Educational Intervention for the Prevention of Falls in Older Adults of Office Number 41

Aging is a natural event that involves a certain number of
anatomical, physiological, psychological and social changes in the
individual’s organism...


Introduction
Aging is a natural event that involves a certain number of anatomical, physiological, psychological and social changes in the individual's organism, but also with broad social repercussions; it does not constitute a simple or unitary process, but rather a bundle of processes associated with each other [1]. Demographic aging is a population phenomenon that has occurred throughout the world, the number of people over 60 years of age has risen from just over 400 million in 1950 to 700 million today, in 2000 the world population of The elderly was 578 million, with a forecast of more than 1200 million for 2025, it is expected that by the year 2050 it will be 1,420 million, that is, it will grow annually at a rate of 2.5% compared to the total world population that it only grows 1.7% [2]. It has occurred in the Cuban population since the twentieth century. At the beginning of it, there were around 72,000 people. Decennial growth is estimated at around 250,000 until the year 2000 and after this year, growth of more than 400,000 is expected until 2025 [3]. The presence in Cuba of more than 1.8 million elderly people, implies not only a simple increase in the proportion, but establishes the absolute increase of a social group with its own characteristics, its existence must be considered as an extraordinary social achievement, but also at the same time, it implies a challenge, that of a healthy old age that has ceased to be an exception and a privilege to become an opportunity in countries like ours, with a life expectancy that exceeds 77 years and programs that aim at a quality of life progressively better, being essential to know the health status of this sector, as well as its demands [4]. It is expected that in 2019 fewer people will arrive of working age and more will retire, with a substantial expenditure on social security, therefore that it is necessary to design health strategies for sciences such as Geriatrics [4,5].
Aging has general characteristics within the geriatric clinic: Atypical presentation of diseases, aging of organs and systems, deterioration of the senses, inadequate information from family members, little functional reserve and great repercussion in the social and family environment, therefore requires a solid culture of satisfying longevity, which dismantles myths and irrational ideas incompatible with full life in old age, acquires habits and behaviors that preserve their physical and mental well-being, and structures more human and realistic needs and motives with relation to their health and take responsibility for their own aging [5]. Accidents in general represent a growing health problem worldwide, with the elderly being a vulnerable group and multifactorial causes of accidents due to falls in the elderly. They can be: intrinsic when they are capable of causing alterations in the osteomyoarticular, cardiovascular, psychological, neurological, gastrointestinal and other systems; or extrinsic when they are due to conditions inside and outside the home such as uneven floors, inadequate lighting, defective stairs, wet or slippery floors, among others [6]. Our state maintains the premise of providing attention to the study and implementation of strategies in all sectors of society to face the high levels of aging of the population and raise the quality of the service provided, in order to achieve the satisfaction of the population and minimize the factors related to falls in the home of the elderly (AM), which imposes a challenge to research, teaching and care performance [7].

Problem Statement
What results does the execution of an educational intervention for the prevention of falls in older adults at the 41 Family Medical Clinic of the Santa Cruz health area, San Cristóbal Municipality offer?

Justification of the Problem
The aging of the Cuban population is identified as an event in full swing. According to the 2015 National Yearbook of Health Sta-tistics, 19.20% of people are 60 years old and over [8]. The Artemisa Province, for its part, shows a population aging index of 17.1 [8] The annual accident rate in the country for all ages is 48.3, in the case of Artemisa province it increases to 48.7, with 4020 deaths reported in those over 60 years of age with a rate that reaches 191.6 and specifically for those over 80 years of age it is 771.9, that is, it increases the death rate from accidents by almost 15 times for all ages [8]. Of this total number of accidents, 2,460 were due to falls, this being the main cause during 2015 with a rate of 21.9 [8]. In the case of San Cristóbal, our population shows a notable increase in the number of people over 60 years of age (15,436), reaching a Roset index (population aging) of 20.76, an indicator that is above the national average (19.0) [9]. Deaths from accidents, even though it decreases in 5 cases and the rate decreases to 27.9, it remains the fourth cause of death in the municipality [9]. The Santa Cruz health area has a total of 4099 elderly people and in the Office, Doctor  Table 1).

Information Processing
We used statistical methods for qualitative variables, chi-square to determine the association of variables and statistical significance, as well as Mc Nemar to evaluate the efficacy of the intervention. The results were processed manually with a calculator, using a Pentium IV PC with a Windows XP program. The texts were processed with Word XP, the tables and graphics were made in Excel XP. The results obtained are shown in contingency tables and graphs using absolute numbers and percentages as a summary measure.

