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Caring for Clients
with Respiratory Issues

With age, changes in the lungs and respiratory system result in more difficult breathing and less effective cough mechanisms. This puts the elderly at greater risk of developing serious respiratory diseases, particularly if they are current or ex-smokers, had jobs
that exposed them to fumes or chemicals, or have suffered from a respiratory illness in the past.

 

Although some respiratory conditions are incurable, there is a lot you can do to help affected elders conduct as normal a life as
possible.

MUCH-REDUCED LIFE QUALITY
The most common respiratory problems in elders are:

  • Asthma

  • Cystic fibrosis

  • Lung cancer

  • Chest infections such as pneumonia from the flu or COVID

  • Chronic obstructive pulmonary disease (COPD)

  • Chronic bronchitis

  • Emphysema

Older adults with these conditions have a much-reduced quality of life. For them, something as simple as breathing can be very difficult and is often complicated by persistent cough, wheezing, and lungs filled with phlegm.
 

With some conditions like COPD, breathing is so severely impaired that elders need a respiratory tank to have enough oxygen to
function properly. Labored breathing (dyspnea) also means that even the easiest of tasks like dressing, walking or just talking, can be extremely difficult.

 

SERIOUS DISEASES
Elders with respiratory disease become progressively unable to do things independently which puts them in a constant state of anxiety and makes them vulnerable to depression. Furthermore, most respiratory problems in the elderly are chronic, meaning that they tend to persist or reoccur over time. And some, like lung cancer and COPD, are incurable.
 

Nonetheless, research clearly shows that caregivers can make it a lot easier for their clients to live with the symptoms of these conditions and prevent them from becoming worse.


TIPS FOR EASIER BREATHING
Helping with breathing is paramount and starts by ensuring your clients don’t become fatigued. This is the all-important first step

to keep their breathing as close to normal as possible and prevent dyspnea. There are also simple breathing exercises and techniques to help improve breathing over time. For example:

  • Purse-lip breathing. Encourage the elder to inhale (breathe in) through their nose and exhale (breathe out) through their mouth with their lips pursed, like they were blowing out a candle. Exhalation should be twice as long as the inhalation. So, for example, you may ask your client to count to two while inhaling, and to four while exhaling. Experts recommend this exercise be practiced for 10 breaths, four times a day. Purse-lip breathing is particularly useful while performing difficult tasks, like climbing stairs. However, it’s best to have your client lie in bed when they are first learning this technique.

  • Breath-holding technique. The client takes a deep, slow breath, holds it for five to 10 seconds, and coughs gently while breathing out.

  • Diaphragmatic breathing. With this technique, the client lies on their back with pillows under their head and knees, and is encouraged to breathe in and out, deeply and slowly, with their stomach rather than their chest.

 

ENSURE A CLEAN ENVIRONMENT
Another way to help with breathing is to ensure a clean environment:

  • Avoid the use airborne irritants, like hairsprays and aerosols

  • Watch out for allergens, such as pollens and pet fur

  • Open the windows regularly to ensure the room is well ventilated

  • Keep all surfaces clean and dusted

 

HELP WITH COUGH
Cough is a common symptom of respiratory diseases. Some clients may try to fight the urge to cough because they feel self-conscious about it and wish not to draw attention to themselves. But coughing is a natural way to force phlegm out of the lungs
and prevent life-threatening chest infections. Discourage them from refraining themselves. It may help, in this regard, to provide some privacy.

 

Close the door or pull the curtains if you are in a hospital setting. If there are visitors, ask them to step out and come back when the cough has stopped. Don’t say anything that might make your client feel embarrassed by their coughing or make them think they are
disturbing others with it.

