Determinação do ponto de corte do IVCF-20 para detecção de qualidade de vida ruim em idosos atendidos na atenção primária à saúde

Abstract

INTRODUCTION: The purpose of elderly care in Primary Health Care (PHC) comprises prevention, early diagnosis and adequate treatment of diseases, aiming at maintaining functionality and good quality of life (QOL), with the latter being a variable that influences patient mortality in this age group. There are several questionnaires validated for the purpose of assessing health vulnerability and QOL in the elderly. The Functional Clinical Vulnerability Index-20 (Índice de Vulnerabilidade Clínico Funcional-20, IVCF-20) was developed to assess health vulnerability in the elderly assisted in PHC in Brazil. However, it does not have a validated cutoff point for detecting poor quality of life in these patients. OBJECTIVES: Determine the cutoff point of IVCF-20 to detect poor quality of life (QOL) in the elderly and assess its prognostic role. METHODS: This cross-sectional study was carried out in the Primary Health Care (PHC) Units of Ceilândia (DF, Brazil), between September 2019 and January 2020. Sample size calculation used a 5% margin of error, a 95% confidence level, 50% prevalence, and an addition of 20% to compensate for possible losses. With the elderly population estimated at 45,022individuals, the calculated sample was 458.The individuals answered the IVCF-20, WHOQOL-bref and the Suemoto Index(a 10-Year Mortality Prediction Model). Three subgroups were created: poorQOL (considered their QOL as “poor” or “very poor” AND were “dissatisfied” or “very dissatisfied” with their health), goodQOL (considered their QOL as “good” or “very good” AND were “satisfied” or “very satisfied” with their health) and undeterminedQOL (combination of answers that did not belong to the two previous groups). The Receiver Operating Characteristic (ROC) curve (using Youden index) showed the IVCF-20 cutoff point for detection of poorQOL (with goodQOL being the control group). Diagnostic tests were performed in all individuals in the sample using this cutoff point. Spearman's correlation was used to assess the correlation between IVCF-20 and the 10-year mortality risk. RESULTS: The IVCF-20 cutoff point to detect poorQOL was ≥ 11. The area under the ROC curve was 0.97 (95% CI: 0.95-0.98). The IVCF-20 diagnostic tests showed good sensitivity (88.1%) and specificity (84.9%). Spearman’s correlation between the IVCF-20 and the 10-year mortality risk was positive with r = 0.32 (p <0.0001). CONCLUSION: IVCF-20 ≥ 11 adequately detected poorQOL in the elderly in PHC. Moreover, IVCF-20 has a positive correlation with the 10-year mortality risk. These data suggest that elderly individuals with IVCF-20 ≥11 should receive special care, through higher frequency consultations at PHC or geriatrics collaborative care, considering the impact that QOL can have on in these patients’ mortality.