Risk of Falls in Older Adults in the Rural Region

Case Study Paccha Cuenca, Ecuador

Johanna Campoverde

, Jessica González

and Ana Pérez

Medical Sciences Faculty, Universidad de Cuenca, Av. 12 de Abril s/n, Cuenca, Ecuador

Keywords: Aging, Old Age, Accidental Falls, Risk Assessment.

Abstract: The growing aging of the population constitutes a challenge in the social and health system which considers

the risk of falls as one of its main health problems. The objective of the study is to determine the risk of falls

in the elderly population of the La Fortaleza group - Paccha, Cuenca. This research corresponds to a

descriptive and cross-sectional case study, where the unit of analysis was the elderly from the La Fortaleza

group. The Tinetti scale determine the risk of falls in older adults, with a reliability 0.95 - 0.8 and Cronbach's

Alpha 0.91. The frequency and distribution statistics were analyzed in the SPSS version 25 program and to

determine the statistical significance the Chi- Square statistic was used 86 older adults with a mean age of

76.65 years (SD = 7.35) were evaluated, determining a high risk of falls (61.6%) in this population. An

association was obtained between the risk of falls and the age variable (p = 0.000); furthermore, the

equilibrium dimension of the Tinetti scale had a greater implication than the march in the risk of falls of the

older adults. Conclusion: The high risk of falls in this population is associated with older age and alterations

in balance. Finally, the need for more studies of different characters and scales is analyzed.

1 INTRODUCTION

Aging corresponds a series of structural and

functional changes that are accentuated after the age

of 65. The theory of aging tells us that we begin to

age from the moment we are born (Morejón et al.,

2018) this process decreases motor, cognitive and

social capacities; making older adults susceptible to

falls or accidents in the environment in which they

operate (Alvarado & Salazar, 2014). According to the

World Health Organization (OMS, 2017) within 50

years, it is estimated that there will be a growing

population of older adults worldwide, this is because

the population pyramid tends to flatten at the top, as

a result of a decrease in fertility and a significant

increase in life expectancy (González, R., 2018). In

Ecuador, a person over 65 years of age is considered

an older adult (Ochoa et al., 2018).

According to data from the Institute of Statistics

and Censuses of Ecuador (INEC, 2015) in 2010 the

adult population was 940,000, which represented

https://orcid.org/0000-0001-6058-9433

https://orcid.org/0000-0002-8371-0045

https://orcid.org/0000-0002-9384-3669

6.5% of the population at the national level. The

Ministry of Economic and Social Inclusion of

Ecuador (MIES), considering data from the

Economic Commission of Latin America and the

Caribbean (ECLAC), established that Ecuador has an

aging index of 28 older adults for every 100 children

under 15 years of age and According to the INEC

population projections in 2020 there were 1,264,423,

in 2050 it will represent 17% and in 2075 it will be

26% of the total population (INEC, 2015). With these

data, it is evident that population aging is on the rise

both nationally and globally, therefore, as society

ages, social and health problems increase (Terra et al.,

2014).

Older adults due to the conditions indicated above

present a series of risks such as suffering from

cardiovascular, respiratory, muscular, joint, and

metabolic diseases and the risk of suffering falls. On

the other hand, falls are defined as any involuntary

event that results in loss of balance and causes the

204

Campoverde, J., González, J. and Pérez, A.

Risk of Falls in Older Adults in the Rural Region Case Study Paccha Cuenca, Ecuador.

DOI: 10.5220/0011000600003188

In Proceedings of the 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2022), pages 204-212

ISBN: 978-989-758-566-1; ISSN: 2184-4984

body to hit the ground or another firm surface that

stops it (Gómez et al., 2016).

Falls are one of the great Geriatric syndromes and

a frailty factor in this population due to its

considerable prevalence percentage that varies

between 30 to 50% and the annual incidence between

25 to 35%, in addition to the fact that as age increases,

the risk of falls increases being 30% in people over

65 to 50% in people over 80 (Villar et al., 2015).

Falls affect the biopsychosocial sphere of the

elderly, since they are the cause of physical and

psychological injuries that require prolonged periods

of treatment and rehabilitation, in addition to

limitations in activity and social participation (Gómez

et al., 2016).

The WHO and the Ministry of Public Health of

Ecuador recognize the negative impact of falls and

the importance of working on it to provide the elderly

with a quality of life that meets their needs, in

Ecuador it is done through a model of Prioritization

of Health Research 2013-2017 where falls are part of

the line of investigation of unintentional or transport

injuries, this document seeks to optimize resources to

carry out research on this problem and from the

results achieve a positive impact in the lives of adults

(Ministry of Public Health, 2013) despite this

information the evaluation of the risk of falls goes

unnoticed by health professionals, this because older

adults do not usually mention these events, they are

not asked about the recurrence of falls because in

some cases there are no serious injuries and mainly

because it is attributed to the normal aging process

(Villar et al., 2015).

