Almost every second person dies in a hospital these days

Almost every second person dies in a hospital these days

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Why so many people die in the hospital

Around every second person in Germany dies in a place that they usually do not choose themselves - in the hospital. Medical doctor Jana Jünger, head of the Institute for Medical and Pharmaceutical Examination Questions (IMPP), which is responsible for state examinations by doctors, explains why this is the case.

Almost nobody wants it, but it happens to every second person. Many people die where they don't want to die: in the hospital. There are many reasons. In 2018, the proportion of those who died in hospitals was 46 percent. In most cases, this does not correspond to the patient's wishes.

How do we want to die?

No way, says 55-year-old Thomas M. when he talks about his father's death five years ago. With an inflammation in the abdomen, the 74-year-old came to a hospital in Ludwigsburg.

Despite surgery, nothing got better. The old man wanted to go home, dawned, a hospital germ came along. The senior doctor ordered another operation. "Why is that, my father is dying?" Asked M .. The professor shrugged. The father never came home.

A typical scenario

"The patient is worse off because he dies - this often goes unrequested between the doctor and the patient or their relatives," explains Jünger. The result: unnecessary interventions, operations, costly periods of suffering in the intensive care unit during the last days of life. According to surveys, almost nobody wants to die in the hospital.

"That's too much!"

But that still happens far too often. According to the German Evangelical Hospital Association (DEKV), 77 percent of Germans die either in a clinic or in a nursing home. According to a study by the Max Planck Institute last year, the proportion of those who die in hospitals has been declining for a long time. According to figures from 2016, it is still 46 percent and has been stagnating since then. "This is far too much because it does not meet the wishes of the patients," says Jünger. "If communication was better here, we could significantly improve this situation within five years."

The care of terminally ill people outside of hospitals is well regulated, for example in Baden-Württemberg, says a spokesman for the Ministry of Social Affairs. "Outpatient care has improved significantly in recent years and is now well on the way." In addition to outpatient hospice services, so-called teams of specialized outpatient palliative care (SAPV) looked after dying adults and children: "Coverage with SAPV teams in Baden- Württemberg is over 90 percent, ”says the spokesman.

Therapy instead of discharge

So why do patients end up in the hospital and die there? One reason is that people with incurable cancer still receive therapy in the last few weeks of their lives instead of being discharged home. Based on billing data between 2012 and 2015, the Barmer Ersatzkasse assumes that around 15 percent of these cancer patients will undergo chemotherapy in the last 30 days of their life - this usually happens in the hospital.

The death wishes of those affected are often unknown

According to Angela Carollo from the Max Planck Institute in Potsdam, another reason could be that the very elderly are often hospitalized with respiratory diseases and die there within a few days. Or there is no living will: relatives are unsure of what to do, do not want to make a mistake, the patient's wish goes unheeded.

Communication limps

But very often there is a problem with the communication between doctor and patient, as Jünger explains. She advocates training doctors and practicing with them how best to discuss their wishes and ideas with patients in view of the approaching death. “This has to be implemented in training and further education. We have to bring these issues into the state exams for doctors, ”she emphasizes.

Over-therapy shortly before death

"Illness and telling the truth at the bedside is always a process," says Benno Bolze, managing director of the German Hospice and Palliative Association (dhpv). It is not always easy for patients to decide whether therapy is still useful or not. However, from the Barmer point of view, criticizing "over-therapy" across the board is not fair. "It is important that patients are involved in the therapy decision." In addition, dignified dying is also possible in the hospital.

"The number of aging people is increasing - we will need a high level of hospice and palliative care," explains Bolze. “And we will never be able to say: That is done, we are on target.” It is important that networks are established and work well: outpatient care services, specialized teams for palliative care, hospices et cetera - they all have to work together. Retirement homes in particular need a close connection to the palliative networks. "Because the resident is at home there and should be able to die there."

Does Mammon Prescribe Morality?

According to Jüngers, financial constraints and false incentives in the health care system, such as non-sensible interventions or therapies, make a significant contribution to depriving people of an appropriate death. "It cannot be that mammon prescribes morality for us - or the ethical notion of patient rights and human dignity," she said. "We have to say: We don't do this for reasons of patient safety and dignity." (Vb; source: Anika von Greve-Dierfeld, dpa)

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