Social determinants of health and the evolution of decubitus ulcers

Șef de lucr. univ. dr. Ioana Soare1,4, Dr. Giuseppe Ceccarelli2,5, Dr. Andrea Ceccarelli2,6, Șef de lucr. univ. dr. Roxana Mirica3,4
1 Facultatea de Medicină, Universitatea Titu Maiorescu, București, România, 2ASL Frosinone, Italia, 3Facultatea de medicină, Universitatea Carol Davila, București, România, 4Expertiză medicală, 5Geriatrie-gerontologie, 6Chirurgie generală

Received: 7.09.2020 • Accepted for publication: 25.10.2020

Abstract

Due to the widespread use of anti-ulcer mattresses, we expected that there would be no patients with decubitus ulcers. However, these patients exist, we also see severe forms, with large, deep lesions. And then we started looking for other factors that could intervene in the incidence and aggravation of this type of injury. A group of 50 Italian patients was studied, and the examination of social factors and statistical interpretation was performed at the Faculty of Medicine in Bucharest, in a joint study. Atypical social factors were noted – most patients lived with their families or were cared for in the asylum, but had large decubitus injuries, between 16-25 cm2. The families, although supportive, were exhausted by the long duration of care provided to the bedridden patient.
The rural environment was considered an aggravating social factor, because it extended the duration from the observation of the ulcer to the scheduling of the visit of the geriatrician at home. The lack of minimum health education was the decisive social determinant, because family members did not ask the attending physician, or if they had the mattress at home, did not use the patient’s anti-ulcer mattress, which dramatically aggravated the evolution. Most patients already had grade 3 and extended surface of the decubitus ulcers when the geriatrician first visited them. We also noted that these home care services were free in Italy (including the mattress), compared to Romania, where they are paid in full.

Keywords: social determinants of health, SDH, decubitus ulcer, antiescara mattress, rural environment, education

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