Alzheimer Disease: Franco A

Vellas B, Gauthier S, Allain H, Andrieu S, Aquino JP, Berrut G, Berthel M, Blanchard F, Camus V, Dartigues JF, Dubois B, Forette F, Franco A, Gonthier R, Grand A, Hervy MP, Jeandel C, Joel ME, Jouanny P, Lebert F, Michot P, Montastruc JL, Nourhashemi F, Ousset PJ, Pariente J, Rigaud AS, Robert P, Ruault G, Strubel D, Touchon J, Verny M, Vetel JM, Anonymous00344. · CHU Casselardit, Toulouse. · Rev Neurol (Paris). · Pubmed #16244574 No free full text.

Abstract: Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary team including geriatritians, neurologists, epidemiologists, psychiatrists, pharmacologists and public health specialists developed a consensus on care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians and specialists based on knowledge available in 2005. At all stages of the disease, the objective of care is to improve as much as possible quality-of-life for the patient and his/her family, including a life project until the end of life. It is always possible to do something for these patients and their family: nutritional status, behavior disorders, and incapacities to deal with basic activities of daily life have to be taken in consideration. Resource allocation and proximity care have to be targeted. Research areas necessary to improve the care of patients with severe dementia has been selected.

Vellas B, Gauthier S, Allain H, Andrieu S, Aquino JP, Berrut G, Berthel M, Blanchard F, Camus V, Dartigues JF, Dubois B, Forette F, Franco A, Gonthier R, Grand A, Hervy MP, Jeandel C, Joel ME, Jouanny P, Lebert F, Michot P, Montastruc JL, Nourhashemi F, Ousset PJ, Pariente J, Rigaud AS, Robert P, Ruault G, Strubel D, Touchon J, Verny M, Vetel JM. · No affiliation provided · J Nutr Health Aging. · Pubmed #16222399 No free full text.

This publication has no abstract.

Petit H, Albarède JL, Bakchine S, Boulliat J, Cogneau J, Darcourt G, Dubois B, Forette F, Franco A, Héres J, Hinault P, Laurent B, Léger JM, Marin La Meslée R, Montagne B, Poncet M, Robert P, Sorbé G, Touchon J, Velas B, Vetel JM. · Neurologue (Clinique Neurologique, CHRU Roger Salengro 59037 Lille Cedex, France. · Rev Neurol (Paris). · Pubmed #10844378 No free full text.

This publication has no abstract.

Montani C, Molines M, Moreaud O, Franco A. · Département de médecine gériatrique et communautaire (DMGC), centre mémoire de ressources et de recherche Grenoble-Arc-Alpin (CMRR GAA), Elisée-Chatin, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France. · Encephale. · Pubmed #18558149 No free full text.

Abstract: There is a growing interest concerning ethical questions. This ethical need is the more important in the field of dementia. Indeed, the ethical concerns related to this field are highly specific, which leaves some of our questions without pertinent answers. METHODS: After three years of experience, it is a good time to assess the Alzheimer ethico-clinic workshop created by a French memory centre (in Grenoble) and encouraged by the French national Alzheimer disease plan. RESULTS: Since their implementation, we have recorded 24 monthly coordination meetings, 10 of which have been held through videoconferences with various participants. Most of the time during the workshops, clinical situations that are experienced in our daily activities are brought up by one of us and then exposed for collective discussion. If no practical situation is available, we organize the meetings through critical readings of texts of law or through comments on articles dealing with Ethics. We retain four main ethical topics: the information given to the patient and his family, the acceptance of the person, the balance of benefits/risks and one's individual ethics as opposed to the ethics of a group. At this point in time, we are pleased with the organization of these workshops and feel that they meet our expectations. Thanks to the diverse experiences and activities of each participant, the discussions on Ethics are of high quality. PROSPECTIVES: As a place of shared discussions/thoughts, these ethical workshops could constitute a reference to be used when making decisions in complex situations. Other than the importance of the ethical questions that are raised, it should encourage open-minded attitudes and enrich the actions of each of us by making us more aware of the ethical concerns in daily situations. Finally, these workshops could be a field of research for theses, dissertations and answer the training and research needs of a memory centre.

Boucharlat M, Montani C, Myslinski M, Franco A. · Psychologue Clinicienne, Université Pierre Mendès-France, Laboratoire de Psychologie Clinique, 38043 Grenoble. · Encephale. · Pubmed #16633295 No free full text.

