Difficulties experienced by geriatric patients regarding respiratory devices and access to health services: A cross-sectional study

Background/Aim: In the treatment of chronic respiratory failure, long-term oxygen therapy at home (LTOT) and domiciliary noninvasive mechanical ventilation (NIV) are important components of home care. The aim was to evaluate the compliance of geriatric patients with LTOT/NIV at home and their access to health services in the last year. Methods: Screening of 669 patients who were hospitalized in our pulmonary intensive care unit between 30.09.2019 and 30.09.2020 revealed a total of 109 patients over 80 years of age with chronic respiratory failure. Among them, 70 died after discharge. Six of the 39 surviving cases were excluded from the study because they were discharged without any LTOT and/or NIV devices, and the COVID-19 PCR tests of 4 patients were positive after discharge. The remaining 29 patients over 80 years of age were enrolled in the study. After questioning the patient's care status, caregivers were asked whether the patients were compliant with NIV and/or LTOT devices at home and their usage in terms of hours during the day and nighttime. In non-compliant patients, the reasons were acquired, and the answers were noted. They were asked whether they gave up on healthcare services and scheduled check-ups, had difficulties in getting a doctor's appointment, and whether they were incompliant with the appointments they made. If the answers were yes, they asked about their reasons for each question. Results: The median age was 85 (80-96) years, and 65.5% (n=19) of the cases were female. The diagnosis which led to hospitalization in 86.2% (n=25) of the patients was hypercapnic respiratory failure. Fifteen patients (51.7%) with LTOT and 9 patients (81.8%) with NIV did not use their devices as recommended. The patients' caregivers expressed that 22 patients (75.8%) could not meet their basic needs and 17 patients (77.2%) did not receive home care services provided by the Ministry of Health. Although the need arose in the post-discharge period, it was observed that 24 patients (82.7%) were not taken to the doctor and 20 patients (68.9%) did not schedule doctor visits after discharge. All caregivers stated that they were afraid of the COVID-19 pandemic and catching the COVID-19 disease from the emergency rooms and outpatient clinics. Conclusions: Our patients' compliance with the LTOT device was poor and 51.7% of the patients used the device less than recommended. Moreover, the patients were mostly incompliant with domiciliary NIV treatment. Receiving nonspecific home care services did not have any effect on LTOT and/or NIV compliance. It was observed that disruption in doctor visits and patient admissions leads to the decreased compliance with LTOT and/or NIV devices and loss of motivation to use these devices. The cases in this study avoided all kinds of admissions to the hospital due to the COVID-19 pandemic. In such conditions, structured and specific home care services for geriatric respiratory failure patients become more important. Continuing education and motivation at home will increase the quality of life of the patients and improve compliance.

Keywords:

Long-term oxygen therapy, domiciliary noninvasive mechanical ventilation, geriatric patients compliance, home care,

PDF

___

1. Ocaklı B. The Feasibility of Domiciliary Non-Invasive Mechanical Ventilation due to Chronic Respiratory Failure in Very Elderly Patients. Turk Thorac J. 2019 Apr 1;20(2):130-5. doi: 10.5152/TurkThoracJ.2018.18119.
2. Janssens JP, Derivaz S, Breitenstein E, De Muralt B, Fitting JW, Chevrolet JC, et al. Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area. Chest. 2003 Jan;123(1):67-79. doi: 10.1378/chest.123.1.67.
3. Özsancak Uğurlu A, Berk Takır H, Ergan B, İn E, Özyilmaz E, Ertan Edipoğlu Ö, et al. Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use at home for chronic respiratory failure. Tuberk Toraks. 2016 Mar;64(1):1-8. English. doi: 10.5578/tt.8651.
4. Farrero E, Prats E, Manresa F, Escarrabill J. Outcome of non-invasive domiciliary ventilation in elderly patients. Respir Med. 2007 Jun;101(6):1068-73. doi: 10.1016/j.rmed.2006.10.005.
5. Cantero C, Adler D, Pasquina P, Uldry C, Egger B, Prella M, et al. Long-Term Non-invasive Ventilation: Do Patients Aged Over 75 Years Differ From Younger Adults? Front Med (Lausanne). 2020 Nov 11;7:556218. doi: 10.3389/fmed.2020.556218.
6. Nava S, Grassi M, Fanfulla F, Domenighetti G, Carlucci A, Perren A, et al. Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomized controlled trial. Age Ageing. 2011 Jul;40(4):444-50. doi: 10.1093/ageing/afr003.
7. American Thoracic Society. Statement on home care for patients with respiratory disorders. Am J Respir Crit Care Med. 2005 Jun 15;171(12):1443-64. doi: 10.1164/rccm.2504001.
8. Cirik MO, Yenibertiz D. What are the prognostic factors affecting 30-day mortality in geriatric patients with respiratory failure in the Intensive Care Unit? Pak J Med Sci. 2021 Jan-Feb;37(1):15-20. doi: 10.12669/pjms.37.1.3189.
9. Aksu T, Fadıloğlu Ç. Solunum sistemi hastalığı olan bireylerin evde bakım gereksinimi ve yaşam kalitesinin incelenmesi. Ege Üniversitesi Hemşirelik Fakültesi Dergisi. 2013;29(2):1-12.
10. Gilmour H. Unmet home care needs in Canada. Health Rep. 2018 Nov 21;29(11):3-11. PMID: 30485384.
11. Karakaş N, Bentli R, Fırıncı B, Zabcı B. Investigation of the relationship between depression and nutritional status of elderly patients in home care. J Surg Med. 2019;3(12):829-32.
12. Loengard AU, Boal J. Home care of the frail elderly. Clin Geriatr Med. 2004 Nov;20(4):795-807. doi: 10.1016/j.cger.2004.07.009.
13. Thumé E, Facchini LA, Tomasi E, Vieira LA. Home health care for the elderly: associated factors and characteristics of access and health care. Rev Saude Publica. 2010 Dec;44(6):1102-11. doi: 10.1590/s0034-89102010005000038
14. Swartz K, Collins LG. Caregiver Care. Am Fam Physician. 2019 Jun 1;99(11):699-706. PMID: 31150177.
15. Gauthier A, Bernard S, Bernard E, Simard S, Maltais F, Lacasse Y. Adherence to long-term oxygen therapy in patients with chronic obstructive pulmonary disease. Chron Respir Dis. 2019 Jan-Dec;16:1479972318767724. doi: 10.1177/1479972318767724
16. Andersson I, Johansson K, Larsson S, Pehrsson K. Long-term oxygen therapy and quality of life in elderly patients hospitalised due to severe exacerbation of COPD. A 1 year follow-up study. Respir Med. 2002 Nov;96(11):944-9. doi: 10.1053/rmed.2002.1370.
17. Gilmour H. Unmet home care needs in Canada. Health Rep. 2018 Nov 21;29(11):3-11. PMID: 30485384.