Therefore, a comprehensive geriatric assessment

where intrinsic factors are clearly identified (personal

pathologies, sense organs), extrinsic factors

(environmental risks) and circumstantial factors

(related to the activity being carried out) (Villar et al.

, 2015) will allow taking the measures of health

promotion and prevention according to the needs of

the elderly and work in a timely manner through the

implementation of effective measures, such as:

eliminating architectural barriers, work on muscle

strengthening, proprioception, balance exercises -

coordination , in addition to making adaptations at

home and thus preserving/improving the

independence and autonomy of the elderly (Terra

Jonas et al., 2014).

Several scales allow the assessment of falls in the

elderly, among these we have: the Downton scale that

assesses risk factors such as previous falls, use of

medications, sensory deficit, mental state, and gait;

Tromp's multiple falls scale that assesses visual

problems, urinary incontinence; and the Get up and

Go Test that assesses mobility about the risk of falls.

Although there is a wide variety of measurement

instruments that allow assessing the risk of falls, the

Tinetti scale is appropriate for assessing gait and

balance; this scale is observational, standardized, and

used to measure and determine the risk of falls in

older adults individually with a total score of 28

points (Beorlegui et al., 2017).

The present case study is done in the context of

the Physical Therapy career of the University of

Cuenca. It was carried out in a rural parish of the city

of Cuenca-Ecuador, where the risk of falls in older

adults was evaluated in this community. Whose

objective was: to determine the risk of falls in the

elderly population of the La Fortaleza group of the

rural parish Paccha. Cuenca - Ecuador (González &

Pérez, 2021).

The document is structured as follows, section 1

presents a brief introduction to the article, in section

2 related works on the proposed research topic are

shown, in section 3 the case study and its planning

design are written, sections 5 - 6 cover the

discussion and conclusion reached by the authors

respectively. Finally, section 7 is contemplated for

future work.

Finally, we emphasize the role played by the

older adult within society and each of their families

with their active participation within the social

context; without a doubt they constitute a true

example for future generations.

2 RELATED WORK

In recent years there have been several studies related

to the risk of falls in older adults. The article

presented below indicates that falls occur at any age

being children and older adults the groups with the

highest incidence, but mortality and disability are

high in the latter. In addition, people who are

dependent on their activities of daily living (ADL)

have a 78% higher risk of falling than an older adult

who does not have ADL limitations, also in this same

article it is considered that 50% of falls are due to

extrinsic factors, such as environmental factors,

architectural environment or elements of personal use

(Álvarez, 2015).

On the other hand, in the study by Topka et al.

(2020) it is mentioned that one in three older adults

falls at least once a year; these events are caused by

the interaction of various internal and external

factors. For (Morales, 2016) other factors related to

falls in older adults are the collateral effects of

medications, physical inactivity, cognitive and visual

Risk of Falls in Older Adults in the Rural Region Case Study Paccha Cuenca, Ecuador

205

alterations, and the lack of adaptations at home.

Another study reports that from the age of 60, 15% of

older adults present gait alterations and at 85 years

these gait alterations increase by up to 50%

predisposing them to falls in the older adult (Pérez et

al., 2020).

Approximately 30% of 65-year-old older adults

living in the community suffer at least one fall per

year, this number increases when the elderly lives in

institutions, 50% of these falls require medical

attention, and 10% end in fracture (Suárez et al.,

2018). Finally, falls and their consequences are a

persistent long-term problem in the older adult, it is

evidenced that there are fewer falls between midnight

and six am, concluding that falls occur more during

daily movement than at night; and that these occur

mostly in the bedroom - bathroom (Anderson & Lane,

2020).

It is essential to know as part of a comprehensive

geriatric assessment the risk of falls in the elderly

population so that health professionals such as

physiotherapists, kinesiologists, and personnel

dedicated to the care of the elderly carry out timely

activities of promotion and prevention of them.

In Ecuador there have been few studies on falls or

similar in the elderly population, among the most

recent is a research work entitled ¨Evaluation of the

physiotherapeutic intervention in the prevention of

falls in the elderly at the Hogar Sagrado Corazón de

Jesús¨ (Cunalata & Garcés, 2017), even when it is

considered that a fall entails expenses at the health

level that imply treatment, rehabilitation, loss of

productivity, early retirements, whether due to

disability, widowhood (Calero et al., 2016); and, at

the province of Azuay little updated bibliography is

reported that provides information on this problem

(Alvarado, L et al., 2014), therefore, this article

provides updated information on the risk of falls in

older adults in a rural parish of Cuenca- Ecuador.

