Decubitus ulcers in the dying: epidemiological, medicolegal and ethical aspects

Background and objectives: Pressure sores usually result from insufficient preventive measures. They are particularly onmipresent among dying persons in geriatric care. This study deals with prevalence, risk factors and the s ignificance of the nursing environment. Patients and methods: The prevalence of pressure sores among the dead was a nalysed in a prospective cross-sectional study based on 10,222 postmortem e xaminations in a crematorium in Hamburg. Results: The overall prevalence of pressure sores from grades I to IV was 1 1.2% (grade 1: 6.1%, grade 11: 3%, grade III: 1.1%, grade IV: 0,9%). A fina l logistic regression model showed that pressure sores of Grade III or IV w ere associated with female gender, date of death in the summer, marasmus, s troke history, neurological disease in general, kidney disease, preceding t raumatic 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 th e grade IV cases (dead from private homes 34.4%). Nursing home residence wa s associated with female gender, marasmus and stroke history which predispo sed to a higher rate of pressure. Conclusions: Nursing homes are confronted with the highest proportion of pr essure sores among dying people when compared to hospitals or private home care. Failure to meet the standards of preventive action against pressure s ores point to the shortfalls in the present public health sector and nursin g home regulations as well as the medical responsibility for supervision of nursing care. Apart from established standards of care, medicolegal assess ment of high-grade pressure sores should also take ethical considerations i nto account when considering maximum therapy goals among dying persons.