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Introduction: A changing and aging population contributes to an increase of Alzheimer-type or related dementia. Encouraged by health policies, home care for patients suffering from these conditions is often dependent on their caregivers' contribution. The demands of such a role may weaken the caregivers and cause them a feeling of burden requiring the recourse to periods of respite. An ancillary study of a research program carried out in the Geneva agglomeration, our study aims to characterize, for the caregivers of patients with dementia, the determinants of a recourse to the devices of respite., Method: Qualitative research conducted by focus groups of caregivers of patients with dementia. Three focus groups were conducted, with 12 participants in the cities of Geneva (Switzerland) and Rouen (France)., Results: Our study notes the concomitance of the evolution of the assisted person's disorder and the emergence of a feeling of burden on the caregiver, related to the duration and the intensity of the aid provided. Our results help to identify the determinants of a recourse to respite periods for the caregiver or institutions and to modelize these determinants., Conclusion: Devices of respite must be coordinated and adapted to the needs of caregivers, both in terms of format and quality, in order to facilitate the use of the most vulnerable populations and to avoid too late recourse.

Behavioural disorders linked to dementia are common. The intertwining of psychiatric and neurodegenerative pathologies means caregivers are faced with complex situations on a daily basis. The expertise of the geriatric psychiatry teams helps to guide the clinical reasoning and to find the best nursing approach in order to understand the symptom and support the patient., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

New technologies offer innovations to improve the care of the elderly with Alzheimer's or and other forms of dementia. Robots, endowed with features such as monitoring of physiological parameters, cognitive training or occupational therapy, have appeared. They are not, however, intended to replace humans. Still underutilized, these robots are in development, much like the digital literacy of the elderly., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Agitation in hospitalized demented patients is troublesome and disruptive for both patients and caregivers. The literature indicates that agitation is strongly related to physical or psychological discomfort and its recent definition includes the additional relation to emotional distress. Hospitalization associated with major cognitive difficulties further activates the need for attachment and security to which caregivers must pay attention. This synthesis review first deals with the evidence related to agitation in people with dementia and its relationship with discomfort. A description of the difficulties with which caregivers must cope follows. The need to primarily use nonpharmacological approaches during agitation to meet the underlying needs causing discomfort is then developed. Recommended approaches generally involve a relational contact, even if facing the risk of mobilizing frequently unsecured and anxious attachment patterns in this population. A conceptual positioning supported by the Kolcaba comfort theory will position this knowledge. A particular point of this theory, based on previous experiences of patients, will be analyzed based on attachment characteristics of people with dementia.

Training could be a lever for improving the quality of care of residents with dementia in nursing homes by changing social representations. Beyond a simple assessment of acquired knowledge, a change of social representations could be indicative of a true appropriation of the content of the training. A study was carried out to assess the impact of training on nursing home caregivers' representations of dementia and Alzheimer's disease., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The description of the different profiles of somatic, psychiatric and socio-relational comorbidites of psychogeriatric inpatient hospitalized due to behavioral and psychological symptoms of dementia and their associated nursing interventions are poorly documented. This study aimed to describe the observations and interventions given to patients from the four LPCI clinical profiles and to reach a consensus of experts on relevant interventions per profile. A content analysis was conducted on computerized nursing notes of 40 patients. By combining individual and collective production phase, the TRIAGE method allowed reaching an expert consensus on relevant interventions. The results showed that the current practices are generally similar for all patients while appropriate interventions from the expert consensus varied depending on the profile. Also, some problems remain poorly invested, such as screening, assessment and treatment of depressive symptoms and the maintenance of functional autonomy. Since most interventions have been tested in long- term institutions, the development of studies to test interventions tailored to acute psychogeriatric environment and the implementation of evidence-based practices are needed.

The issue of self-neglect in the elderly concerns society as well as caregivers who, in their practice, are ill at ease and frequently disorientated when faced with this behaviour which hampers the care approach. Here more than elsewhere, the choices of the people in question seem to collide with the care objectives, in such a way that it is important to remain curious in the face of what appears to be the height of incuriosity.

Serious games are becoming ever more innovative and increasingly popular within the healthcare profession. Developed as a remote training tool, they support health professionals in a fun way, enabling them to update their knowledge and aptitude. This article looks at a serious game developed for nursing homes., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Keeping a resident with psychiatric disorders in a nursing home is a major challenge for geriatric and psychiatric disciplines. In order to create a satisfactory organisation, the teams must come together and understand their mutual difficulties and priorities in order to construct a liaison psychogeriatrics project for the benefit of the resident.

