Hyperbaric Oxygen Therapy in treating an Aging Population
A variety of conditions involving a diminished oxygen availability or inflammation provide health challenges to an aging population. These conditions could benefit from Hyperbaric Oxygen Treatment. In nursing facilities, the quality of life can be positively affected as hyperbaric oxygen therapy is integrated into the care plans of patients with injuries related to falls, issues related to diabetes, kidney failure, arterial disease, as well as ulcers in bed –bound patients and wounds from cancer treatments. In many cases patients with conditions such these provide challenges to wellness and adversely affect the quality of life in this patient population.
Abstract: Hyperbaric oxygen (HBO2) therapy has long been used to treat decompression sickness, but more recently has been explored as a primary or adjunctive therapy for a number of injuries and medical conditions, many of which commonly affect the aging adult population. Properly timed, its potential benefit conditions such as acute traumatic ischemia, necrotizing soft tissue injuries, non-healing ulcers, and osteoradionecrosis can significantly impact outcomes, and quality of life issues while providing noticeable cost containment. Yet despite evidence for its benefit in many challenging, there are few randomized controlled clinical trials documenting the effects of HBO2 therapy for the range of other conditions for which it has been reported to have benefit. Much of the research remains to be done regarding the advantages and efficacy of HBO2 therapy, so that clinicians are enabled to develop treatment plans for their elderly patients that incorporate all possible beneficial therapies. The article provides a brief overview of HBO2 therapy, reviewing its history, potential mechanism of action, indications in older adult population, safety and side effects, and its potential role in nursing home care.
The use of HBO2 therapy chambers are first documented back to 1834 and were used to treat a variety of conditions, but at that time, chambers used compressed air verses pure oxygen. Then in 1917, Bernhard and Heinrich Dräger first used pressurized oxygen to treat decompression illness from diving accidents, creating the foundation for today’s treatment protocol.
How does it work? Our body delivers oxygen to our tissue through our red blood cells, for cellular energy and to support tissue and cell repair and healing. Unfortunately, any injury or disease can diminish the flow of oxygen at a time when it’s needed the most.
It’s important to note that HBO2 therapy is not the same as just breathing 100% oxygen. Increasing the atmospheric pressure not only causes more oxygen to enter the bloodstream, but it also delivers more oxygen to nerve and brain cells, lymph fluid, plasma, and areas of poor circulation such as ligaments and bones. HBO2 therapy also has an antimicrobial effect which kills bacteria and helps the body reduce swelling and inflammation.
Elderly patients suffer from a variety of conditions that could benefit from this treatment. In nursing facilities, the injuries related to falls, issues related to diabetes, kidney failure, arterial disease, as well as ulcers in bed–bound patients and wound from cancer treatments can all benefit from HBO2 therapy. This is just to name a few of the many conditions that these facilities face daily.
The main obstacle to providing this therapy for the elderly is availability and insurance coverage or very little reimbursement. Even those that provide some coverage, may limit it to only a small number of pre-approved conditions verses all conditions that have been approved for use by the US FDA or those that have shown promising results in trial studies.
Very few nursing facilities have on-site hyperbaric therapy available and those that do, face challenges for cost containment for in-patient care. Those that do not have on-site HBO2 therapy must transport patients to other out-patient facilities for treatment, which entails additional costs and considerations.
Recently, researchers from Israel have been providing insight into the use Oxygen delivered under hyperbaric pressures and its impact on the aging population. Their work has shown that hyperbaric treatments are extending quality of life through the entire life. This gives individuals the opportunity to be the best they can possibly be. Many of the health challenges to the elderly could benefit from this therapy. Education and training for nursing facility staff, insurance companies and the public is needed so that all patients are made aware of this treatment option when it’s appropriate.
Conclusion: Many indications for HBO2 therapy have been proven in well-controlled studies, while others have not received careful review or have been evaluated using less than optimal research methodology and study design. Conclusive data is needed and exposure of physicians to this treatment modality must be provided so that the optimal clinical decisions can be made. Nevertheless, as our population continues to age, it is likely that we will see a greater pressure placed on the healthcare system to contain costs and provide for the wellness of this aging population. Hyperbaric oxygen is an excellent therapeutic option and it use in the role of maintaining wellness provides a solution to cost avoidance as we move away from a system of disease management to a system that rewards outcomes. Therefore, it behooves all healthcare providers to be familiar with this treatment option, including those caring for geriatric patients in the long-term care setting, to ensure all eligible patients are at least made aware of this treatment option when appropriate.
Citation: Annals of Long-Term Care: Clinical Care and Aging, 2014;22(7/8):37-42