3 CASE STUDY

This study is quantitative, descriptive in scope, and

cross-sectional. The participants were older adults

from the “La Fortaleza” group belonging to the

Decentralized Autonomous Government project of

the Paccha - Cuenca parish, which was evaluated in

July 2021, to determine the risk of falls in this

population.

This section presents the design and execution of

the case study according to the guidelines of Runeson

& Höst (2008) that propose the following

organization: i) the design and planning of the case

study, ii) the preparation and collection of data, iii)

analysis and interpretation of the findings and iv)

threats to the validity of the study.

3.1 Design and Planning

Carrying out a design and planning of the collection

and the subsequent analysis of data allows

guaranteeing the directionality of the study to comply

with the objectives set. In this sense, the objectives,

the delimitation of the case and the unit of analysis, a

brief frame of reference, and the research questions

are presented.

3.1.1 Objectives of the Case Study

This case study has the following objectives:

 Characterize the participants according to

age and sex.

 Identify the level of risk of falls by

applying the Tinetti scale.

 Compare the factors with the highest and

lowest scores derived from the Tinetti scale.

3.1.2 The Case and the Unit of Analysis

This case study corresponds to a holistic-unique

study. In other words, the phenomenon (risk of falls)

will be analyzed in a single context and the

characteristics of the cases (participants) are

homogeneous, as shown in figure 1.

Figure 1: Case study design.

Context: in Ecuador, the Decentralized Autonomous

Governments are institutions that make up the

territorial organization of the state with political,

administrative, and financial autonomy regulated by

the Constitution of the Republic of Ecuador and the

Organic Code of Territorial Organization, Autonomy

and Decentralization (COOTAD) (Mafla, 2019). The

rural parishes constitute remote sectors of the city,

where its inhabitants live from agricultural and

livestock activities. Paccha is a rural parish that is

2,600 meters above sea level, located northeast of the

city of Cuenca, inhabits 6,467 inhabitants and covers

a territorial area of 26.4 km, which represents 0.8%

of the total cantonal territory (GAD Paccha, 2019).

The population over 65 years of age represents 9.5%

ICT4AWE 2022 - 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health

206

of the total population of the Paccha parish

(CONAGOAPRE AZUAY, 2011).

Case: the group "La Fortaleza" is directed -

coordinated by a Graduate in Physiotherapy; among

its objectives is to provide comprehensive care to the

elderly in the Paccha parish. This group is attached to

the Municipal GAD previously described in an

agreement with the Ministry of Economic and Social

Inclusion (MIES) since 2015 (Ministry of Economic

and Social, 2015).

Theory: Falls are the fourth geriatric syndrome

with the highest prevalence, they produce a decrease

in the functionality of the older adult and an increase

in admission to emergencies. The Tinetti scale is an

instrument that makes it possible to assess older adult

mobility by assessing the gait and balance domains to

detect the risk of falls in the geriatric population

(Guevara & Lugo, 2012). The first domain assesses

balance in various actions (for example: sitting,

attempts to get up, immediate standing) with a

maximum score of 16 pts; For its part, the gait domain

includes items related to the start of the gait, length,

step height, among others; scoring a maximum value

of 12 pts, which adds up to a total of 28 (Rodriguez

& Lugo, 2012).

3.1.3 Research Questions: Constructing the

Questions from the Dimensions

With all the aforementioned, this case study seeks to

answer the following research questions:

● Are there differences between men and

women with respect to standing balance?

● Who is at slight risk of falls, men or women?

● What age range is at high risk of falls or

suspected of a claudication pathology?

3.2 Data Preparation and Collection

Lehtbridge (2005) points out that before data

collection it is essential to identify the degree of

involvement of the researcher at the time of data

collection. In a case study, the collection is director of

the first degree; that is, the researcher uses data

collection methods that allow him to be in direct

contact with the subjects and the data is collected in

real-time. Therefore, the observation is based on the

protocol designed and validated by Tinetti. Runeson

& Höst (2008) propose different types of observation

depending on the degree of interaction by the

researcher and the degree of knowledge of the

observed subjects. The types of research can be of 4

categories as presented in Table 1.

Table 1: Types of case study observed research.

Knowledge of the observed

subject

High Low

Degree of

interaction by the

researcher

High Category 1 Category 2

Low Category 3 Category 4

This study belongs to category 1 and the analysis

approach will be quasi-statistical or descriptive

statistical.

3.3 Analysis and Interpretation of the

Findings

The results are presented below based on the

objectives set out in section 3.1.1. The characteristics

of the participants are shown in Table 2. It is evident

that the majority of the participants are women (n =

56) and range between 75 and 79 years; being the

mean age of all participants 76.65 years (SD = 7.35).

