title: Domiciliary non-invasive ventilation in the elderly. Effective, tolerated and justified.
abstract: OBJECTIVE
  To determine if the long terms effects of non-invasive home mechanical ventilation (NIHMV) in the elderly are as beneficial as in younger subjects for a dedicated non-invasive ventilation unit in a tertiary referral hospital within the UK.
  
  
  METHODS
  The study population included 256 patients who were successfully established on NIHMV between May 2009 and August 2013. Patients were divided into three groups according to age: group 1 (n=103) ≥75; group 2 (n=81) 65 -74; and group 3 (n=72) < 65 years of age. Initial assessments, both prior to starting NIHMV and at 12 month follow up were determined which included establishing the primary cause of respiratory insufficiency, measurement of arterial blood gas parameters, spirometry, overnight oximetry, and sniff nasal inspiratory pressure (SNIP) in those patients with neuromuscular disease. The number of hospital admissions in the year prior to starting NIHMV, and in the subsequent year, along with the number of days spent as an inpatient were ascertained as a measure of burden to local health care resources. Compliance with NIV at follow up, facilitated by recorded data within the ventilator software, was established along with an assessment of any reported side effects.
  
  
  RESULTS
  Group 3 had the most profound abnormalities in lung function and blood gas parameters at initial assessment with a trend towards a higher number of acute admissions. In absolute terms, there was a greater decline in the number of admissions for subjects in group 2 after being established on NIHMV. Although more subjects in group 3 had chest wall deformities, COPD or bronchiectasis, this group had the lowest number of subjects with neuromuscular disease. Improvements in gas exchange were most pronounced for group 3 subjects despite no significant differences in the selected ventilator settings across the 3 groups. For neuromuscular patients, when measured, SNIP pressures were lowest in group 3.
  
  
  CONCLUSIONS
  NIHMV was effective and tolerated for all three age groups. There was an improvement in measured patient centred endpoints across all three age groups, all of whom benefited equally.
authors.affiliation: Consultant Respiratory/Sleep Physician, Birmingham Heartlands Hospital, Birmingham, B9 5SS.
authors.forename: D M
authors.initials: DM
authors.lastname: Comer
authors.affiliation: Consultant Respiratory/Sleep Physician, Birmingham Heartlands Hospital, Birmingham, B9 5SS.
authors.forename: A
authors.initials: A
authors.lastname: Oakes
authors.affiliation: Consultant Respiratory/Sleep Physician, Birmingham Heartlands Hospital, Birmingham, B9 5SS.
authors.forename: R
authors.initials: R
authors.lastname: Mukherjee
mesh_terms: D000328:Adult; D000368:Aged; D001987:Bronchiectasis / Q000150:complications; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications; D063087:Noninvasive Ventilation; D010343:Patient Admission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D035441:Thoracic Wall / Q000002:abnormalities
keywords: Non-invasive ventilation; elderly; respiratory failure