Ventilator-Assisted Living©

Spring 2004, Vol. 18, No. 1

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This article is adapted from a presentation at the Ninth International Noninvasive Ventilation Conference: “From the ICU to Home,” Orlando, Florida, October 23-25, 2003.

Aging and Respiratory Function

Anita Simonds, MD, FRCP, Royal Brompton Hospital, London, England

photo of Anita SimondsMany factors need consideration in the transition to old age. These include the physiological effects of aging, the progression or late effects of the neuromuscular disease/condition, the effects of medication, the increased likelihood of surgery, and the quality of ventilatory support in care/nursing homes.

Social and psychological factors are also a major part of this transition. These include retirement, economic changes, loss of family ties, and the desire to retain one’s autonomy and involvement in decision-making.

The effects of aging on respiratory function include:

The increased likelihood of invasive procedures and surgery in later years necessitates careful risk/benefit assessment. Some ventilator users are told they are “not fit for surgery,” but the risks of not carrying out the surgery must be weighed.

Many procedures and scans can be carried out safely under sedation, and individuals can use their own home ventilators, but liaison with the anesthetic team is vital. For pre-operative assessment, the surgical/anesthetic team must know the complete medical history, ventilatory equipment needs and care plan.

Some ventilator users may also need management and treatment for cancer/malignant disease. They need to ask questions: “What is the ideal treatment for my cancer — surgery, chemotherapy, radiation and/or hormone therapy? Is there any reason why I should not have treatment? If problems are anticipated, can we work around them?”

For ventilator users and people with chronic pulmonary diseases, pulmonary rehabilitation programs can improve exercise tolerance and increase quality of life.

Attributing new or progressive symptoms to “just getting older” without consideration of other possibilities is unwise. If you are a polio survivor, do not automatically ascribe new symptoms to the late effects of polio without eliminating other causes.

Aging brings changing goals and complex issues. There is often a lack of correlation between the views of the individual and those of the family and caregivers. Make sure your family, caregivers and health care team know your wishes — prepare advance directives and living wills.


Observations by older ventilator users:

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