Table 2: Sociodemographic characteristics.

Sociodemographic characteristic N %

Sex

Men 30 34,9

Women 56 65,1

Age

65 – 69 10 11,6

70 – 74 12 14,0

75 – 79 21 24,4

80 – 84 19 22,1

85 – 89 16 18,6

90 – 94 6 7,0

95 – 99 2 2,3

The level of risk of falls of the participants is

shown in Figure 2. It is evidenced that the majority of

older adults have a high risk of falls (n = 53; 61.6%)

and only 7.0% (n = 6) reports a slight risk of falling.

Figure 2: Frequency of risk of falls.

Risk of Falls in Older Adults in the Rural Region Case Study Paccha Cuenca, Ecuador

207

Table 3: Sociodemographic characteristics and level of risk

of falls.

Characteristics

Mild Moderate High



p

n % n % n %

Sex

Female 2 3,6 16 28,6 38 67,9

0,13

Male 4 13,3 11 36,7 15 50,0

Age

65to69years 4 36,4 7 63,6 ‐ ‐

0,00

70to74years 1 8,3 8 66,7 3 25

75to79years 1 4,8 10 47,6 10 47,6

80to84years ‐  2 11,1 16 88,9

85to89years ‐  ‐  16 

≥to90years ‐  ‐  8 

The characteristics related to the level of risk of falls

are shown in Table 3. It is evidenced that the risk of

falls has a statistically significant difference in the

different age groups (X2 = 53.691; df = 10; p =

0.000), being participants over 80 years of age those

with a higher level of risk. Regarding sex, there are

no statistically significant differences between men

and women (X2 = 4.087; df = 2; p = 0.130); however,

women (n = 38; 67.9%) score a higher risk of falls

according to the Tinetti scale. The frequency of

scoring the balance and gait factors is shown in Table

4. Regarding the gait parameter, it is evident that none

of the participants obtained the maximum score (12

points); on the contrary, 18.60% (n = 16) of the older

adults obtained a score of 8. On the other hand,

concerning balance, it is shown that almost half of the

participating older adults (n = 41; 47, 68%) oscillate

a score between 8 and 11 points out of a total of 16 in

this dimension.

Table 4: Frequency of Balance and Gait Score.

Score

Balance Gait



% N



3 0 0,00 2 2,33

4 1 1,16 6 6,98

5 6 6,98 13 15,12

6 7 8,14 12 13,95

7 6 6,98 13 15,12

8 10 11,63 16 18,60

9 11 12,79 11 12,79

10 9 10,47 9 10,47

11 11 12,79 4 4,65

12 7 8,14 0 0,00

13 5 5,81

‐



‐

14 6 6,98

‐



‐

15 7 8,14

‐



‐

16 0 0,00

‐



‐

3.4 Threats of Validity

A case study, due to the nature of the research, entails

threats to validity that need to be mitigated. Next, the

threats that this study has had and the different

solutions to face them are presented.

3.4.1 Construct Validity

The theoretical proposal about the assessment of the

risk of falls has been consolidated by Dr. Mary Tinetti

(1986). This construct has been widely addressed by

the scientific community (Köpke & Meyer, 2006;

Stucka et al., 1999). To evaluate it, scales have been

validated that allow quantifying the dimensions that

compose it (gait and balance). The Tinetti scale is a

tool whose main objective is to determine the risk of

falls in the elderly, it is made up of two dimensions:

balance, which is subdivided into 9 items and gait into

7 items. The responses of the items are scored as: 0

when it is not possible to maintain stability in the face

of postural changes or has an abnormal gait pattern, 1

when there is stability in the face of postural changes

or gait patterns through postural compensation and 2

when there is no difficulty. to carry out the activities

of the scale.

The maximum score of the balance dimension is

16 points and the gait dimension is 12 points. The sum

of both dimensions gives us a total score of 28 points,

categorizing the risk of falls as mild with a score of

less than 19 points, moderate between 19 to 24 points

and high risk with a score lower than 19 points.

3.4.2 Internal Validity

The factors that can influence the results during the

application of the Tinetti Scale are: the use of

medications in the wrong doses, confusion in the

administration of very frequent situations in the

elderly population, or the use of medications such as

antidepressants and diuretics that mainly affect

mobility, gait, and balance (Cabrera, Roy, & Toriz,

2019). Therefore, in the present study older adults

who meet these conditions were considered

exclusion criteria.

