You are here: MEDICA Portal. Teil V: Decubitus. Health Care Politics.
The Unknown (Part 1)
Most people have never heard of this disease, decubitus still is a great unknown. The reason being: These nasty wounds that really are pressure ulcers - hard to heal, very painful, often open down to the bone - are hardly ever a topic in public discussion in Germany. The only occasion decubitus becomes a topic for the media: When a celebrity suffers from it - the German yellow press reported on full the last time in 2002 when a famous German entertainer called Harald Juhnke - already in the state of dementia - acquired a bedsore.
In reality, these chronic wounds are a great problem especially for immobile elderly. In 2002, the Robert Koch-Institute and the Federal Statistical Office estimated that each year more than 400,000 people suffered from a bedsore requiring treatment – with costs ranging somewhere between 700 million and 2 billion Euros. At the same time, a study conducted by a coroner from Hamburg raised the attention of persons in charge: Klaus Püschel from the university hospital Hamburg-Eppendorf (UKE) wanted to find out how many old people acquired decubitus before dying. He examined 10,000 deceased and discovered at least one decubitus in about 11 percent. If these numbers are extrapolated to the whole of Germany it would mean that a few thousand people each year lie on bare flesh or bones for weeks or months.
People in charge in Hamburg tried to solve the problem and therefore decided ten years ago to start an investigation in order to learn more about decubitus hoping for a way to avoid the problem in future. Data were collected about the patient's condition before and after a hospital stay. The surprising results: „We were not able to avoid a certain percentage of decubitus even though a few years ago everybody thought that it is possible to prevent bedsores with the right measures altogether“, Hans-Jürgen Thomsen says, head of care at UKE. Now, experts assume that some patients will incur a decubitus in spite of any prophylaxis. According to Thomsen these patients are either not suited for preventive measures due to the severity of their illness or they belong to a very high risk group such as intensive care patients with bad nutritional condition.
„However, we did succeed in decreasing the incidence of decubitus at UKE with the help of The Decubitus Prophylaxis Standard for Experts developed by the German Network for Development of Quality in Care“, Thomsen says. This standard is obligatory to all care institutions in the Federal Republic. Hamburg, however, is a pioneer in the recording of pressure ulcers as well as conducting a structured dialog which means that institutions with a conspicuously high number of patients with a decubitus will be contacted. The dialog is supposed to clarify the reasons and to initiate more prevention measures, if necessary.
However, last year the coroner Püschel repeated his study in Hamburg and observed a prevailing high number of people suffering from a decubitus in spite of all measures that were put into action during previous years: Scientists examined 8518 deceased 60 years and older. 12 percent of them exhibited at least a minor pressure ulcer, 3 percent had suffered from a pressure ulcer grade 3 or 4 – deep chronic wounds that in the worst case reach down to the bone.
- Part 1: The Unknown
- Part 2: A Fatal Lack of Research