The treatment of psychological disorders in the elderly is very specific, requiring multi-disciplinary skills. A partnership between professionals from different fields working with elderly people is therefore essential. A survey was carried out in order to find out psychiatrists' point of view with regard to this specific care.

Background: The use of touch and simple massage are first-line non-pharmacological interventions used in the comprehensive care for the elderly with dementia (EWD)., Context: These acts have positive effects on both the level of anxiety and self-esteem of EWD. Nevertheless, they are not carried out by all caregivers in the same manner., Objectives: This study seeks to describe the representations of EWD's caregivers and their perceptions of practice of touch with this population. It will also highlight their ways of coping with any difficulties encountered., Method: It is based on a qualitative analysis of 31 semi-structured interviews (17 nurses and 14 health care assistants) conducted with caregivers working primarily with elderly patients with dementia., Results: The results indicate that touch, although well integrated in all activities of personal care, is not considered as a care intervention in itself. It is subject to multiple influences. Indeed, on the one hand, the representations those caregivers have of the elderly patient with dementia overlap with those of their roles and skills and change the type of touch and their intentions when they touch. On the other hand, the emotions generated by the "dirty" work and the aggressiveness of the elderly patient with dementia sometimes make it difficult to touch them., Discussion: The perspective of caregivers is essentially self-referenced and touch does not appear as an indicator of institutional norms.

The care relationship requires a specific nursing approach, especially when it is with a person with impaired verbal communication. Placing the human being once again at the heart of care, with all his or her dignity and individuality, draws on skills which, thanks to certification, can be analysed, put into words and enhanced, accounting for the practical experience developed over time by caregivers in geriatrics.

People with Alzheimer's disease and related disorders in nursing homes are also subject to sleep disorders. An in-depth study was therefore carried out to install a familiar setting that is based on the architectural environment and on specific support taking into account the size of healthcare teams.

Helping and caring for patients suffering from Alzheimer's disease and related dementias are mostly provided by the patient's entourage at his home. The non-professional caregivers are described under the name of « natural or informal help ». Although more and more studies are coming out concerning the notion of caregiver burden, very few deal with the consequences upon the intrapsychic experience of the person sharing the life of the demented patient. Even fewer studies are devoted to specific aspects of the conjugal bond at the center of dementia. How will time and old age affect this bond, both on the objectal and narcissistic levels? What can explain the fact that, for some, the conjugal bond becomes pathological? What will happen when one adds dementia to the equation? In a situation of aging conjugopathy, where one member of the couple develops a neurodegenerative disease, what allows some caregivers to take advantage of new psychic investments whereas others fall apart? The propensity to experience satisfactions in the caregiving situation seems to depend, among other things, upon personality traits, as illustrated by one clinical case.

The finger foods project, based on the natural tendency to use the fingers to eat, was initiated by caregivers in response to the problems encountered by some elderly people when eating. It is part of an approach to help people suffering from dementia to feed themselves.

Facing difficulties due to dementia syndromes, systemic care is necessary. Amongst therapies assessed specifically to caregivers, psychoeducative steps seem to be the strongest effective one on neuropsychiatrics symptoms. Psychoeducations tend to teach the caregivers to modify their interactions with patients via a better understanding of illnesses and patients. Our training "Pour mieux vivre avec la maladie d'Alzheimer", applied in groups of eight to twelve persons, consists in twelve sessions of two hours each. To assure the biggest possible availability, we recently incorporated the concomitant coverage of patients into artistic workshops. These sessions of art-therapy realized in parallel to our psychoeducative program will thus be estimated according to the same rigorous methodology. The critical evaluations realized by participants at the end of our program reflect the outcome of our main objective (to teach to modify interactions with the patients) while contributing to the improvement of social contacts and to the learning of calling to existing helps. These preliminary results strongly argue for the pursuit and even extension of this kind of caregiver's management.

Most people in contemporary western society die of the chronic diseases of old age. Whilst palliative care is appropriate for elderly patients with chronic, non-malignant disease, few of these patients access such care compared with cancer patients. That patients dying with dementia have significant health care needs, comparable with cancer patients, is now well established. Yet, their families typically describe poor advance-care planning and an inadequate level of symptom control, with distress associated with pain, pressure sores, constipation, restlessness and shortness of breath. A comparison of people dying with advanced dementia or terminal cancer found that those with dementia were more likely to experience burdensome interventions and restraints and to have had poor advance-care planning. Prognostic models that attempt to estimate survival of >6 months in demented patients have generally poor discrimination, reflecting the unpredictable nature of most nonmalignant disease. However, a number of generic and disease-specific predictor variables were identified that may help clinicians identify older, non-cancer patients with poor prognoses and palliative care needs. Simple, well-validated prognostic models that provide clinicians with objective measures of palliative status in demented patients are needed. Additionally, research that analyses the effect of comprehensive geriatric assessment and geriatric palliative care on psychosocial outcomes in demented patients and their caregivers is needed. Advances care planning and directives making before death allow meeting patient's preferences.