3.4.3 External Validity

The data provided by the Tinetti Scale on falls in the

elderly are of vital importance for the Ministry of

Public Health, Geriatric Centre’s and Decentralized

Autonomous Governments due to the costs in

treatment and rehabilitation, as it requires the hiring

of gerontologists and the specialization of nurses,

ICT4AWE 2022 - 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health

208

doctors, physiotherapists in the specific management

the older adult (Villar. T., 2015).

3.4.4 Reliability

The Tinetti scale in Latin America has been validated

in Spanish since 2012 with inter-and intra-observer

reliability of 0.95 - 0.8 and a Cronbach's Alpha of 0.91

(Rodriguez & Lugo, 2012); the gait dimension has a

sensitivity of 88% - specificity of 63%, while the

balance dimension has a sensitivity of 81% and

specificity of 75% (Park, et al., 2018).

4 DISCUSSION

The objective of this case study is to determine the

risk of falls in the elderly population of the La

Fortaleza group - Paccha, Cuenca. The importance of

it lies in the fact that older adults are especially

sensitive to physiological changes derived from the

aging process that can reduce their locomotion and

hence their functionality. In the geriatric age, falls

represent the most common cause of accidents

generating physical, psychological, and economic

consequences that negatively influence the quality of

life of the elderly (de Alejo et al., 2020).

After applying the Tinetti scale, it was determined

that the study population presents a risk of falls, being

distributed as follows: high risk of falls 61.6%,

moderate risk of falls 31.4% and low risk of falls 7 %,

results similar to those obtained in the study by Silva

et al. (2014) in which it was recorded that 54.7% had a

high risk of falls, in the same way in the study by

Samper et al. (2016) 73.1% presented a high risk of

falls, as can be seen in these studies there are

significant values of high risk of falls which

demonstrates the importance of evaluating balance

and gait through a standardized scale such as the

Tinetti scale since through this assessment the

geriatric patient could be recommended and guided

about any technical help they would need to prevent

and/or reduce this problem.

In the descriptive analysis of the present study,

when relating the risk of falls with sex, there was no

statistical relevance (p = 0.13), coinciding with the

study by Carballo et al., (2018). However, several

studies indicate that the female sex has a higher risk

of falls arguing that the physiological and structural

characteristics at the musculoskeletal level, hormonal

changes related to menopause and the performance of

multiple housework predispose the possibility of

suffering a fall (Petronila et al., 2017; Samper et al.,

2016; Silva et al., 2014; Smith et al., 2017). It is

important to mention that most of the studies are

carried out in a sample made up of more women than

men, as in our study where 65.1% belong to the female

sex, this difference between the female and male sex

could be justified because the life expectancy is

greater in women (Samper et al., 2016).

The average age in our study was 76.65 (SD =

7.35) years and statistically the risk of falls was

higher in advanced ages, observing a high risk of falls

in ages over 80 years. About this, the study by Samper

et al., (2016) mentions that there is controversy

regarding the age range and the risk of falls because

on the one hand it is stated that the risk of falls is

higher in the 80 years and that people have more

pathologies; and on the other hand, people under 75

years of age fall more because they have more

movement, which increases exposure to risk factors,

in addition to not recognizing that their physical

condition is decreasing and they may suffer falls due

to carelessness.

According to a study where the Tinetti scale was

applied to a group of older adults it concluded that

when the balance is slightly compromised there was

a slight deterioration in gait, especially in activities of

daily living (Álvarez, M & Espinosa, A., 2018).

As can be seen older adults are at risk of falling,

therefore, it is suggested that physical activity plans

and programs that involve balance exercises,

coordination, dissociation of upper and lower limbs,

muscle strengthening, and gait be promoted.

According to Martínez et al., (2018) aging is

considered an achievement in public health and

socioeconomic policies, which is why the

Ecuadorian state seeks to implement public policies

with an emphasis on human rights and social

participation with the family, community and state,

by promoting active ageing multifactorial and

multicomponent preventive interventions are

considered the most effective because they have as

pillars physical exercise, medical evaluation,

environmental modification and medication

adjustment in preventive interventions. (MIES,

2015).

5 CONCLUSIONS

At the end of the study, it was determined that of the

86 older adults evaluated with the Tinetti scale,

61.6% had a high risk of falls. The factor that was

associated with a high risk of falls was age (p = 0.000)

being statistically significant; about sex, there are no

statistically significant differences between men and

women. And regarding the gait and balance

Risk of Falls in Older Adults in the Rural Region Case Study Paccha Cuenca, Ecuador

209

parameter of the Tinetti scale, it is evidenced that

none of the participants obtained the maximum score

in the gait parameter (12 points) and 18.60% (n = 16)

of the older adults obtained a score of 8; on the

contrary, in the equilibrium parameter, it is shown

that almost half of the participating older adults (n =

41; 47.68%) obtained a score between 8 and 11 points

out of a total of 16 in this dimension which this means

that the balance dimension had a greater implication

than the walking dimension in determining the risk of

falling according to the Tinetti scale in the older adults

of the La Fortaleza group, this may be because

balance demands the integral performance of multiple

systems such as the vestibular, visual and

proprioceptive; and if there is an alteration at the level

of balance the risk of suffering a fall is imminent. The

application of the Tinetti scale has proven to be

feasible in our study population allowing us to

evaluate the risk of falls and collect information of

interest to the Autonomous Decentralized

Government (GAD) of the urban parish ¨Paccha¨ to

interventions and strategies are developed to reduce

the risk of falls.

