The objective of this chapter is to identify the latest evidence on the elderly critical patient with chronic obstructive pulmonary disease. Nine articles were analysed. The effectiveness of NIV has been demonstrated in cases of elderly critically ill patients with acute COPD. Evidence has been shown to decrease hospital stay and mortality, although long-term survival has been shown to be short. The prediction of NIV failure is multifactorial, including very old age, comorbidities, low analytical values of albumin, simplified severity index II, pH < 7.3 of arterial blood, PaCO2 (Carbon Dioxide Pressure) < 45 mmHg, CAT (COPD Assessment Test) elevated, Glasgow Coma Scale < 11, and APACHE II (Acute Physiology and Chronic Health Evaluation) 29. NIV has demonstrated efficacy in elderly patients in situations of acute COPD.
TopTheoretical Framework
Currently, there is an increase in the number of people over the age of 65 worldwide, especially in developed countries where there is already an aging population, that is, an inversion in the demographic pyramid. To mark World Population Day (11 July 2015), the National Statistics Institute (INE) elected the analysis of some demographic indicators related to the aging of the population in Portugal and in the context of the European Union. In terms of the global proportion of people over 60 years of age, there was an increase from 9.2% in 1990 to 11.7% in 2013 and it is expected to continue to increase, reaching 21.1% in 2050. In absolute figures, the United Nations projections indicate that the number of people aged 60 or over will rise to more than two billion by 2050 and the number of people aged 80 or over may more than triple, reaching 392 million in 2050 (INE, 215).
In Portugal, as a result of the drop in birth rates and the increase in longevity in recent years, there was a decrease in the young population (0 to 14 years old) and in the working age population (15 to 64 years old), in simultaneously with the increase in the elderly population (65 years of age or older) (INE 2015). The aging index, which reflects the relationship between the number of elderly people and the number of young people, reached 141 elderly people for every 100 young people in 2014. In the same year, the resident population in Portugal was made up of 14.4% of young people, 65.3% of people of working age and 20.3% of the elderly (INE, 2015).
According to the World Health Organization (WHO, 2002), the elderly can be defined chronologically as the person aged 60 years or older in developing countries and 65 years old or older in developed countries. The WHO Annual Report on Aging and Health also states that:
As the evidence shows, the loss of abilities commonly associated with aging is actually only loosely related to people's chronological age. There is no such thing as a “typical” elderly person. The diversity of the capacities and health needs of older adults is not random but comes from events that occur throughout the course of life and are often modifiable, highlighting the importance of the life cycle approach to understand the process of aging. (Chan, 2015, p. 3).
All of this leads to the observation of a population that is weaker and more vulnerable to the development of diseases, essentially chronic pathologies. The European Respiratory Society (ERS, 2013) estimates that about one billion of the world population suffers from chronic respiratory diseases and that four million will die for that reason, with an impact on health, society and the world economy.
If we speak at the national level, the same situation is verified, with the number of people with respiratory pathology on the rise, largely due to the older age groups (65 years of age or older), with 18% as having chronic obstructive pulmonary disease (COPD) (DGS, 2015). In this age group, respiratory diseases are the third leading cause of death, after cardiovascular disease and tumours, the fifth leading cause of hospitalization and the first cause of mortality (ONDR, 2017). In the Report of the National Program for Respiratory Diseases (2017), in 2015, the mortality rate of the group of diseases in which COPD was inserted was 20.92%, with the latter in second place in the list of hospitalizations, with 14.04%. Respiratory failure is responsible for 33% of hospitalizations due to respiratory disease and 12% of the mortality rate associated with this pathology (British Thoracic Society / Intensive Care Society Guidelines for the Ventilatory Management of Acute Hypercapnic Respiratory Failure in Adults, 2016).