In caring for old people with dementia, we observe that family solidarity remains strong, which allows to delay nursing home admission. Emphasis is put on the disease altering the sense of security among old people and their families. Spontaneous attempts from caregivers in order to counterbalance often lead to a lack of energy available for change when entering a nursing home, as they have put a lot into making up for the affected sense of security of the failing relative. A complex story has then emerged from a real relationship between the caregivers and the disease, and this has to be taken into account in the helping process as much as the utter exhaustion of the family.

Background: Estimates suggest that there are more than 700,000 adult caregivers of persons with dementia in this country, a large number of whom experience some form of sleep disturbance during the course of their caregiving career. Health care professionals are in the best position to detect and address this significant public health problem., Objectives: Prospective study of sleep with the main caregivers providing home-care for demented patients., Methods: This study was performed on elderly persons living at home. Two populations were concerned. The control group concerned 86 old persons living in the area of Limoges (France) and was contacted to join by the senior clubs of this city. The other group concerned caregivers to persons with dementia, living with them at home, and the assessments were done during the patient assessment. Each group had a cognitive evaluation by a Folstein's test and answered a questionnaire to describe their possible sleep difficulties., Results: Sixty-eight caregivers face sleep disturbance versus 25 non-caregiver controls. Caregiver sleep-problems are often linked to sleep disturbances in the care-recipient. Night-time awakenings by persons with dementia are a common precipitating cause of sleep/wake disturbances in vulnerable caregivers. Caregivers awake 2.3 times during the night versus 1.2 for control persons. Caregivers awake earlier (around 6:20) than non-caregivers (around 7:05) and their sleep time is shorter by one hour. Caregivers are more often depressed (28 in 98 versus 13 in 86) and have more often high blood pressure (56 in 98 versus 24 in 86). They received more medications and used more often self-medication., Discussion: Three major contributors to caregiver sleep-disturbance are pointed in this paper: the apparition of caregiver disrupted sleep routines, caregiver burden and depression and the caregiver's physical health status. Successful treatment of a caregiver's sleep disturbance requires careful consideration of each of these contributors. Non-pharmacological options are generally recommended as a first line of treatment for managing sleep disturbances in older adults, including caregivers of persons with dementia., (2009 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Chronic pain is often underdetected and undertreated in long-term care facilities. The use of self-report measures of pain (such as the visual analogue scale) is often problematic for older adults residing in long-term care because of the high prevalence of visual and auditory deficits and severe cognitive impairment. Observational measures of pain have been developed to address this concern. A systematic grid designed to assess the properties of existing observational measures of pain was used for seniors with dementia. The grid focused on the evaluation of content validity (12 items), construct validity (12 items), reliability (13 items) and clinical utility (10 items). Among the 24 instruments that were evaluated, several were deemed to be promising in the assessment of pain among older persons with severe dementia. Nonetheless, additional research is needed before their routine integration in the practices of long-term care settings.

The rights of families of an institutionalized elderly relative with dementia have yet to be recognized. The results of our pilot study based on a participatory approach show, among other things, that family caregivers, women for the most part, have little input in the decisions regarding their relative's care and are uneasy to express their opinions to health care staff. As part of the pilot study, caregivers developed a group intervention program entitled "Taking Care of Myself" geared, among other things, towards increasing their competence in expressing their viewpoint to health care staff and in taking part in care-related decisions. According to an efficacy study conducted after the pilot study, the program produced successful outcomes in terms of caregiver competence in dealing with the health care staff and of perceived challenge of the caregiver situation. Recommendations are made aimed at giving caregivers recognition, that is their due.

Background: In the context of a cohort study on the socio-economic consequences of dementia in Belgium, we evaluated the validity, reliability and feasibility of the French version of the Dutch Sense of Competence questionnaire (SCQ), and of its short version (the SSCQ), in caregivers of demented patients The questionnaire was based on Zarit's burden interview and on a theoretical family-crisis model., Methods: Construct validity was evaluated by factor analysis and by comparison of the results with those of the original SCQ study. Reliability was evaluated by Cronbach's alpha and by item-total correlations. Feasibility was assessed by a standardized index of missing values., Results: The three domains found in the original SCQ were identified by factor analysis: consequences of involvement in care for the personal life of the caregiver, satisfaction with one's own performance as a caregiver and satisfaction with the elderly person as a recipient of care. The mean scores were similar to those in the original study, except for the consequences for personal life. Cronbach's alpha for both the SCQ and the SSCQ exceeded the 0.70 criterion. Two of the 27 items did not meet the item-total correlation criterion; the SSCQ items all met the criterion. The standardised index of missing values was deemed acceptable., Conclusions: The French versions of the SCQ and the SSCQ are valid and reliable. Like the Dutch version, the French version of the SCQ can be a useful outcome measure for the evaluation of intervention studies and the SSCQ is suitable for the daily practice.

