Non-invasive home ventilation in patients over 75 years of age: tolerance,compliance, and impact on quality of life

The adequacy of domiciliary non-invasive positive pressure ventilation (NIH V) for hypercapnic restrictive pulmonary disease in patients aged 75 years or above has been questioned, because of a lower life expectancy, a higher risk of neuropsychological impairment and a lower potential for adapting to NIHV. This study aims to illustrate that the use of NIHV is possible and e fficient in this age group. In our referral area, all patients under NIHV have been included in a datab ase since 1994; at the end of 1996, all patients in whom NIHV had been init iated at age 75 years or above were studied. We performed a cross-sectional study of six patients (two men, four women, age: 79 +/- 3 years at time of study) who had been under NIHV for 31 +/- 17 months. Patients underwent pu lmonary function testing, assessment of respiratory muscle strength, physic al disability and neuropsychological performance, tolerance and compliance to NIHV, and heath-related quality of life : (SF-36, St. George Respiratory Questionnaire: SGRQ). Hospitalization rates were recorded for the year pri or and the 2 yr following initiation of NIHV. By the time of the study, all patients showed improved arterial blood gases when compared to values before NIHV (PaCO2: 46 +/- 9 vs 66 +/- 10 mmHg, P = 0.04). Patients adapted well to NIHV, with minor side-effects and an aver age daily use of ventilator of 10.5 +/- 2 h. None of the patients showed si gns of emotional disturbance; SF-36 scores for mental health, subjective we ll-being and vitality, or social functioning, did not differ from that of a ge-matched controls. SGRQ scores were similar to those published for younge r patients under NIHV. Use of health care facilities was similar to that of younger patients under NIHV; hospitalization rates decreased significantly after initiating NIHV (40 +/- 31 days fos year before NIHV, vs 13 +/- 14 d ays and 0.8 +/- 0.4 days for the 2 yr following NIHV, P = 0.02). Age above 75 years should not be considered per se as a contraindication to NIHV in patients with well-accepted indications for this treatment. Our re sults suggest that in this age group, the cost/benefit ratio of NIHV may be favourable.