Ethical Aspects
This research was adjusted to the recommendations contained in the Declaration of Helsinki 1989, respecting the voluntary nature and the right of people to participate or leave the study at the time they consider it respecting their will. After applying the survey and the questionnaire, the consent of the person was requested in writing (Appendix 1), with the guarantee of anonymity and confidentiality of the data collected in the forms ( that can contribute to the fact that the fall is more frequent in the elderly, they are divided into two large groups, the intrinsic ones that depend on the person and can be chronic in nature and the extrinsic ones that depend on the environment, which are refers to Table 6, which shows that before the intervention, only 3.2% of the elderly did not present any risk factor, which increases at the end of the educational strategy to 89.1%, of the 12 elderly who presented unsafe conditions without The need for resources was reduced to 8.1%, persisting 2.7% of the elderly with unsafe conditions due to the need for resources.      on the incidence of malignant diseases is higher in men than in women, which has justified the inversion of the population pyramid in terms of gender, with a predominance of the female sex after 60 years. The greatest concern of women for their health and for estrogenic protection has also been raised [14].
The validity for daily activity observed in our subjects is high and is equivalent to that found in other studies in our country [15].
subjects do not need any help and most older people can use their daily routine to solve their physiological, hygiene and personal care needs, make visits, go up and down stairs or stay alone at night, they can make their food and wash or iron your clothes without difficulties; They are capable with the purchase of errands and manage without requiring help [16] In other research, the same results are not observed since the elderly, suffering from chronic diseases adds to the aging process itself and the social situation in which they live, as the population ages, the prevalence of disabling chronic diseases increases and makes them fragile and dependent [17,18] The main immediate consequence of falls is fracture, from Parkinson's disease, cancer and chronic pain [27,28].
Seife M considers that chronic disorders or diseases vary from relatively benign ones, such as a partial loss that can be hearing, visual, to serious diseases such as cancer, cardiovascular diseases, diabetes, musculoskeletal diseases and even more alarming from the point of view From a statistical point of view, the greatest number of people will develop some type of disability or chronic disease that can become the cause of death. Most chronic diseases affect important aspects of life in people who have them. One of the main changes and perhaps the one that generates the greatest deterioration is the emotional aspect, since the person is necessarily forced to a rapid adaptation process for which they go through different stages that arouse a series of commonly negative emotions (fear, anger, anxiety) [27]. The changes produced by aging and chronic diseases that the elderly present are the main intrinsic causes of falls. Central nervous system diseases such as Parkinson's disease, dementia, strokes, confusional states, labyrinthine disorders, seizures, and peripheral neuropathy predispose to falls.
The most frequent cardiovascular risk factors are arrhythmias, syncope, orthostatic hypotension, and myocardial infarction [29].
Many authors argue that drugs play an important role in the etiology of falls, since many elderly take 1 or more drugs than per different mechanisms can cause falls such as sedatives, hypnotics, hypoglycemic agents, diuretics, alcohol [30,31].
In today's world it is a proven fact that as life expectancy increases, frailty rates and the prevalence of chronic diseases increase, aspects that accompany the last stretch of life [32]. It is therefore expected that a most of the older adults are frail and also suffer from chronic diseases [33][34][35]. Recent epidemiological studies document this association. Such is the case of a crosssectional study carried out in 740 older adults in a community of Santiago de Chile that analyzed the relationships between frailty, comorbidity and disability, the results of which revealed that 7.4% met Fried's criteria for frailty, of which 81.8% had associated chronic diseases and 29.1% had disabilities for activities of daily living [36]. The main extrinsic factors for falls inside the home are usually floors soaked by water or urine, polished floors, abandoned toys, pets, poor or intense lighting, carpets, lack of auxiliary bars in the bathroom, Stairs without handrails poorly lit with very high or worn steps. Falls also occur frequently in recent days after being admitted to the hospital or a residence, when we go for a walk through the unevenness of the floors, gaps and all the architectural barriers that exist [37]. The most dangerous places in the house are the bathroom and the kitchen; in the first, falls are suffered when slipping, when entering or leaving the shower, in the second, burns.
Small and stagnant furniture, lack of light, small rugs that can slip also influence; shoes without caps [38]. We must individualize all the extrinsic and intrinsic factors that could influence the fall, taking into account the multifactoriality of the fall, it is necessary to draw up a plan to prevent them, assessing and treating the intrinsic risk factors, assessing and eliminating the extrinsic factors, and analyzing the circumstances in which the fall occurred. The success of the treatment of falls lies in its prevention and the fundamental link is in the home and the community [39,40]. From the social point of view, the family abruptly breaks its usual functional harmony with work, home, psychologically the great anxiety that the elderly person may fall down again, and overprotection is making the elderly increasingly dependent, a high Afterwards, a number of these elderly need institutionalization in assisted residences because the family is not able to take care of them, so accidents can be avoided with caution, special supports must be installed, order and good lighting in the house can prevent them [41,42].
With the increase in life expectancy and the decrease in mortality, new social scenarios have been generated in which the coexistence of different generations in the same territory can be appreciated; this coexistence does not always translate into a positive link of communication and understanding. The different generations can already be found in family nuclei, in the coexistence of the same space as a home, but they cannot effectively be a bond based on the solidarity paradigm. In other cases, older adults may no longer live close to their family networks, they are in residences where ties must be forcibly established with other older adults in the same situation or in unfavorable conditions, where communication is seen reduced between the staff in charge of the caregiver work and the older adult himself. Therefore, the main objective of the educational strategy is to provide a collaborative learning space through the development of cognitive and social skills that contribute to the prevention of falls through the identification and elimination of risk factors effectively among the family. , society and older adults, with learning applicable to other dimensions [43].

Conclusion
The highest percentage of the patients that made up our sample was comprised between the groups of 70 and 79 years, with a predominance of males. Most of the elderly were independent in their evaluation, and in just over half there was a history of falls.
The vast majority presented a decrease in visual acuity as a cause associated with falls. Cardiovascular diseases predominated as antecedent. Following the strategy, both extrinsic risk factors for falls and unsafe conditions were reduced.