[Better assessment, better care: Quetci, a questionnaire for assessing cognitive disorders in nursing practice]

Cognitive disorders can have significant repercussions on the quality of care and daily life for patients. We have developed a new tool specifically designed for nursing practice to identify these problems in patients with brain tumors. The Cognitive Impairment Assessment Questionnaire for nursing practice is an objective, quick and easy-to-administer tool that is readily accepted by patients.

Core elements of the interpersonal care relationship between nurses and older patients without cognitive impairment during their stay at the hospital: A mixed-methods systematic review

BACKGROUND

The fundamental importance of establishing an interpersonal care relationship for quality nursing care has been highlighted. However specific elements of the interpersonal care relationship of importance to older patients in the hospital have not been identified.

OBJECTIVES

The aim of this review was to explore and synthesise research findings regarding the elements of the interpersonal care relationship concept from the perspectives of older patients.

DESIGN

A systematic mixed-methods review.

DATA SOURCES

An extensive search was conducted up until October 2018 for articles without any publication date time limit in PubMed, Web of Science, Cochrane Database of Systematic Reviews and CINAHL.

REVIEW METHODS

Primary studies were included if they concerned patients aged 65 years or older and their perspectives on the elements of the interpersonal care relationship with nurses. Inclusion was limited to patients without cognitive impairment who were admitted to an acute hospital setting. The methodological quality of each study was assessed using the Critical Appraisal Skills Programme for qualitative studies, the Quality Assessment Tool for Quantitative Studies and the Mixed-Methods Appraisal Tool. Thematic analysis was used to structure the results of the included studies.

RESULTS

Of the 7596 studies found, 24 were included in this review. Twenty articles had a qualitative, three a quantitative and one a mixed methods design. Older patients consider dignity and respect as core values that need to be met in the interpersonal care relationship. Five core elements of the interpersonal care relationship were identified to meet these core values: elements related to caring behaviour and attitude, person-centred care, patient participation, communication and situational aspects. These core elements were structured according to three categories, identified in the literature, that determine the quality of the interpersonal care relationship: nurse-, older-patient-related elements and situational aspects.

CONCLUSIONS

The elements identified in this review can guide efforts to define the interpersonal care relationship between older patients and nurses. Nurses should be supported and motivated by education and practice to adapt their behaviour, attitudes and communication to meet older patients' expectations. Hospital management can also encourage nurses to communicate well. Investment in the current organisation of care is needed to improve nurses' work overload and presence. Further research is needed to clarify the underlying processes influencing the experience of the interpersonal care relationship from the perspectives of older patients, nurses, informal caregivers and hospital management.

[The analogon, a caregiving resource in geriatric psychiatry]

Few caregivers know what analogons are, yet they use them on occasion, intuitively, for the benefit of their patients. An analogon, an identifying object, enables patients with cognitive disorders to 'decipher' their environment and find meaning in it. Caregivers sometimes use analogons without being aware of the theory behind them.

[The reconstruction of meaning in dementia]

Dementia brings about progressive cognitive deterioration, combining memory problems, language difficulties and thought disorders. While there is currently no treatment for the organic disorders causing the dementia, help can be given to patients to slow down the regressive processes. Psychological mediations exist to support patients in their efforts to make sense of their environment.

[Cognitive disorders and the Montessori method]

Trained in the Montessori method, a team takes a very positive approach to their patients. The nurses base their practice on patients' remaining capacities, helping them work around their impairments. They seek to offer each person the possibility to pursue a social life through individualised treatments.

Video-phone communication with cognitively impaired elderly patients

We investigated the potential role of remote interactions via video-phone in the care of the elderly. Family members and nursing staff were interviewed about their experiences of communicating with elderly people via video-phone. Seven family members and seven nursing staff participated in the studies. The interviews were analysed using qualitative content analysis. The results showed that it was possible for elderly people with cognitive impairment to engage in remote communication when certain conditions were met. There were also indications that the video-phone interaction sometimes increased the attention and focus of the elderly subjects.

[Cognitive remediation and nursing care]

Therapies based on cognitive remediation integrate psychiatric care. Cognitive remediation helps to ease cognitive disorders and enable patients to improve their day-to-day lives. It is essential to complete nurses' training in this field. This article presents the example of a patient with schizophrenia who followed the Cognitive Remediation Therapy programme, enabling him to access mainstream employment.

The Effects of Caregiving Resources on Perceived Health among Caregivers

This study examined how various types of resources influence perceived health of caregivers. Guided by the conservation of resources theory, a caregiver health model was built and tested using structural equation modeling. The caregiver health model consisted of caregiving situations (functional limitations and cognitive impairments of older adults and caregiving time), resources (financial resources, mastery, social support, family harmony, and service utilization), caregiver burden, and perceived health of caregivers. The sample included 1,837 unpaid informal caregivers drawn from the 2004 National Long-Term Caregiver Survey. The model fit indices indicated that the first structural model did not fit well; however, the revised model yielded an excellent model fit. More stressful caregiving situations were associated with fewer resources and higher burden, whereas greater resources were associated with lower burden and better perceived health of caregivers. The results suggest explicit implications for social work research and practice on how to protect the health of caregivers.

