of
the elderly in their home environment and beyond. To pre-
vent is to anticipate something that is known, avoiding the
situation of illness and injury(18). Prevention actions are nec-
essary, from the evaluation of individual and domestic risks
by the health services to the actions of health education for
the empowerment of the elderly and caregivers. In this way,
prevention strategies are related in an interlacing process that
goes through professional actions and that adjust to the degree
of illness and health. It is essential that the relatives of the
elderly be involved in prevention and care actions in order
to facilitate the identification of risk factors, the selection of
strategies to reduce their occurrence and the follow-up of the
injuries related to them(19). The family acts as a protection fac-
tor and in the presence of diseases and disabilities, the change
of intrafamily roles occurs, with possible choice of the main
caregiver. However, one should not exclude the right of the
elderly to care for themselves, it is important to empower and
support self-care(20).

Prevention is also to provide for clinical and interventional
measures that focus the problem and aggravate health in an
early manner. The model proposed by Leavell and Clark in
1965 analyzed the three different levels of disease prevention,
such as: primary, secondary and tertiary prevention. Primary
prevention is characterized as an idea of the level of protection

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Repercussions of hospitalization due to fall of the elderly: health care and preventionLuzardo AR, Paula Júnior NF, Medeiros M, Wolkers PCB, Santos SMA.

against a pathological agent and agents of the environment, in
which are found the measures to increase health, such as edu-
cational actions and counseling at all therapeutic moments be-
tween professionals and users. In secondary prevention is the
presence of a diagnosis and indication of treatment for a health
problem that has already been established. In tertiary preven-
tion, rehabilitation measures regarding illness are identified(18).

Awareness of falling as a health hazard does not only de-
pend on an event or information. In order to promote preven-
tion actions, it is necessary to consider the complexity of the
multiple factors involved, and especially not to devalue the
functional independence capacity of the elderly(21). Financial
investments are necessary so that preventive measures are ac-
tually taken in the context of the fall, in order to preserve the
functional capacity of the elderly in order to allow them to
live longer and better. With longevity is meant the adoption of
measures of early detection, risk assessment and monitoring of
diseases as a focus of attention to health(1).

Limitations of study
Some elderly people were unable to be in the interview

due to neuropsychomotor limitations; in this case, the inter-
viewee was the caregiver.

Contributions to the area of nursing and public health
It is understood that the adoption of preventive measures,

individual and collective, could affect the situations of vul-
nerability of the elderly population, minimizing hospital costs
and unfavorable effects. Among these measures, we highlight
the evaluation of comorbidities present in the life of the elder-
ly, which potentiate the harmful consequences of a fall, as well
as the analysis of structural characteristics of the environment,
both inside and outside the home.

Analyzing these factors, according to the reality of each el-
derly person, can contribute to full, comprehensive and more

determined care at all levels of prevention. These strategies
make possible the maintenance of the autonomy of the elderly,
the continuity of family and social coexistence, provoking re-
flections on prevention practices.

In this sense, it is also suggested to health professionals, includ-
ing nurses, the production of research aimed at the elderly, devel-
oping intervention studies to prevent falls that can be applied in
clinical practice and that make it possible to manage vulnerability.

FINAL CONSIDERATIONS

In this study, it was possible to know the repercussions of
the fall, reported by elderly and caregivers, from which the
health condition was impaired, self-care due to the vulner-
ability situation and the functional capacity of the elderly to
perform daily life activities. The repercussions of the fall were
evidenced also in the naturalization of the phenomenon, as if
it were part of the life of the elderly and the passivity of the
same with the harmful consequences of the event.

It was noticed that the fall began to be valued by the group
studied, after which consequences considered more serious,
for example, needing hospitalization and surgery. The study
participants, given the degree of importance they attributed,
did not value recurrent falls. It is believed, then, that the fall
gained visibility in the face of painful repercussions. It was
observed that the repercussion of the fall was positive, when
it led the participants to reflect on preventive aspects associ-
ated to the fact that the elderly had more tranquil behavior to
perform daily activities.

Thus, the training and empowerment of the elderly and
caregivers and the permanent education of health profession-
als, mainly Primary Health Care, are crucial so that they can
understand the magnitude of the event with a view to recog-
nizing, valuing and intervening in situations of risk with focus
on prevention and health care.

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