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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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References

Austin Health Tracheostomy and Review Management Service Tracheostomy Care Resources (2006) A Guide to the creation of Site Specific Tracheostomy Procedures and Education, Heidelberg, Austin Health.

Craven D (1992) Prevention and management of nosocomial pneumonia. Emergency Medicine 24(16): 97-108.

Day T and Bench S (2006) Breathing. In Redfern S and Ross R (eds) Nursing Older People. Churchill Livingstone, Philadelphia.

Diaz E, Rodriguez AH and Rello J (2005) Ventilator-associated pneumonia: Issues related to the artificial airway. Respiratory Care 50(7): 900-909.

Dikeman KJ and Kazandjian MS (2003) Communication and Swallowing Management of Tracheostomised and Ventilator-Dependent Adults 2nd edn. California, Thompson Learning.

Donnelly F and Wiechula R (2006) The lived experience of a tracheostomy tube change: a phenomenological study. Journal of Clinical Nursing 15: 1115-1122.

Duckett S and Jackson T (2004) Do the elderly cost more? Casemix in the Acute Setting. In Nay R and Garrett S (eds) Nursing Older People; Issues and Innovations 2nd edn, pp.31-40, Churchill Livingstone, Sydney.

Ely E, Wheeler A, Thompson BT, Ancukiewicz M, Steinberg KP and Bernard GR (2002) Recovery and Prognosis in older persons who develop acute lung injury and the respiratory distress syndrome. Annals of Internal Medicine 136(1): S68.

Feinberg M, Ekberg O, Segall L and Tully J (1992) Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management. Radiology 183: 811-814.

Hales P (2004) Swallowing. In Russell C and Matta B (eds) Tracheostomy, A Multi Professional Handbook, Cambridge University Press,

Hauck K (1999) Communication and swallowing issues in tracheostomised / ventilator dependent geriatric patients. Topics In Geriatric Rehabilitation 15(2): 56-70.

Hughes T (2003) Neurology of swallowing and oral feeding disorders: assessment and management. Journal of Neurology Neurosurgery Psychiatry 74(suppl iii): iii48-iii52.

Hunt K and McGowan S (2005) Tracheostomy management in neurosciences: A systematic, multidisciplinary approach. British Journal of Neuroscience Nursing 1(3): 122-125.

Marik PE (2006) Management of the critically ill geriatric patient. Critical Care Medicine 34(9)(Suppl.): S176 - S182.

Mick DJ and Ackerman MH (2004) Critical care nursing for older adults: pathophysiological and functional considerations. Nursing Clinics of North America 39: 473-493.

Nielson C and Wingett D (2004) Intensive care and invasive ventilation in the elderly patient, implications of chronic lung disease and comobidities, Chronic Respiratory Distress 1: 43-54.

Parker V (1997) Confronting life and death: Living through critical illness and intensive care hospitalisation. Unpublished Masters thesis. University of Newcastle. NSW.

Phelan BA, Cooper DA and Sangkachand P (2002) Prolonged mechanical ventilation and tracheostomy in the elderly. AACN Clinical Issues 13(1): 84-93.

Russell C (2005) Providing the nurse with a guide to tracheostomy care and management, British Journal of Nursing 14(8): 428-433.

Sengupta P, Sessler DI, Maglinger P, Wells S, Vogt A, Durrani J and Wadhwa A (2004) Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiology 4(8): 1-6.

St John R and Malen J (2004) Contemporary issues in adult tracheostomy management. Critical Care Nursing Clinics, North America 16: 413-430.

Wakefield B and Holman J (2007) Functional Trajectories Associated With Hospitalization in Older Adults. Western Journal of Nursing Research 29(2): 161-177.



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