Satisfaction and difficulties of French professional home caregivers in supporting older people with Alzheimer's disease or alcohol misuse

In France, few studies have examined home care when it comes to ageing support and even fewer have considered alcohol misuse in this context. The studies also show that being old and having alcohol use disorders are two unfavourable conditions for receiving help, whereas for the Alzheimer's disease, there is a clear need for optimal care. In this article, we study professional home caregiver's perceptions of their job along with their difficulties and satisfactions in supporting older people with Alzheimer's disease or alcohol misuse. Out of the 23 professionals approached, 17 took part in a research interview from October 2013 to January 2014. All interviews were recorded, fully transcribed and lexically analysed with Alceste^® software. Among the five classes that were identified from 63% of the initial data, the main themes that emerged illustrate the nature of the associated pathologies, the perceptions and satisfactions related to the profession, their adaptive skills, the difficulties related to the life context of the older person, and the wine consumption of the latter. The lexical discourse analysis shows that the professional home caregivers are involved in looking after not only people with Alzheimer's disease but also those with alcohol misuse. However, despite the difficulties and satisfactions encountered, adaptation to the older people seems to be their priority and one of the many skills that they have acquired during their professionalisation. Most of the older people who are helped are women and the difficulties mentioned by their caregivers usually arise at the time of their death. Lastly, when caring for alcohol misusers, they describe negative attitudes in their support. Although research in this area is rare while home care for the older person, whatever the pathology, is increasing, professionals need to be supported by the associations or companies that employ them and should be trained to help them provide the appropriate care.

[Old age and smoking]

Elderly people today have seen a radical change in the image of smokers over the last half century. While once it was approved, it is now demonised. Although smoking declines with age, there are still many elderly smokers. The risks and harm of smoking remain, even in old age. An individual choice to start with, smoking becomes a collective issue in a nursing home. Stopping smoking always brings benefits, even after the age of 80.

[Elderly women and alcohol]

It is important to understand the reasons for alcohol abuse in elderly people and in particular women. Psychological suffering must be envisaged. This behaviour can be considered as a necessary narcissistic retreat when ageing. The mental health of these women should be taken into account when providing them with help when they want it. This involves understanding them and supporting them as they adjust to the passage of time.

[Psychological effects of alcohol misuse on the professional home caregivers in support with elderly people]

Very little research is made on professional home caregivers in support of seniors, especially those dealing with alcohol misuse. The aim of this study was to investigate the relationships between professional home caregivers and seniors with alcohol misuse, in terms of job satisfaction, professional life and emotional exhaustion. 99 professional home caregivers completed a professional data questionnaire (ESVP) and an inventory of professional burnout (MBI). Demographic and professional data, as well as dimensions of professional life satisfaction and professional exhaustion questionnaires were analyzed. Out of the 99 participants, 36 professional home caregivers reported difficulties dealing with alcohol misuse in seniors. The mean age of the home caregivers was 35 years old and half of them did not receive any training for support. The majority of them qualified the relationship with the aged as "distant and nonexistent". In contrast, most of them were satisfied with regard to the relationship with the relatives of the subjects, and were almost as many to call it "cordial" as well as "cold distant, non-existent". Job satisfaction was positively correlated with the satisfaction of the relationship with the relatives. Emotional exhaustion was negatively correlated with their job satisfaction in the support of the subjects. This study is, to our knowledge, the first one to highlight the importance for professional home caregivers to have good relationships with the relatives of seniors with alcohol misuse. Research in this area is scarce, despite the development of home care for the elderly, whatever their pathologies, and at the early start of a French ministerial plan on society's adaptation to ageing.

[Alcohol in care homes for the elderly]

The majority of those living in care homes for the elderly are very old, with multiple pathologies and taking multiple forms of medication. They are therefore more fragile and vulnerable in the face of alcohol, both with occasional consumption or with addictive behaviour. Far from anecdotal, these situations arise almost on a daily basis for the frontline caregivers. They are sometimes difficult to detect by other professionals who do not have such prolonged contact with the residents. Addressing the risk as well as the misuse of alcohol in a nursing home is a matter for the whole institute and must involve all the players, professionals, families and residents, in a cross-disciplinary and coherent approach. Addiction treatment, in the particular case of nursing home residents, as for the general population, considers all methods of consumption and actions, from prevention to the reduction of risks or harmful effects, to curative treatment, including alcohol withdrawal.

[Home aides and families faced with alcoholic behavior in elderly people]

Alcoholic behaviour in elderly people living at home leads to the establishment of a singular relationship between the family and the home helpers. The professionals have a special role within the family system but one which at the same time is, paradoxically, limited. The intervention of a third party, in the framework of an alcoholism support network, can help to avoid the breakdown of the care within the home as a result of the mental exhaustion of the various players, as well as the occurrence of conflicts within the family circle in the home.

