trends and confounding

Ergebnisse zur Dekubitusprävalenz sind wichtige Indikatoren für das Ausmaß der Erkrankung in unterschiedlichen Sektoren und Bereichen des deutschen Gesundheitswesens. Valide und präzise Zahlen zur Prävalenz sind zur Bewertung des Ressourcenbedarfs und Planung von Gesundheitsleistungen dringend erforderlich. Durch die vorliegenden Studien kann das Ausmaß der Dekubitushäufigkeit in bundesdeutschen Pflegeheimen und Krankenhäusern bestimmt werden. Es bestehen Hinweise, dass von einer externen Validität der Studienergebnisse ausgegangen werden kann. Dabei muss die bisherig angenommene hohe Prävalenz von 30% in Pflegeheimen deutlich nach unten korrigiert werden. Die standardisierten jährlichen Erhebungen lassen den Schluss zu, dass sich die Dekubitusprävalenz seit 2001 sowohl in Pflegeheimen als auch in Krankenhäusern reduziert hat. War vor 10 Jahren noch jeder zehnte Bewohner/ Patient von Dekubitus betroffen, so ist es im Jahre 2011 nur noch jeder 20. Kranken-hauspatient und nur noch jeder 25. Pflegeheimbewohner. Der Vergleich von institutsbezogener Prävalenz sollte ausschließlich risikoadjustiert erfolgen, da nur dadurch faire Vergleiche zwischen unterschiedlichen Sektoren, Bereichen und Einrichtungen möglich sind und der Einfluss von Confoundern weitestgehend reduziert wird. Die durchgeführten Studien ermöglichen die Weiterentwicklung von statistischen Modellen. Analog zu dem im Rahmen dieser Studie vorgestellten SRISAG Modell sollten derartige Modelle einfach und handhabbar sein und dadurch eine sinnvolle Problem- und Qualitätsbestimmung des Pflegeproblems Dekubitus in unterschiedlichen Institutionen des deutschen Gesundheitswesens ermöglichen.Results of studies about pressure ulcer prevalence are important parameters about the size of the problem in different sectors and areas of the German health care services, because valid and precise figures about its prevalence are necessary for the adequate planning of actual care needs. The provided studies of this Habilitation provide this information for German Hospitals and nursing homes. The results can be considered as sufficiently external valid. Former estimation of a high pressure ulcer prevalence of about 30 percent in German nursing homes have to be adjusted downwards notably. The standardized annual studies lead to the conclusion, that the pressure ulcer prevalence has dropped since 2001 in nursing homes and hospitals. Ten years ago, every 10th hospital patient and nursing home resident had at least one pressure ulcer. In the year 2011 this is only the case in every 20th hospital patient and every 25th nursing home residents. The comparison of institutional related prevalence rates should always be done by applying risk adjustment measures. Thus fair comparison between different sectors, areas and institutions will be guaranteed and the influence of possible confounders will be minimized. The preformed studies allow the further development of statistical models. Alike the in this habilitation proposed SRISAG-Modell, these models should be easy and manageable and can be used to determine the size of the problem and the quality of the nursing problem pressure ulcer in different institutions of the German health care system

Smart@home – supporting safety and mobility of elderly and care dependent people in their own homes through the use of technical assistance systems and conventional mobility supporting tools: a cross-sectional survey

Background: The use of technical solutions and conventional mobility supporting aids can support the independence of people into old age in their own homes. However, we found relatively few empirical investigations on the effects and costs of these systems. Methods: The aim of the study was to investigate usability, user satisfaction and the correlation between costs and benefits of different built-in smart home solutions and conventional mobility supporting tools in the home of elderly, partially care-dependent tenants (> 65 years). A cross-sectional survey was conducted from February to March 2018 with tenants of a housing association in apartments equipped with smart home technology and conventional mobility supporting tools. The response rate in the intervention group was n = 37 persons (out of 46 tenants with installed smart home and conventional solutions) and in the control group n = 64 persons (out of 100 tenants without built-in smart home and conventional solutions). Data were collected by a written questionnaire regarding usability and satisfaction of the tenants with the built-in smart home solutions and conventional mobility supporting tools. In addition, both the intervention and the control group were asked general questions about communication, safety and how to deal with the need for long-term care in their own living environment. Results: Results showed that with regard to usability, satisfaction and price performance ratio of the installed smart home solutions, the installation of the corresponding solutions with an overall score of 1.41 (on a scale of 1 (very good) to 6 (unsatisfactory)) was mostly positively evaluated by the tenants. Overall, users rated the installed smart home solutions better than the conventional mobility supporting tools (such as handholds and increased balcony floor level). Conclusions: Analysis of the price performance ratio showed that smart home solutions are generally more expensive than conventional tools, but also contribute significantly to an increased security of the tenants, and thus may enable longer living in a familiar environment. We recommend modularized offers consisting of various components of smart home solutions, since this significantly reduces installation costs and allows for an individual composition according to requirements. Moreover, smart home solutions should be considered to be listed as medical aids