 

THE HUFF COUGH TECHNIQUE
A major issue in the elderly with respiratory diseases is that their cough is generally very weak and not as effective at clearing phlegm from their airways. This is particularly true for those with COPD. A special coughing technique called a “huff cough” can help overcome this problem. Instruct your client to cough as follows:

  • Eliminate excessive air from the lungs by exhaling gently and slowly over three/four breaths

  • Take a deep breath, keeping their mouth open, shaped like an “o”

  • Give a short and gentle cough – this should produce a “huff” noise (huff cough) and should be repeated two or three times

  • Take another deep breath

  • Give one last, stronger huff cough

 

COUGHING UP PHLEGM?
If your client is coughing up phlegm, discourage them from reswallowing it. Make certain they spit it in a tissue. This ensures the phlegm is eliminated. Sometimes, however, this is too sticky and is only partially eliminated. It remains in the airways, causing repeated attempts at swallowing and a distressing feeling of choking.
 

Your client may panic and have uncontrollable coughing spasms. Encourage them to stay calm and breathe slowly. Offering a sip of water my also help. Regularly inspect your client's phlegm. This should be done at least twice a day. Look, in particular, for:

  • Color. Is the phlegm colored? Does it have a different color than what it usually has?

  • Quantity. Is the client producing phlegm in increasing amounts?

  • Consistency. Is the phlegm becoming thicker?

Increasing amounts of colored, thick phlegm may indicate that your elder has an infection and needs to be reported. Keep a close eye on them, as the presence of phlegm increases their risk of dying by an astonishing three times, according to research in the journal Thorax, especially if this is produced regularly, first thing in the morning.
 

IF THEY CAN’T COUGH UP THE PHLEGM EASILY
If the phlegm is hard to expectorate because it’s too thick, the airways may become clogged making breathing even more difficult. Depending on the client’s conditions, the physician may recommend one of the following techniques to help loosen the phlegm and remove it by coughing:

  • Postural drainage. The person leans over the side of the bed, with the head down and a pillow under the elbows. The caregiver encourages them to cough while gently tapping on their chest wall for three to five minutes. Note that there are several different positions for postural drainage. It’s important to find the one that is most comfortable for your client.

  • Percussion. With your hand cupped and palm facing down, tap rhythmically over the ribs of the client’s chest wall, avoiding the areas over the spine, breastbone and stomach.

  • Vibration. With your hand flat and palm facing down, gently – but firmly – shakes client’s chest wall.

 

Consider playing the client’s favorite music or simply talking with them while performing the above techniques. This will help them relax and will make the experience more pleasurable and effective. Remember, these techniques should never be performed on bare skin. Also, remove rings and bracelets from your hand and wrist, and remain in the upright position so you won’t damage your back. Always follow medical advice before initiating any technique, as each client is different and some techniques may be better than others for each person.

WATCH OUT FOR CHEST INFECTIONS
Older people with chronic respiratory problems are more likely to develop viral and bacterial life-threatening chest infections like the flu, COVID, bronchitis and pneumonia. This means you have to keep a watchful eye on their conditions. If you see them deteriorating, report it to the office immediately.
 

GET THE FLU SHOT
The risk of a chest infection is higher during the influenza season. So is the risk of dying from it. A team at the University of Manitoba at Winnipeg, Canada, showed that for adults aged 65 and older, the number of deaths from respiratory illnesses during four influenza seasons was nearly double the number of deaths during fall periods.
 

That’s not all. Mortality was significantly higher among nursing home residents than in community living elders. The best way to prevent these deaths is a flu vaccination. Make sure your clients receive the flu shot when it’s time and have it yourself as well. A randomized, controlled study in The Lancet has demonstrated that in long-term care settings, staff immunization can reduce
influenza-related mortality by 42 percent.

 

Remember, the flu shot is necessary each year, ideally in early October to mid-November.

 

COVID-19 BOOSTER

People ages 65 and older should get a COVID-19 booster vaccination four months after their last one, according to new reports from the CDC. The move endorses a recent recommendation from the agency’s advisory committee that older adults should get the extra shots.

 

“Data continues to show the importance of vaccination to protect those most at risk for severe outcomes of COVID-19,” the news release stated. “An additional dose of the updated COVID-19 vaccine may restore protection that has waned since the previous vaccine dose, providing increased protection to adults ages 65 years and older.”