[Systemic reading, another way of thinking to apprehend situations of elderly abuse]

In 2007, a national call number was created to receive reports of ill-treatment for aged or handicapped subjects, and departmental platforms of phone-tapping were organized. Professionals of listening receive the calls for assistance or confidences of distresses related to ill treatments. They should initiate a relationship and assess the danger of the condition, therefore, in a systemic paradigm, performing a double task. According to the systemic approach, ill-treatments are usually the product of interaction and not that of an individual. They do not only concern individuals which suffer or undergo ill treatment but a system including all people leaving at home and social environment. To apprehend the complex relationships of ill treatments by professional of listening requires clarification of the situation together initiating a relation of confidence between the person calling and the professional. Therefore, the requests necessary for clarification should not be intrusive but create conditions of an exchange of information allowing a co-construction with the person calling for help. To accommodate a call for a critic situation, we need to take into account the context and not to be focused on the search of the causes of ill-treatment.

Epileptic motor behaviors during sleep: anatomo-electro-clinical features

BACKGROUND

Sleep-related complex motor seizures have long been considered pathognomonic features of Nocturnal Frontal Lobe Epilepsy (NFLE). In recent years, these manifestations have also been reported to have a temporal or insular origin.

METHOD

We describe 40 drug-resistant epileptic patients with complex motor seizures during sleep, submitted to presurgical stereo-EEG (SEEG) evaluation and seizure-free after surgical resection of the epileptogenic zone.

RESULTS

In a significant proportion (30%) of these patients, seizures arose from extra-frontal regions, including mainly the temporal lobe and the insular cortex, but also the parietal and occipital lobes. In patients with extra-frontal epilepsy, when complex motor behaviors appeared, SEEG revealed that the ictal discharge involved the cingulate and the frontal regions. Finally, at histology, Taylor's focal cortical dysplasia (TFCD) was the most common finding (90% of patients), independent of the site of seizure onset.

CONCLUSION

As previously reported by other studies, this histologic substrate may be a major determinant of sleep-related seizures in drug-resistant epileptic patients.

[Assessment and clinical aspects of community professional care of elderly with alcohol misuse]

For elderly living in the community, alcohol misuse is not uncommon. Experience of professionals of social care services to face alcoholism misuse has rarely been assessed. The work of these professionals is to allow aged people to stay at home in spite of impaired physical and/or mental age-related abilities. We studied the experienced difficulties and feelings of professional caregivers for ten aged subjects with alcohol misuse compared to ten aged subjects without, to identify their needs in terms of training for the home care service associations. The participants took part in an interview and completed a research questionnaire concerning their reactions to alcohol misuse in elderly subjects. No significant difference was found between the responses from the two groups. All participants felt powerless in front of the denial of the alcohol misuse by the patients and experienced difficulties with the behavior of some family members. They reported that they would be comforted by the opportunity to share their experiences with colleagues and people in charge. They hoped to meet specialized teams in the field of addictions to develop skills for supporting elderly people with regard of alcohol misuse. Presently, the services in charge of the aged people should review the interventions and training of their employees, especially of those caring for subjects with alcohol misuse, to improve the quality of their actions in an evolving environment.

[Left ventricular aneurysms: principles of surgical treatment]

After reviewing the historical background, the morphology and physiopathology of left ventricular aneurysms, the authors review the physiology, the technical aspects, and the current surgical indications of aneurysmectomy, with a particular emphasis on the concept of endoventriculoplasty of Jatène & Dor.

[Pulmonary bronchogenic cysts: clinical observation and literature review]

Pulmonary bronchogenic cysts are benign lesions that can be suspected from clinical background and imaging. We present the case of a huge subcarinal bronchogenic cyst and review the embryology, physiopathology, surgical indications and techniques of this congenital lesion.

[Surgery under hypnosedation. A new therapeutic approach to hyperparathyroidism]

The elective unilateral approach, sometimes under local anaesthesia, offers many advantages in terms of less invasive and faster surgical approach compared to the conventional surgery under general anaesthesia. Nevertheless this approach is restricted to patients unsuspected of multiglandular disease, free from thyroid disease and for whom localization studies are contributive. Surgery under hypnosedation offers the same advantages and provides the possibility of not only exploring the four glands but also of performing a partial thyroidectomy if needed. In our experience 21 patients underwent a cervicotomy under hypnosedation for primary hyperparathyroidism (HPT). No conversion to general anaesthesia was needed; mean operative time was 52 +/- 16 min. In 17 cases, HPT was due to a single adenoma, in 3 cases to hyperplasia (among them a MEN-1 case), and in one last case to a double adenoma. The four glands were identified in 85%. With a follow-up running from 4 to 45 months, all patients are cured. Hypnosedation offers the same medical and economic advantages than the unilateral access under local anaesthesia. Moreover indications are not restricted to selected patients.