6 FURTHER WORK

This research is a case study that has the limitation of

not being able to extrapolate the results to other

contexts; therefore, it is suggested to carry out

multicentre studies, which allow characterizing the

risk factor. For this reason, it is also suggested that

analytical and longitudinal studies be carried out to

identify factors associated with the loss of

functionality of the Elderly.

In addition, it is recommended to generate kinetic

intervention programs which combine balance and

coordination exercises aimed at the elderly

population, empower older adults on the prevention

of falls, their causes, and consequences through

communication strategies, develop studies that

analyse the risk of falls about the influence of

extrinsic factors, finally we suggest that the

governments of the day develop projects aimed at the

development of comprehensive geriatric care framed

in the improvement of the physical and mental health

of the elderly.

ACKNOWLEDGEMENTS

This research was developed thanks to the support

provided by the University of Cuenca through support

strategies for teachers and students interested in

generating research. We thank the Vice-Rector for

Research and Postgraduate Studies of the University

of Cuenca for the technical, academic and financial

support.

REFERENCES

Alvarado, A. M., & Salazar, Á. M. (2014). Análisis

del concepto de envejecimiento. Gerokomos, 25(2), 57-

62.

https://doi.org/10.4321/S1134-

928X2014000200002

Alvarado Astudillo, L., Astudillo Vallejo, C., & Sánchez

Becerra, J. (2014). Prevalencia de caídas en adultos

mayores y factores asociados en la parroquia

Sidcay. Cuenca, 2013. (Bachelor’s thesis)

[Tesis, UNIVERSIDAD DE CUENCA].

http://dspace.

ucuenca.edu.ec/bitstream/123

456789/6729/1/TESIS.pdf

Álvarez, L. M. (2015). Síndrome de caídas en el adulto

mayor. Revista Médica de Costa Rica y Centroamérica,

72(617), 807-810.

https://www.medigraphic.com/pdfs/

revmed

coscen/rmc-2015/rmc154w.pdf

Álvarez, M & Espinosa, A. (2018). VIDA Y SALUD CON

LA GIMNASIA PARA ADULTOS MAYORES. Revista

Conrado. 14(61): 73-76. http://conrado.ucf.edu.cu/

index.php/conrado

Anderson, L & Lane, K. (2020). Characteristics of falls and

recurrent falls in residents of an aging in place

community: A case-control study. Applied Nursing

Research,51:151190.https://doi.org/10.1016/j.apnr.201

9.151190

Beorlegui, M., Larramendi, N., & Carvajal, A. (2017). La

prevención de caídas recurrente en el paciente anciano.

Gerokomos, 28, 25- 29.

https://scielo.isciii.es/pdf/geroko/

v28n1/113

4-928X-geroko-28-01-00025.pdf

Cabrera VO, Roy GI, Toriz SA. (2020). Factores de riesgo

para síndrome de caídas en adultos mayores con

polifarmacia. Aten Fam, 27(1):27-31

Calero, M., López, G., Ortega, A & Cruz, A. (2016).

Prevención de caídas en el adulto mayor: Revisión de

nuevos conceptos basada en la evidencia. European

Journal of Investigation in Health, Psychology

and Education, 6(2), 71-82.https://doi.org/10.30552/

ejihpe.v6i2.16

Carballo, A., Gómez, J.,

Casado, I., Ordás, B., Fernández,

D., Carballo, A., Gómez-, J., Casado, I., Ordás, B., &

Fernández, D. (2018). Estudio de prevalencia y perfil

de caídas en ancianos institucionalizados. Gerokomos,

29(3), 110-116. https://scielo.isciii.es/scielo.php?

script=sci_ abstract&pid=S1134

928X2018000300110&

lng=es&nrm=iso&tl

ng=es

CONAGOPARE (Consejo Nacional de Gobiernos

Parroquiales Rurales del Azuay). (2011).

https://conagopareazuay.gob.ec/w30/poblacion-de-las-

parroquias-del-azuay/

Cunalata, M., & Garcés, L. (2017). Evaluación de la

intervención fisioterapéutica en prevención de caídas

del adulto mayor del Hogar Sagrado Corazón

ICT4AWE 2022 - 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health

210

de Jesús” [UNIVERSIDAD TÉCNICA DE

AMBATO].Pdf.

http://repositorio.uta.edu.ec/jspui/handle/12

3456789/25722

De Alejo-Plaín, A. P., Roque-Pérez, L., & Pazos, C. P.

