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Background: Medical progress and the lifestyle modification have prolonged life expectancy, despite the development of chronic diseases. Support and care for older subjects are often provided by a network of informal caregivers composed of family, friends and neighbors, who are essential in helping older persons to continue living at home. It has been shown that the extent and diversity of informal tasks may jeopardize the physical, mental and social wellbeing of caregivers., Methods/design: The aim of the Informal Carers of Elderly cohort is to define, through a longitudinal study, profiles of caregivers of older patients with a diagnosis of one of the following diseases: cancer (breast, prostate, colorectal), neurodegenerative diseases (Parkinson's disease, Alzheimer's disease and similar diseases), neurovascular diseases (stroke), sensory diseases (age-related macular degeneration (AMD)) and heart disease (heart failure). Patients must be at least 60 years old and living in the region of Burgundy-Franche-Comte (France). By following the different phases of the caregiving relationship from the announcement of the diagnosis, it will be possible to assess the quality of life of caregivers, coping strategies, levels of anxiety and depression, social support and the extent of their burden. We will also evaluate the efficacy and efficiency of the implementation of a pragmatic intervention by a social worker to help informal caregivers, through a randomized interventional trial nested in the cohort. Qualitative approaches aimed at studying the caregiver/patient relationship, and situations leading to breakdown of the caregiver relationship will be also undertaken., Discussion: Through an analytical and longitudinal definition of profiles of informal caregivers, this study will gather detailed information on their life courses and their health trajectory by identifying consequences associated with the concept of their role as carers. In addition, the randomized interventional trial will explore the relevance of the implementation of a supportive intervention by a social worker to help caregivers. These data will help to identify strategies that could be used to improve the existing sources of aid and to propose new approaches to help caregivers. This study will provide the opportunity to identify the most relevant means of support adapted to caregivers, and provide an impulse for new health care policies., Trial Registration: ClinicalTrials.gov Identifier: NCT02626377 . Retrospectively registered on 9 December 2015. Protocol date/version: 23 October 2014/version 2.

L'objectif de cet article est de comprendre, d'un point de vue clinique et psychopathologique, l'apport de la théorie de l'attachement dans le travail d'élaboration psychique de la mort d'un sujet âgé accueilli en établissement. Les expériences de pertes physiques, cognitives et sociales que vivent les individus vieillissant leur font prendre conscience de leur mort. Intégrer psychiquement la perspective de sa mort passe par un travail d'élaboration psychique entendu ici comme l'aptitude du sujet à verbaliser le sens qu'il donne aux événements. Le travail d'élaboration est directement lié aux capacités de mentalisation, parfois altérée par la proximité de la mort. Cette altération ne permet pas le recours à des stratégies émotionnelles interrelationnelles adaptées (mises en évidence grâce à l'étude des modalités d'attachement) pour exprimer une demande d'aide et ainsi bénéficier de soutien social. Ce soutien pourrait cependant aider le sujet à comprendre son état interne et donc viendrait étayer la mentalisation et le travail d'élaboration. Nous faisons l'hypothèse que la difficulté à accéder à un soutien social, liée à des stratégies interrelationnelles inadaptées du fait d'un défaut de mentalisation, limite le travail d'élaboration de la mort. À travers l'étude de cas de Pierre, 90 ans, accueilli en établissement d'hébergement, cet article montre que la mentalisation et la recherche de soutien social (qui dépend des modalités d'attachement) sont des concepts clés pour comprendre l'apport de la théorie de l'attachement dans le travail d'élaboration de la mort. Cette étude de cas permet également de questionner la place de l'autre et soulève un paradoxe. L'autre peut en effet être considéré comme une source de soutien social étayant la mentalisation et facilitant le travail d'élaboration. Mais la comparaison à l'autre comme différent de soi est aussi une stratégie identitaire venant renforcer l'estime de soi. From a psychological point of view, this article aims to understand the attachment theory's contribution to the psychical elaboration of death for 'resident elderly' in nursing homes. Physical, cognitive and social losses make people to be aware of death. A psychical elaboration–the ability to attribute subjective meanings to events - permits to integrate death. Psychical elaboration depends on mentalization, but proximity of death alters mentalization: individuals are no longer able to use appropriate emotional strategies to express a request for social support. These strategies are highlighted by attachment. Social support can help individuals to understand their state of mind. So, social support can ease mentalization and psychical elaboration. We assume that difficulties in finding social support, due to alteration of mentalization and inter relational strategies, complicate psychical elaboration of death. We report a clinical case of Pierre, 90 years old, who lives in a French nursing home. This case comes from a qualitative study carried out with thirty-three nursing homes' residents in Switzerland and France. In-depth interview – inspired by Adult Attachment Interview – investigated the participants' life stories through their relationship experiences, the entry in nursing home, their views on their present and their future, and the meaning of their life. The Relation Scales Questionnaire measured attachment and the Mini Geriatric Depression Scale measured depression. To understand the psychical elaboration of death, mentalization and the way how individuals seek social support - underlined by attachment - must be investigated. The proximity of death alters mentalization. The difficulties of mentalization influence attachment: the individuals use emotional regulation strategies which do not allow them to benefit from social support. However, this support could help them to understand their internal state and indirectly support difficulties of mentalization and favour the psychical elaboration. Social support is therefore essential in the psychical elaboration of death. The other's place in old age is also questioned and raises a paradox. Get closer to the other to benefit from social support allows to overcome difficulties of mentalization. But the comparison of oneself with the other as different reinforces the self-esteem. For professionals in nursing homes, providing social support to people who do not seek help and do not appear to need social support is essential. Adopting the therapeutic framework (art therapy, the use of a media) to each person's personality seems to be important. [ABSTRACT FROM AUTHOR]