Patient safety. Factors for and perceived consequences of nursing errors by nursing staff in home care services

Aim: To identify factors for and perceived consequences of nursing errors by nursing staff in home care services in correlation with qualification, work experience, working hours and trainings. Background: Patient safety has increasingly been brought into focus of politics and care practices over the past few years. However, little evidence has been provided yet on nursing errors in out-of-hospital settings. Design: A cross-sectional study. Methods: Randomized sample of 107 home care services and 656 nurses and nursing assistants recruited from all 16 federal states in Germany. Results: Missing trainings on error management within the past 2 years were identified to be an important factor for mistakes regarding hygienic measures and medication administration. However, most errors arose in documentation without any significant differences in qualification, work experience, training and working hours. Conclusion: Findings indicate that insufficient hygiene and medication administration might be reduced by implementing error management trainings on a regular basis in home care services

A Multicenter Study

PURPOSE The purpose of this study was to evaluate associations among use of walking aids, mobility status, and occurrence of urinary incontinence (UI) in geriatric patients residing in nursing homes, and to examine associations between UI severity (frequency and amount) and its impact on health-related quality of life (QoL). DESIGN Multicenter descriptive cross-sectional prevalence study. SUBJECTS AND SETTING A total of 2044 patients from nursing homes were included in the study. A majority were female (72.0%), the mean age of participants was 82.1 years (SD 11.2), their mean body mass index was 26.1 (SD 5.4), and their mean Care Dependency Scale score was 46.0 (SD 18.2), indicating a medium to high care dependency. The study setting was 30 nursing homes throughout Germany from 2014 to 2015. METHODS Data were collected by trained nurses using a standardized data collection form to collect information about demographic characteristics, health conditions, mobility status measured according to the Elderly Mobility Scale (EMS), UI, and QoL measured using the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF). RESULTS The prevalence of UI was 69.7% (n = 1804). Analysis of variance showed that, in 1659 nursing home residents with information on UI, 572 reported a medium amount of leakage with a mean impact on health-related QoL of 2.2 (SD 2.2, P < .001) on a scale from 0 (no impact) to 10 (very high impact). The mean of the impact on QoL in 235 residents who reported a large amount of leakage was 2.4 (SD 3.0, P < .001). In 1741 residents with information on the frequency of UI, 637 reported being urinary incontinent more than once a day with a mean impact on QoL of 2.2 (SD 2.1, P < .001) and 359 residents with permanent UI stated a mean impact on QoL of 2.1 (SD 2.8, P < .001). According to the bivariate association of UI with use of walking aids, the highest prevalence of UI (61.2%) was in patients who did not use any walking aids. The Chi-square Automatic Interaction Detector (CHAID) of the relationship between mobility according to the EMS and UI indicated that 71.1% of all patients with UI did not use any walking aids, although their mobility status had been reduced. CONCLUSIONS Findings indicate a significant association between impaired mobility and UI in nursing home residents. Chronic, severe urinary incontinence exerted the greatest impact on health-related QoL. Therefore, we recommend measures to preserve or regain mobility to minimize or prevent UI in geriatric residents and patients and, thus, increase their health-related QoL

A Cross‐Sectional Study

The burdens caused by chronic wounds on the affected persons themselves and also on the health care system are well recognised. The aim of this study was to investigate the prevalence and risk factors of chronic wounds in German nursing homes. An annual cross-sectional study was conducted in nursing home residents from 2012 to 2018. The proportion of men affected by chronic wounds was to some extent higher than that of women, 9.0% males vs 7.5% females. In total, 7.8% of all residents were affected by chronic wounds. Of all residents with a chronic wound, 50.5% were affected by pressure ulcer. Male residents were twice as often affected by diabetic foot ulcer than female residents (18.0% vs 8.9%; P = 0.002). Bivariate analysis showed that chronic wounds were highly associated with poor nutrition, urinary incontinence, stool incontinence, diabetes mellitus, and limited mobility (P = 0.000). According to multivariate analysis, the strongest predictors for chronic wounds were limited mobility and diabetes mellitus. The highest prevalence of chronic wounds was in residents who were not restricted in their mobility, had diabetes, were male, and lived in a metropolitan region (23.7%). This study identified the prevalence and risk factors of chronic wounds in nursing home residents. Further research is needed to identify causal factors of the gender difference in the prevalence of chronic wounds. This may have an impact on the choice of prophylactic and therapeutic measures