Abstract: INTRODUCTION: Elderly people and their family helpers are often isolated at home and do not have access to the professional psychological help that they require. For an elderly population, the trips to consulting rooms are difficult, tedious and expensive. Besides, maintaining a patient at home is heavy to manage for close relatives because of the organization, financial issues and above all the risk of psychological burnout. The literature shows us that psychological assistance is more common at distance from home, in hospitals, in special institutions or specific organizations. However, there is a clear need of help at home. We propose to develop psychological assistance at home for the patient/helper tandem in cases of dementia. This prospective study reports three different cases. METHOD: This study is a qualitative pilot study. Participants characteristics: patients were diagnosed with severe dementia, assistance showed deep fatigue of the helper, both members of the tandem lived at home, age above 69 years, the eed for nursing care at home. THERAPEUTIC ASSESSMENT: The psychological clinician acts after proposing his helpand not on a clear request from the patient. He will meet his patient 7 times during 4 months. The meetings always take place in the same place and last 45 minutes. Confidentiality during the meeting is explained and guaranteed so the patient can speak openly. EVALUATION: An independent psychologist assessed the monitoring in the hospital. Our methodology included two assessments: the first, assessing the task of the helper before the evaluation and the second taking into account a new measurent of the task and the opinions of the participants following a semi-directed interview. The evaluation of the task was performed using Zarit's scale. The evaluation was also based on the clinical observation of the psychologist. RESULTS: Organization of the monitoring: one meeting per week was sufficient for all participants with a minimal duration of 45 minutes. The fact that the meetingsrook place at home was appreciated, because of their simple and convenient organization. The patient/helper tandems in those suffering from advanced dementia could only have taken place in the home because transport any where else would have beent too difficult for them. The sessions during this research study were free of charge. Two out of three participants were ready to pay so long as the study could continue. The managers were bothered a few times by phone calls and/or unexpected visits, invitations for a cup of tea and requests for a small service (like mailing a letter). Assistance for the caregiver: all the caregivers declared that assistance was a personal improvement in a period of doubt, loss of self-confidence and isolation. Furthermore, clinical observation of the therapeutic assistance appears to show that psychological help at home could lead to the improved psychological function of the helper. This was emphasized when we established the limits of the caregiver/patient relationship. We observed a better balance in the input of investing and de-investing and better acceptance of the identity modifications which were required for the caregiver. Assistance for the patient: we believe that this sort of intervention has positive effects on the patients themselves. This care at home protects the destructurated identity of the patients and their intimity. Moreover, intrapsychic tension can be lowered by being shared with the psychologist. Assessment of the burden: among the three patients who wete studied, the burden was unaltered in one case (43/88; 43/88), significantly improved in one case (41/88; 24/88) and remained light in one case (18/88; 16/88). DISCUSSION: We discovered that Zarit's test showed some limits. The time to complete the test is quite long and tedious for caregivers. Some questions are too direct and can put the caregivers in a guilty position. The mini Zarit version with only seven items, appears more satisfactory because it's shorter and provokes less guilt. The other point concerns the therapeutic frame at home. The usually represents all the constants of the therapeutic process including the role of the psychologist and all the items that refer to space, time, management of the timetable, payement and interruptions in care. Could the fact of being at home be harmful for the therapeutic process? Of course, the place of residence is less neutral than a office in an institution and the superposition of the frame of life and of the therapeutic frame raises lots of questions for the psychologist: entering a private house is like entering a private life, which is not without consequences on the follow-up. We are here far from a classical frame of therapeutic interviews, so the frame must be clearly defined. CONCLUSION: This prospective study leads us to the conclusion that the superposition of the frame of life and of the therapeutic frame represents a limit to psychotherapy but is not exclusive of psychological support at home. As a supplement to this face to face follow up at home, we could imagine other ways of providing such psychological support, by phone or by telemedicine for instance. Could the new technologies of communication help to compensate the lack of means in favour of the caregivers at home? Although these new technologies are more dedicated to institutions than to providing care at home, could they not be helpful for organizing psychological help at home? However, in order to validate such devices, they need to be fried and assessed at home.

Filippi M, Allenet B, Calop J, Gavazzi G, Couturier P, Franco A. · No affiliation provided · Presse Med. · Pubmed #11505835 No free full text.

This publication has no abstract.