Correspondence (reply): In Reply

We are pleased to reiterate our comment that the primary objective of preventing decubitus ulcers and any other medical measure should be to maintain quality of life for elderly patients: “Pain should be noted and adequately treated, as the advantages for the patient (better quality of life, improved mobility) outweigh the disadvantages (diminished perception). Frequent repositioning and skin inspections remain indispensable. For patients in the final, preterminal phase of life, individual desires may take precedence over the prevention of decubitus ulcers.” Identifying and treating pain regularly, on the basis of the analgesic ladder from the World Health Organization (guidelines for pain management: http://www.uni-duesseldorf.de/WWW/AWMF/ll/ll_041.htm) therefore ranges among the quality criteria for the clinical treatment and medical attendance of patients in long term care. (http://www.mds-ev.de/media/pdf/BRi_Pflege_090608.pdf). Because some patients cannot express their pain experience—for example, as a result of severe dementia—we recommend training specialist nurses to recognize non-verbal symptoms such as grimacing, adopting a protective posture, or vegetative reactions. In this context we wish to mention the working group “pain and age” of the the German Society for the Study of Pain (http://www.dgss.org, Deutsche Gesellschaft zum Studium des Schmerzes). Validated pain assessment instruments to document pain in these target groups include the BESD (1); to record the observed course of a patient’s quality of life, the DCM (2) and H.I.L.DE (3) (available from 2011). In order to coordinate treating the underlying illnesses, stressful symptoms such as pain, and the prevention of decuibitus ulcers, geriatric assessment is the method of choice (http://www. gericareonline.net/tools/index.html). Non-pharmacological interventions—such as exercise promotion—rank highly in such an assessment.