Prevalence, Risk Groups, Wound Characteristics and Methodological Issues

Titelblatt und Inhaltsverzeichnis Deutsche Zusammenfassung Article1:prevalence and risk groups Article2:wound characteristics Article3:non-response bias questionnaire and comments on article1Prävalenz von Dekubitus (ICD-10: L89) misst das Ausmaß dieser Erkrankung in definierten Bevölkerungsgruppen. Bisher veröffentlichte internationale Studien in Pflegeheimen und Kliniken geben Prävalenzen von unter 5% bis über 40% an. Für die Bundesrepublik Deutschland lagen bis 2001 derartige Daten zu Dekubitus aus bundesweiten und unabhängigen Studien nicht vor. Um gemessene Ergebnisse vergleichbar zu machen, müssen Risikogruppen, Wundcharakteristika und der Einfluss der Nichtteilnahme an der Studie berücksichtigt werden. Ziel der Forschungsarbeit ist der Vergleich von deutschen Pflegeheimen und Kliniken im Hinblick auf das Ausmaß des Phänomens Dekubitus, unter besonderer Berücksichtigung methodologischer Probleme. In den Jahren 2001 bis 2003 wurden bundesweit in 158 Einrichtungen Stichtagserhebungen mittels Fragebogen durchgeführt. Das Durchschnittsalter bei 4.827 Pflegeheimbewohnern lag bei 81,8 (sd. 12,2), das der 19.661 Krankenhauspatienten bei 63,9 (sd. 19,3) Jahren. In den Pflegeheimen bestand bei etwa zwei Dritteln und in den Krankenhäusern bei etwa 40 % aller teilnehmenden Personen ein Dekubitusrisiko. In den untersuchten Pflegeheimen war die Dekubitusprävalenz bei Risikopersonen deutlich niedriger als in den untersuchten Krankenhäusern. In den Krankenhäusern hatten die Hälfte der Dekubituspersonen mehr als ein Dekubitalulzera, in den Pflegeheimen etwa 30 %. Am häufigsten entstanden diese innerhalb der Einrichtungen und an Sakralbereich und an den Fersen. Etwa die Hälfte der gefundene Dekubitalulzera waren Grad 2 oder höher. Beim Entstehungsort, Lokalisation und Schweregrad waren die gefundenen Unterschiede zwischen Pflegeheimen und Kliniken gering, bezogen auf die Dauer zeigte sich jedoch, dass Dekubitalulzera in Pflegeheimen deutlich länger bestehen. Der Einfluss der Nichtteilnehmer aus den untersuchten Stichproben auf die Prävalenzen konnte durch eine entwickelte Formel errechnet und berücksichtigt werden. Durch die vorliegende Forschungsarbeit liegen verlässliche und vergleichbare Zahlen zu Dekubitus in deutschen Pflegeheimen und Krankenhäusern vor. Die Ergebnisse der untersuchten methodologischen Fragestellungen werden in den Empfehlungen für die klinische Forschung zusammengefasst.Prevalence of pressure ulcer (ICD-10: L89) assess the extent of the problem of this phenomena within a population,. So far published international studies range from less than 5 % to more than 40 % in nursing homes and hospital. Until 2001 there were no such data available for Germany. Besides prevalence, it is necessary to give information about risk group size, wound characteristics and the influence of non response bias to be able to compare data between nursing homes and hospitals. Therefore, the overall aim of the study is to provide current and accurate and comparable data regarding the problem of pressure ulcers in German nursing homes and hospitals From 2001 to 2003 samples were taken from 158 health care organizations throughout Germany. Mean age of 4827 nursing home residents was 81,8 (sd 12,2); of 19661 hospital patients it was 63,9 (sd. 19,3). In nursing homes 2/3 of all residents were considered at risk for developing a pressure ulcer in comparison to hospitals, where 40% of all patients were are risk. Pressure ulcer prevalence was statistically significant and clinically relevant lower in nursing homes than in hospitals. More than half of the pressure ulcer hospital patient had more than one wound, as this was the case only in 30% of all nursing home residents with pressure ulcer. Most common location of the wound was the lower back area and heels. About half of the ulcer were severe. Regarding origin, location and severity there was little difference within each kind of institution. Duration of the existing ulcers was longer in nursing homes than in hospitals. By using a newly developed formula non response bias could be considered and results could be compared between nursing homes and hospitals. This thesis provide accurate independent data about the pressure ulcers in German nursing homes and hospitals and gives recommendation on methodological issues in performing pressure ulcer prevalence surveys