Decubitus: The Unknown (Part 2)

by Wiebke Heiss / MEDICA.de15/09/2009

Part 2: A Fatal Lack of Research

But why do measures for the prevention of decubitus do not take hold resulting in only a slight decrease in the incidence of these wounds? This question cannot even be answered by medics yet - the world of experts is confronted with pressure ulcers still surrounded by many unknown facts. Theo Dassen, professor for Care Science at the Charité in Berlin, says: „We do not know why some people develop a decubitus already after three days whereas others do not. We do not know why the tissue beneath the skin disintegrates. We do not even know after one hundred years how to really define decubitus.“ Therefore, physicians are rather clueless when standing around a newborn with a decubitus since nobody knows how to prevent these cases which are an example that, even though the elderly are at the highest risk, anybody being forced to lie down for a long time can develop these chronic wounds.

However, all experts agree that an increase of the proportion of older people in society will be accompanied by an increase in chronic diseases which in turn will most probably be followed by more decubitus cases. It is about time to learn more about tackling the pressure ulcer problem. „We would really like to pursue more research in this area“, Dassen says. „However, it is very hard to get people supporting this with money.“ Funds are a lot more readily available for topics such as cancer or HIV. Still, according to Dassen, decubitus is one of the biggest problem in health care: Costs could be reduced by millions of Euros each year since the treatment of a decubitus sums up to about 50,000 Euros. „Nonetheless, no statistics exist about this disease, especially since it most often occurs as a comorbidity.“

Therefore, Dassen and colleagues have been collecting data themselves and published them in a current report. The study included nursing homes and hospitals. The results show that the number of pressure ulcers generally decreased in the participating institutions since 2005 – from 21 to 14 percent in hospitals and from 9 to 6 percent in nursing homes. However, again it was not possible to completely avoid the ulcers. It is unclear, whether this is due to wrong measures or due to a high number of patients with an overall bad condition.

„I doubt it that decubitus can be seen as a sign for bad care anymore“, Dassen states. He is sure that there is not a single intensive care nurse in the whole of Europe who would not be alarmed by a pressure ulcer. „Neither one single director of nursing.“ The professor does not deny appalling isolated cases but he does not think that this is a ubiquitous problem. „Generally, hospital or care nurses know what to do with a decubitus“, Dassen explains. As long as they keep up-to-date with training courses. „At best once a year.“

Dassen sees the real problem with decubitus in the lack of proven scientific results. As a matter of fact, decubitus numbers in Germany are similar to those in other countries. „All over the world, experts are trying to find a solution to the pressure ulcer problem“, the professor explains. „Despite all the efforts, the percentage of decubitus cannot be reduced underneath a certain level.“ Maybe this truly is due to a lack of proven scientific results not only in prophylaxis but also in the treatment of the ulcers. „There is only little evidence for prevention measures and treatment“, the professor says, „and that really is a problem.“ The reason again is not enough research which results in guidelines that are based on knowledge „that is made up by 80 percent of best practice experiences that have not been scientifically proven.“

Wiebke Heiss
MEDICA.de

- Teil 1: Der große Unbekannte
- Teil 2: Mangel an Forschung