(2020, abril 16). Las caídas, causa de accidente

en el adulto mayor. 2020, 59(16), 276.

http://www.rev16deabril.sld.cu/index.php/1 6_04/

article/view/705

GAD Paccha. (2019). Datos Generales del Gobierno

Autónomo Descentralizado de Paccha. GAD

PARROQUIAL PACCHA. https://paccha.gob.ec/azuay/

Gómez, L. P., Chicharro, S. A., & Morcuende, B.

C. (2016). Caídas en ancianos institucionalizados:

Valoración del riesgo, factores relacionados y

descripción. Gerokomos, 28(1):2-8

https://scielo.

isciii.es/scielo.php?script=sci_ arttext&pid=S1134-

928X2017000100002

González, J., & Pérez, G. (2021). Evaluación del riesgo de

caídas en personas mayores de 65 years del grupo La

Fortaleza de la Parroquia Paccha—Cuenca, Julio-

Diciembre 2021 [Estudio descriptivo]. Universidad de

Cuenca.

González, R. (2018). Calidad de la atención médica dirigida

a adultos mayores frágiles. Rev. Arch Med Camagüey,

22(1), 4. http://revistaamc.sld.cu/

INEC. (2015). Mujeres y Hombres del Ecuador en cifras

III: serie información estratégica. Ecuador en

Cifras.

https://www.ecuadorencifras.gob.ec/wp-

content/descargas/Libros/Socioeconomico/ Mujeres_y

_Hombres_del_Ecuador_en_Cifr as_III.pdf

Köpke, S., & Meyer, G. (2006). The Tinetti test. Zeitschrift

für Gerontologie und Geriatrie, 39(4), 288-291.

https://doi.org/10.1007/s00391-006-0398-y

Lethbridge, T. (2005). “O desafio de trabalhar com o pai”.

Exame. 838(5), pp. 22-30.

Mafla. (2019). El arte de gobernar un Gobierno Autónomo

Descentralizado es, primero, un problema

conceptual. Estudios de la Gestión. Revista

Internacional de Administración.203-212. https://doi.

org/10.32719/255506641.2019.5.8

Martínez, T., González, C., Castellón, G & González, B.

(2018). El envejecimiento, la vejez y la calidad de vida:

¿éxito o dificultad? Revista Finlay, 8(1), 59-65.

Recuperado en 16 de febrero de 2022,

http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=

s2221-24342018000100007&lng=es&tlng=es

Ministerio de Económica y Social. (2015). CONVENIO DE

COOPERACIÓN ECONÓMICA N°AM 06-91D01-

01211. ENTRE EL MINISTERIO DE INCLUSIÓN

ECONÓMICA Y SOCIAL (MIES) Y EL GOBIERNO

AUTÓNOMO DESCENTRALIZADO PARROQUIL DE

PACCHA PARA LA IMPLEMETACIÓN DE

SERVICIOS DE ADULTOS MAYORES.

Ministerio de Salud Pública. (2013). Prioridades de

investigación e n salud, 2013-2017.

Instituto Nacional de Investigación en Salud Pública.

https://www.healthresearchweb.org/files/Prioridades20

132017.pdf

MIES (Ministerio de Inclusión Económica y Social).

(2015). Dirección Población Adulta Mayor. (2015).

https://www.inclusion.gob.ec/direccion-poblacion-

adulta-mayor/

Morales, M. C. (2016). Resumen de factores que

contribuyen a las caídas en adultos mayores e

implicaciones para enfermería. Enfermería

Clínica, 26(4),

258-260. https://doi.org/10.1016/j.

enfcli.2016.03.004

Morejón, M., Hernández, A., Pujol, A., & Falcon

Díaz, M.

(2018). Postura y equilibrio en el

adulto mayor. Su

interrelación con ciencia, tecnología y sociedad. Revista

Cubana de Medicina Física y Rehabilitación, 10(1), 122-

133. http://www.sld.cu/sitios/revrehabilitacion/

Ochoa, P., Castro, D & astro, N. (2021). Quality of life in

Older Adults: Evidence from Mexico and Ecuador

GERIATRICS, 6(3), 92; https://doi.org/10.3390/

geriatrics6030092

OMS. (2017). Envejecimiento y cambios demográficos.