In partnership with the EMS of French-speaking Valais, Switzerland, this study has brought to light certain characteristics in the care of elderly patients suffering from dementia. The interviews were conducted between two professional groups: 19 certified nurses' aides (CNA) and 19 registered nurses (RN). The medical facilities were investigated on the basis of psycho-sociological representations, time, professional security, interactions, the types of services offered, and work satisfaction. The CNAs confuse the depictions of aging and dementia, which corresponds to the belief of the general public. The RNs identify with a professional ideal which, as a consequence, fails to differentiate between the individuals who have been treated. These accounts give a reliable perspective for the two professions, but also serve as a screen for the diversity of situations involving elderly patients suffering from dementia. Concerning the time needed for the supplementary workload, the CNAs and RNs favor its efficiency, and the time needed is justified by the end results. The nurses' aides go about their work essentially on the basis of the tasks and services required by the institution, which is largely inspired by the hospital model. Confronted by the unconventional behavior of the residents suffering from dementia, the risk of assault results in deliberations for CNAs, whereas the unpredictability of the situations is fundamental for RNs. The lack of security measures is equally due to the shortcomings of the medical profession regarding dementia and the specific types of care required. These interactions, while regarded as essential by both CNAs and RNs, are not considered therapeutic, despite the fact that communication is a primary function! Both groups share the types of care offered. Ils limitations are chiefly in the area of satisfaction regarding psychological needs. This health-care project is better able to answer the needs of institutionalized patients rather than in providing individual attention. CNAs and RNs are said to be satisfied by their work with patients suffering from dementia with regards to its utility and professional ideal. In conclusion, the particulars of health care are first of all relative to the context (structure, make-up of personnel, type of residents), relying to a lesser degree on the kind of training obtained by the health care professionals.

This qualitative study is based on twenty observations. Problems with spoon feeding of hospitalized, elder, demented patients are rarely considered. This study aims at analyzing their practical, conceptual and ethical specificities. Ten patients were directly observed and their ten nurses of reference responded to structured interviews. We established three significant observations: 1. The use of spoon feeding appeared inoperative as it did not help resolve the problems that were invoked to justify its implementation. 2. Three months after the observations six patients were deceased, three were able to feed themselves and one did not improve. 3. In all observed cases, spoon feeding was initiated as a tacit evolution, with no formal decision process. To avoid this dead end we consider it indispensable to evolve this feeding practice from its current state of unchallengeable humane duty to the conceptual level of patient care, and to develop evaluation tools which will enable its integration into a structured strategy of nursing interventions.

This detailed research tries out a "Touch-Massage" action about the studies of reflex and estimates the repercussion this action may have as regards the abnormal behaviour (either in connection with wandering and/or restlessness and/or shouting) of the Elderly who stay in a same place and show cognitive deficiency in connection with an Alzheimer's dementia. In order to check the "intra personal" consequences this action may have, 4 elderly people were chosen and an experimental estimate with different levels was made with them. Two sessions a week of 30 minutes each during 6 months (51 sessions) were suggested that is to say a total of 204 sessions. The effects of this approach regarding the different abnormal behaviour are estimated on one hand from a special clinical grid which assess the different reactions, verbal or not, which occurred during the session. On the other hand the effects are observed directly fifteen minutes after the session. The results are explained, first, for each person and compared between each other; then they are explained according to a collective way regarding the 4 old people. What emerges from all that is that for the whole sessions which were proposed, the activity was accepted at 95%. During the session, the signs showing physical relaxation (59%), sleepiness (34%), research of different manners to communicate with us (59%), stop or decrease of the abnormal behaviour (79%) prove the actual benefit the activity brings during thirty minutes. Fifteen minutes after the session, the signs showing physical relaxation (52%), sleepiness (42%), research of different manners to communicate with us (23%), stop or decrease of the abnormal behaviour (70%) are always significant. In view of the above results, we can stay this new approach using the activity of "Touch Massage" brings a further possibility of nursing care and can help to answer the question "how to take in charge every day an elderly demented patient".