Trends and challenges in the management of tracheostomy in older people: The need for a multidisciplinary team approach

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 comorbidities; 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.