Dekubitus im Umfeld der Sterbephase

TY - JOUR

T1 - Dekubitus im Umfeld der Sterbephase

T2 - Epidemiologische, medizinrechtliche und ethische Aspekte

AU - Heinemann, A

AU - Lockemann, U

AU - Matschke, J

AU - Tsokos, M

AU - Püschel, K

PY - 2000/1/21

Y1 - 2000/1/21

N2 - BACKGROUND AND OBJECTIVES: Pressure sores usually result from insufficient preventive measures. They are particularly omnipresent among dying persons in geriatric care. This study deals with prevalence, risk factors and the significance of the nursing environment. PATIENTS AND METHODS: The prevalence of pressure sores among the dead was analysed in a prospective cross-sectional study based on 10,222 postmortem examinations in a crematorium in Hamburg. RESULTS: The overall prevalence of pressure sores from grades I to IV was 11.2% (grade I: 6.1%, grade II: 3%, grade III: 1.1%, grade IV: 0.9%). A final logistic regression model showed that pressure sores of Grade III or IV were associated with female gender, date of death in the summer, marasmus, stroke history, neurological disease in general, kidney disease, preceding traumatic events and nursery home residence at the time of death. More than half of all the grade IV cases were diagnosed among nursing home residents whereas those who had died in hospitals contributed to only 11.5% of all the grade IV cases (dead from private homes 34.4%). Nursing home residence was associated with female gender, marasmus and stroke history which predisposed to a higher rate of pressure sores. CONCLUSIONS: Nursing homes are confronted with the highest proportion of pressure sores among dying people when compared to hospitals or private home care. Failure to meet the standards of preventive action against pressure sores point to the shortfalls in the present public health sector and nursing home regulations as well as the medical responsibility for supervision of nursing care. Apart from established standards of care, medicolegal assessment of high-grade pressure sores should also take ethical considerations into account when considering maximum therapy goals among dying persons.

AB - BACKGROUND AND OBJECTIVES: Pressure sores usually result from insufficient preventive measures. They are particularly omnipresent among dying persons in geriatric care. This study deals with prevalence, risk factors and the significance of the nursing environment. PATIENTS AND METHODS: The prevalence of pressure sores among the dead was analysed in a prospective cross-sectional study based on 10,222 postmortem examinations in a crematorium in Hamburg. RESULTS: The overall prevalence of pressure sores from grades I to IV was 11.2% (grade I: 6.1%, grade II: 3%, grade III: 1.1%, grade IV: 0.9%). A final logistic regression model showed that pressure sores of Grade III or IV were associated with female gender, date of death in the summer, marasmus, stroke history, neurological disease in general, kidney disease, preceding traumatic events and nursery home residence at the time of death. More than half of all the grade IV cases were diagnosed among nursing home residents whereas those who had died in hospitals contributed to only 11.5% of all the grade IV cases (dead from private homes 34.4%). Nursing home residence was associated with female gender, marasmus and stroke history which predisposed to a higher rate of pressure sores. CONCLUSIONS: Nursing homes are confronted with the highest proportion of pressure sores among dying people when compared to hospitals or private home care. Failure to meet the standards of preventive action against pressure sores point to the shortfalls in the present public health sector and nursing home regulations as well as the medical responsibility for supervision of nursing care. Apart from established standards of care, medicolegal assessment of high-grade pressure sores should also take ethical considerations into account when considering maximum therapy goals among dying persons.

KW - Aged

KW - Aged, 80 and over

KW - Cross-Sectional Studies

KW - Ethics, Medical

KW - Female

KW - Germany

KW - Home Nursing

KW - Hospitals

KW - Humans

KW - Male

KW - Middle Aged

KW - Mortuary Practice

KW - Nursing Homes

KW - Pressure Ulcer

KW - Prevalence

KW - Seasons

KW - Terminal Care

U2 - 10.1055/s-2007-1023905

DO - 10.1055/s-2007-1023905

M3 - SCORING: Zeitschriftenaufsatz

C2 - 10681998

VL - 125

SP - 45

EP - 51

JO - DEUT MED WOCHENSCHR

JF - DEUT MED WOCHENSCHR

SN - 0012-0472

IS - 3

M1 - 3

ER -