People in that age group accounted for more than half of COVID hospitalizations in the last quarter of 2023. Seniors remain among the most vulnerable to severe cases of the illness, while younger people are broadly forgoing the shots. 

Some of the COVID-19 vaccines are known as mRNA shots. How are they different from traditional vaccines? And do they contain the real virus? As of mid-February 2024, 22% of adults in the United States had received the updated vaccine that became available in the fall. Public health officials have expressed disappointment in the low uptake. Older people have been more likely to get the shots, with 43% of people ages 75 and older getting the latest injection.

“Today’s recommendation allows older adults to receive an additional dose of this season’s COVID-19 vaccine to provide added protection,” CDC Director Mandy Cohen, MD, MPH, said in the news release. “Most COVID-19 deaths and hospitalizations last year were among people 65 years and older. An additional vaccine dose can provide added protection that may have decreased over time for those at highest risk.”


GOOD HYGIENE IS CRUCIAL
You also need to comply with the principles of good hygiene to help prevent chest infections. In this regard, hand washing is your
number one strategy. Wash your hands with soap for at least 20 seconds before and after providing care to your clients (even if you wear gloves). Also, wash your hands before and after eating and after going to the restroom. Make sure your clients, visitors and coworkers do the same.

 

PROVIDE REGULAR, EFFECTIVE ORAL CARE
Vaccination and hand hygiene alone, however, are not enough. Poor oral care has been repeatedly associated with respiratory infections, particularly pneumonia – the leading cause of death among nursing home residents.
 

By contrast, research consistently shows that good oral hygiene not only reduces the risk of developing the condition, it also makes those affected less likely to die from it. Of particular significance are the results of a recent study in the Journal of the American Geriatrics Society, showing that, in a sample of 143 elders who were followed for nearly two years, deaths from pneumonia were three times higher among those who did not receive proper oral care than in those who did.
 

It’s important that your clients have their teeth and tongue cleaned every day. Also, inspect their mouth daily and ensure regular visits to the dentist.
 

KEEP THEM ACTIVE
The National Institute of Health recommends that elders with respiratory diseases exercise regularly. There are two reasons for this,
says professor of nursing, Dr. Barbara Resnick, of the University of Maryland School of Nursing, Baltimore. First, lack of exercise makes these conditions worse. Second, given enough time, gentle exercise can produce improvements in quality of life greater than medications alone.

 

Of course, type and length of exercise need to be chosen according to what your client can, and likes to do. Consider for example, that walking is the easiest form of physical activity, and preferred by many older people. Ideally, your clients should exercise 20 to
30 minutes a day (not necessarily consecutively), on most weekdays. However, some of them will be able to do less, or more, depending on their conditions.

 

Offering rewards is very important to keep the person motivated. “A hug for a completed walk, [or] a lunch date can be very effective rewards,” says Resnick. “Identifying personal goals, such as being able to walk for longer periods, or ambulate without use of oxygen, also can be gratifying.”

 

THE IMPORTANCE OF ARM TRAINING
Those with COPD should be encouraged to perform arm training. This involves raising arms to shoulder level or above, just a few times per day. Something as simple as this has been associated, in studies, with increased oxygen uptake, reduced need for oxygen tanks, improved performance in activities of daily living, like dressing, eating, and grooming, and less labored breathing.
 

This is of particular relevance, given that COPD is the fourth leading cause of death in the United States. Note: COPD is associated
with smoking. In other words, the devastation of COPD is preventable by simply not smoking.

 

COMFORT AND REASSURANCE
Finally, remember that many clients with a respiratory condition are frightened by the idea of suffocating. Thus, anxiety and panic are not uncommon. These clients need all the reassurance and support they can have. Show understanding for the daily struggle they face as a result of their condition. Be positive and encouraging at all times. You will give them brighter days and help
them maintain that all-important confident outlook on life they need.

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