"Peacefully passing away at home is now a thing of the past"
There's a prevalent practise in German hospitals involving a high volume of respiratory treatments, including intubation and mask ventilation, towards the end of life and for elderly patients. According to a recent study, an alarming number of individuals die on a ventilator. This phenomenon has numerous contributing factors.
As per a research group led by Intensive Care Medicine expert Christian Karagiannidis from the Lung Clinic Cologne-Merheim, over 10% of adults in Germany reportedly experience their final moments on a ventilator in a hospital. Their findings were reported in the journal "The Lancet Regional Health - Europe."
Analyzing information from over one million adults who were ventilated in approximately 1400 German medical facilities between 2019 and 2022, including the Covid-19 pandemic, the team determined that more than 43% of the ventilated patients passed away in the hospital. They calculated this proportion based on statistics from the Federal Statistical Office to determine the death rate during the research period.
The primary reasons for respiratory support through endotracheal tubes or masks were heart conditions, lung infections, chronic obstructive pulmonary disease (COPD), and cerebrovascular diseases such as strokes. These figures remained consistent even following the pandemic, reported co-author Wolfram Windisch from the Lung Clinic Cologne-Merheim.
"Mechanical ventilation was widespread in Germany before, during, and after the Covid-19 pandemic," the group penned. Windisch further noted that over 1,000 individuals aged 80 and above were ventilated annually per 100,000 inhabitants, with a mortality rate of 59%, significantly higher than reported statistics previously. For contrast: In England, around 200 people in the same age range per 100,000 were ventilated, while in Canada, it was 700.
Is Germany's elderly population receiving excessive care?
Karagiannidis noted, "We have one of the highest tendencies, along with the USA, to conduct a lot of respiratory therapy at the end of life and for the elderly." Windisch, who also serves as President of the German Society for Pneumology and Respiratory Medicine (DGP), stressed in a DGP press release, "Peaceful dying at home is no longer a reality for many people - they often stay in hospitals."
How about the idea that Germany's elderly population is receiving too much care? "The study can't answer that question," Windisch remarked. Potential contributing factors may also revolve around the presence of numerous individuals with chronic conditions in Germany, potentially linked to high tobacco consumption rates.
One undeniable fact, according to Windisch: Ventilating patients brings in revenue for German hospitals. Financial motivations could also play a role in these decisions. "We have a system where each clinic can do anything it wants," he declared. "Our research aims to spark a societal discussion - also in connection to hospital reform."
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Due to the findings of the study led by Christian Karagiannidis, there's a concern about the high number of elderly individuals in Germany experiencing their last moments in a hospital on a ventilator. This trend, as highlighted by Wolfram Windisch, is associated with a disproportionately high mortality rate compared to other countries like England and Canada.
Furthermore, the widespread use of mechanical ventilation in Germany, as indicated by the research, raises questions about the potential for excessive care in the healthcare system, which could have financial motivations. This situation, according to Windisch, necessitates a societal discussion about hospital reform.
