Community survey of home nebulizer technique by elderly people

Age and Ageing, July, 1995 by C. Teale, A. Jones, C.J. Patterson, M.T. Kearney, A.J. Stanners, M.F. Muers

To determine the prevalence and nature of difficulties elderly subjects experience using home nebulizers we have studied all patients in the Leeds Health District aged 70 years and older loaned a nebulizer from the hospital for at least 6 months. Of 42 subjects with a nebulizer, 40 (95%) agreed to assessment. They had a mean age of 79 years (range 70-84 years) and mean duration of nebulizer use of 38 months (range 6-120 months). Twenty subjects had one or more problems with 14/40 (35%) rated as moderate or severe; difficulties with cleaning 16/40 (40%) and filling 7/40 (18%) were the most frequent; 13/40 (33%) were sometimes or always dependent on their carers to administer their nebulizers. Elderly subjects often experience practical difficulties, or require help from a carer, when using a home nebulizer.

Introduction

Several studies have highlighted practical difficulties experienced by elderly subjects with treatments which require manual dexterity such as the use of eye-drops [1] and support collars [2]. Airflow limitation is common in elderly people [3, 4] with inhaler therapy the mainstay of management for many patients. Difficulties with the use of metered-dose inhalers have been well documented [5, 6] with up to one-third of elderly patients being unable to use these devices [6]. For subjects with severe asthma and chronic obstructive airways disease the possibility that high-dose nebulized bronchodilators may improve airflow limitation has led to the widespread use of home nebulizers [7] with many being prescribed for elderly people [8]. It has been suggested that home nebulizers may be easier to use than standard metered-dose inhalers but whether elderly patients experience practical problems with their use has not been studied. To identify the prevalence and type of difficulties elderly subjects have using home nebulizers we have assessed patients on long-term nebulizer therapy in the community.

Methods

Home compressors and nebulizers for patients resident in the Leeds Health District are loaned by the medical physics department based at the Regional Cardiothoracic Centre in Killingbeck Hospital. The majority of patients have a 6-8-week nebulizer and inhaler assessment at home before a nebulizer system and particular drug regimen is prescribed [9, 10]. During the assessment they receive instruction in nebulizer and compressor use and further training is given by a physiotherapist when the nebulizer is issued. Compressors are recalled every 6 months for servicing.

We identified all patients aged 70 years and older loaned a nebulizer for at least 6 months. All patients were invited to attend the pulmonary function laboratory and those who preferred were visited in their own home. They were assessed by a respiratory nurse specialist (A.J.) who observed them setting up and operating their nebulizer and recorded the results using a standard protocol and questionnaire which covered assembly, filling, dosage, administration, cleaning, carer dependence and physical disability. Patients were allowed help from their carer if this was normally given, with any difficulties graded as mild, moderate or severe.

Results

Forty-two patients aged 70 years and older had been loaned a nebulizer for at least 6 months. Of these, 40 (95%) were traced and agreed to assessment. They had a mean age of 79 years (range 70-84) and a mean duration of nebulizer use of 38 months (range 6-120 months). Problems identified are shown in Table I. Overall, 20 (50%) had one or more difficulties and in 14 (35%) cases they were rated as moderate or severe. The most frequent problems were with cleaning 16/40 (40%), filling the reservoir 7/40 (18%) and assembling the nebulizer 5/40 (13%). Table II shows the numbers of patients receiving assistance from a carer and the reasons for assistance; 6/40 (15%) were always dependent on their carer to administer their nebulizer and a further 7/40 (18%) were at times dependent on a carer. Intermittent reliance on a carer was primarily required when patients were more breathless (six subjects). Constant reliance on carers was due to pre-existing disabilities such as visual impairment (two subjects), arthritis (three subjects) or previous stroke (one subject).

Table I. Problems in home nebulizer use by elderly patients
(age 70 years and older), with help from carers if appropriate,
on long-term home nebulizer treatment
                    Number of patients (n = 40)
Problem             Mild     Moderate       Severe    Total
Cleaning            7        7              2         16 (35)
Filling             4        2              1          7 (18)
Assembly            4        1              0          5 (13)
Dose incorrect      2        1              0          3 (8)
Table II. Assistance required by elderly patients (70 years and
older) on long-term home nebulizer treatment and reason for
assistance (total number of patients = 40)
                                            No. of patients (%)
Assistance required                         (n = 40)
Independent: no assistance from carer       27 (67)
Carer sometimes assists
(6 if breathless, 1 if muddled)              7 (18)
Carer always assists (3 arthritis,
2 visual impairment, 1 stroke)               6 (15)