Salud en las Américas. https://www.paho.org/salud-en-

las- americas-2017/mhp-aging-es.html

Park, J., Koh, S., Kim, H., Oh, E., Kim, J., Yun. J., Kwon,

Y., Park,J., Youn, J., & Jamg , W. (2018). Validity and

Reliability Study of the Korean Tinetti Mobility Test

for Parkinson’s Disease. 11(1): 24-29. DOI:

10.14802/jmd.17058

Pérez, A., Roque-Pérez, L., & Pazos, C. P. (2020). Las

caídas, causa de accidente en el adulto mayor.

ECIMED, 59(276), 1-6.

http://www.rev16deabril.sld.cu/

index.php/1

6_4/article/view/705

Petronila Gómez, L., Aragón Chicharro, S., Calvo

Morcuende, B., Petronila Gómez, L., Aragón Chicharro,

S., & Calvo Morcuende, B. (2017). Caídas en ancianos

institucionalizados: Valoración del riesgo, factores

relacionados y descripción. Gerokomos, 28(1), 2-

8.https://scielo.isciii.es/scielo.php?script=sci_ abstract

&pid=S1134

928X2017000100002&lng=es&nrm=iso&tl

ng=es

Rodriguez, C., & Lugo, L. (2012). Validez y confiabilidad

de la Escala de Tinetti para población colombiana.

Revista Colombiana de Reumatología, 19(4),

218-

233.

https://doi.org/10.1016/S01218123(12)70017-8

Runeson, P., & Höst, M. (2008). Guidelines for conducting

and reporting case study research in software

engineering. Empirical Software Engineering, 14(2),

131.

https://doi.org/10.1007/s10664-008-9102-8

Samper, B., Allona, S., Cisneros, L., Navas, C & Marín, R.

(2016). Análisis de las caídas en una residencia de

ancianos y de la influencia de entorno. Gerokomos,

27(1), 2-7. https://scielo.isciii.es/scielo.php?script=sci_

abstract&pid=S1134

928X2016000100002&lng=es&

nrm=iso&tl

ng=es

Silva, J., Porras, M., Guevara, G., Canales, R. , Fabricio, S.,

& Partezani, R. (2014). Riesgo de caída en el adulto

mayor que acude a dos Centros de Día. Lima, Perú.

Horizonte Médico (Lima), 14(3), 12-18.

http://www.scielo.org.pe/scielo.php?script= sci_abstract

&pid=S1727-

558X2014000300003&lng=es&nrm=iso&tl

ng=es

Smith, A., Silva, A., Rodrigues, A., Moreira, S., Nogueira,

J., & Tura, F. (2017). Evaluación del riesgo de caídas

en adultos mayores que viven en el domicilio1. Revista

Risk of Falls in Older Adults in the Rural Region Case Study Paccha Cuenca, Ecuador

211

Latino-Americana de Enfermagem, 25. https://doi.org/

10.1590/1518- 8345.0671.2754 8345.0671.2754

Stucka, A., Walthert, J., Nikolaus, T., Büla, C., & Beck, J.

(1999). Risk factors for the functional status decline in

community- living elderly people: A systematic literature

review. Social Science & Medicine, 48(4), 445-469.

https://doi.org/10.1016/S0277 9536(98)00370-0

Suárez, G., Velasco, V., Limones, M., Reyes, H., &

Zacarpias, B. (2018). Factores asociados con caídas en

el adulto mayor. PARANINFO DIGITAL, 12(28), 3.

http://www.index- f.com/para/n28/e025.php

Terra, L., Diniz, K., Soares, M., Mendes, M., da Silva, J.,

& Ribeiro, P. (2014). Evaluación del riesgo de caídas

en las personas mayores: ¿cómo hacerlo?

Gerokomos, 25(1): 13-16. https://doi.org/10.4321/

S1134-928X2014000100004

Tinetti, M. (1986). Preventing Falls in Elderly Persons. The

new England journal of medicine, 34(2), 119-116.

http://www.bumc.bu.edu/imresidency/files/2013/03/Fa

lls-NEJM.pdf

Topka, W., Kwiatkowska, M., Skierkowska, N., Prylińska,

M., & Gajos, W. (2020). Falls among the elderly.

Journal of Education, Health and Sport, 10(9), 614.

https://doi.org/10.12775/JEHS.2020.10.09. 073

Villar, T., Mesa, M., Esteban, A., Sanjoaquin, A., &

Fernández, E. (2015). ALTERACIONES DE LA

MARCHA, INESTABILIDAD Y CAÍDAS. 1:11.

Tratado de Geriatria. 84-689-8949-5.

ICT4AWE 2022 - 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health

212