Comparação de ferramentas de avaliação de risco e vulnerabilidade em pacientes idosos da atenção domiciliar

Abstract

Population aging is a global phenomenon—accelerating rapidly in developing countries like Brazil—driven by increased life expectancy, declining fertility rates, and reduced mortality. This demographic shift triggers an epidemiological transition characterized by the prevalence of chronic non-communicable diseases, which require continuous, comprehensive care with an emphasis on preserving functional capacity. Although the National Health Policy for the Elderly adopts functionality as a key health indicator, its implementation across Basic Health Units (UBS) remains uneven. Multidimensional assessment is crucial for the early identification of vulnerability and the guidance of individualized therapeutic plans, yet it is not yet standard practice in many services. The primary objective of this study is to analyze the risk and vulnerability of elderly individuals receiving home-based care using the following scales: VES 13, IVCF-20, and the Risk and Vulnerability Scale for Home Care in Primary Health Care (APS) developed by Ribeiro and Fiúza. The study also describes the sociodemographic and clinical profile of the population linked to the Bacumixá UBS and compares the aforementioned scales. This is a descriptive, cross-sectional, quantitative study conducted in the catchment area of the Bacumixá UBS in Trairi, Ceará (CE), involving a sample of 36 homebound elderly patients. Data collection was carried out by the lead researcher during home visits, utilizing a sociodemographic and clinical questionnaire alongside the VES-13, IVCF-20, and Ribeiro and Fiúza scales. The homebound elderly population was found to have the following profile: the majority were over 75 years old (75%), female (63.9%), and retired (97.2%); most had a family income of 1–4 minimum wages (91.7%) and were illiterate (61.1%). It was also observed that hypertension was the most common comorbidity (97.2%), with polypharmacy (38.9%) being prevalent. All individuals evaluated exhibited some degree of dependence regarding instrumental activities of daily living, and more than one-third showed dependence for basic activities of daily living. Regarding the Ribeiro and Fiúza Risk and Vulnerability Scale, the following risk profile was obtained: 5.6% low risk, 44.4% medium risk, 25% high risk, and 25% very high risk; the domains predominating in the final score composition were functional dependence, polypharmacy, mobility, sarcopenia, urinary incontinence, and palliative care, with values ranging from moderate to strong. As for the IVCF-20, the following risk classification was obtained: 44.4% medium risk and 55.6% high risk; the domains predominating in the final score were functionality, depressive symptoms, cognition, mobility, gait, urinary incontinence, vision problems, and polypharmacy, with values also considered moderate to strong. Regarding the comparison between the scales, a moderate-to-strong correlation was observed in equivalent domains, with a very strong equivalence concerning the final classification of the IVCF-20 and the Ribeiro and Fiúza Risk and Vulnerability Scale. It is concluded that the scales used are important tools for managing home visits in Primary Health Care (PHC). As this is an initial study, further research with a broader scope, larger sample sizes, and different contexts is needed to better establish the correlation between the scales.