Elderly patients suffer from a variety of conditions that could benefit from Hyperbaric Oxygen Therapy 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.
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. Its potential benefit in conditions such as acute traumatic ischemia, necrotizing soft tissue injuries, non-healing ulcers, and osteo-radionecrosis are of particular interest. Yet despite evidence for its benefit in decompression sickness and air embolism, 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 it’s potential role in nursing home care.
The use of HBO2 therapy chambers are first documented back to 1877 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 send 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 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 FDA or those that have shown promising results in trial studies.
In addition, very few nursing facilities have on-site therapy available and those that do, face challenges for payment reimbursement from insurance carriers for in-patient care. Those that do not have on-site HBO2therapy must transport patients to other out-patient facilities for treatment, which entails additional costs and considerations.
The bottom line, although there are few randomized controlled clinical trials available, clinical experience reports have shown HBO2 therapy to be relatively safe with only a few minor side effects. Many of the health conditions of the elderly would 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 with inconclusive data available upon which to form clinical decisions; thus, this is an area where high-quality, randomized, controlled clinical trials are desperately needed. Nevertheless, as our population continues to age, it is likely that we will see a greater number of conditions that may benefit from HBO2 therapy, particularly because its uses are continuing to be explored in clinical settings. 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