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Trends and Challenges in the Management of Tracheostomy in Older People
The need for a multidisciplinary team approach
Vicki Parker
CNC Research and Practice Development, Greater Newcastle Sector, Hunter New England Area Health Service, Newcastle NSW
Gai Shylan
Hunter New England Area Health Service, NSW
Wendy Archer
Speech Pathologist, Hunter New England Area Health Service, NSW
Paula McMullen
Nurse Educator ICU, Hunter New England Area Health Service, NSW
Kelvin Smith
CNC ICU, John Hunter Hospital, Hunter New England Area Health Service, NSW
Michelle Giles
CNC IT, Research and Practice Development, Greater Newcastle Sector, Hunter New England Area Health Service, NSW
Jane Morrison
Case Manager, Neurosurgery, John Hunter Hospital, Hunter New England Area Health Service, NSW
Nikki Austin
Physiotherapist, John Hunter Hospital, NSW
Abstract
The trend towards increasing representation of older people as recipients of health care in acute care settings is matched with a corresponding increase in the numbers of older people undergoing tracheostomy. The reasons for tracheostomy in this age group are varied, including respiratory failure, neurological injury/ event and carcinomas. Further, current research supports early tracheostomy for patients requiring medium to long-term ventilation and unconscious patients at risk of airway obstruction.
In spite of this increase very little has been written about decision-making and ongoing nursing care for these patients. There is an abundance of literature on the physiological processes of aging and the problems related to co-morbidities; however there has been very little exploration of how these impact on the occurrence of complications and other outcomes for older patients with a tracheostomy, and the consequent implications for care provision.
This article examines clinical issues of significance to older people with tracheostomy and outlines the implementation and benefits of a multidisciplinary team approach.
Keywords
tracheostomy, older person, multidisciplinary care
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