The Lived Experiences of Israeli Arab Moslems Who are Caring for a Relative with Cognitive Decline

The study examined the lived experience of caring for a relative with cognitive decline. The informants were 18 Arab, Moslem caregivers living in rural communities in Northern Israel who participated in personal interviews. The transcripts were analyzed using the hermeneutic phenomenological approach to the study of human behavior (van Manen, 1998). The results clarified how social location affects caregiving perceptions, decisions, and actions. The portrayed experiences were complex and involved the dimensions of life, including individuals, family-neighbors, and social-political environments. The holistic overview of the transcripts indicated the inseparable political and personal influences on perceptions of caregivers, a conflict of old and new social viewpoints, the absence of one main caregiver for the divided duties of several family members, and the lack of scientific information about the condition of the relative. Several motivations for caregiving were documented and examples of personal, interpersonal, and community resources were provided.

Managing the Care of the Older Patient with Delirium and Dementia

As the population ages, nurses in various clinical settings must identify high-risk groups that are vulnerable to delirium and dementia. They also must be able to provide psychosocial and pharmacologic interventions that promote comfort and safety for patients and their families experiencing these distressful medical conditions. Efforts to facilitate health resolution and restore the patient and caregivers to an optimal level of functioning must be priorities.

The relationship between burden and well-being among caregivers of Italian people diagnosed with severe neuromotor and cognitive disorders

In studies on caregiving, high levels of perceived burden are commonly considered as synonymous with poor well-being. This study aimed at better disentangling the relationship between burden and well-being dimensions through their joint investigation. To this purpose, perceived well-being and social resources were evaluated among caregivers reporting different levels of burden. Participants were 91 caregivers (mean age=50.4; SD=9.6), parents of people diagnosed with severe neuromotor and cognitive disorders. Participants completed a semi-structured interview and a set of scaled questionnaires: Caregiver Burden Inventory (CBI), Satisfaction with Life Scale, Positive and Negative Affect Schedule, Depression Anxiety Stress Scale, Eudaimonic and Hedonic Happiness Investigation, Resilience Scale for Adults, and Multidimensional Scale of Perceived Social Support. Participants were divided into two groups according to their perceived burden level, assessed through CBI. In both groups, the subjective components of burden accounted for the major fraction of the total burden level. Participants perceiving high burden reported higher levels of depression related emotions, lower life satisfaction and lower resilience than participants perceiving low burden. No group difference emerged in perceived meaningfulness and social support. A regression analysis showed that the best predictor of perceived burden was life satisfaction, followed to a lesser extent by resilience, while depression related emotions did not provide significant contribution. Findings suggest that the joint assessment of burden and well-being dimensions, that are co-existing in caregivers' experience, allow for the identification of personal and relational resources that can be usefully included in interventions addressed to caregivers.

Assessment of subjective cognitive impairment among older adults

Subjective cognitive impairment (SCI) refers to an individual's everyday concerns related to cognitive functioning, which can exist even in the absence of objectively assessed impairment. SCI is common among older adults, and although symptoms may be mild, SCI is associated with subsequent cognitive decline as well as significant negative effects on everyday functional ability, mood, and social engagement. Despite the potential consequences, SCI is often underreported and undetected. Thus, it is critical to consider assessing for SCI among older adults to determine cognitive impairment risk and support early intervention to promote functional well-being and health management. The current article reviews factors related to SCI, evaluates existing methods for the assessment of SCI, and proposes a person-centered framework for enhancing assessment. Application of the framework is further illustrated through the use of clinical examples.

A randomised controlled trial testing the impact of exercise on cognitive symptoms and disability of residents with dementia

A randomized controlled trial was undertaken to measure effects of exercise on: 1) the progression of cognitive symptoms related to dementia using the Clock- Drawing test Shulman et al. 1993); and 2) disability using the Revised Elderly Persons Disabilities Scale (REPDS; Fleming and Bowles 1993). Data was analysed from 75 nursing home residents with dementia who were randomly assigned to one experimental group and two control groups. Group 1 (control) received no intervention, Group 2 (control) received a social visit equivalent in duration and frequency as those undertaking the exercise program in the experimental group, Group 3. A specifically designed, frail aged appropriate, twelve week exercise program was undertaken by the those in the experimental group three times per week, each session lasted for thirty minutes. The findings from: 1) the clock drawing test showed that exercise may slow the rate of progression of the cognitive symptoms related to dementia; and 2) the REPDS showed that exercise slowed and reversed disability in some of the activities of daily living.

The synergistic effects of HIV, diabetes, and aging on cognition: implications for practice and research

Thanks to highly active antiretroviral therapy, many people infected with HIV will likely live into old age. Although this is a welcome prognosis, new issues are emerging that may complicate the ability to successfully age in this clinical population. HIV and aging independently are related to cognitive impairments, so there are concerns that those aging with HIV may be more at risk of such cognitive impairments. Moreover, highly active antiretroviral therapy itself can create metabolic disorders, such as prediabetes and/or frank type 2 diabetes, which have also been linked to poorer cognitive functioning. Thus, concerns increase that, as people age with HIV and develop comorbid metabolic disorders that may lead to type 2 diabetes, they will be at triple risk of developing cognitive impairments that can impair everyday functioning and reduce quality of life. This article explores these issues and provides implications for practice and research.

Food security: who is being excluded? A case of older people with dementia in long-term care homes

OBJECTIVES

PURPOSE

To explore the extent of food security among older people, particularly those with cognitive impairments residing in Canadian long-term care homes (LTCHs) through a focused review of literature.

METHOD

Databases including Medline, Nursing and Health Sciences (SAGE), Psych Info, Social Sciences Abstract, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and HealthSTAR were searched for peer-reviewed articles related to food experiences of older individuals in industrialized countries including Canada. Only articles that were published in English between 1997-2012 were included.

RESULTS

Sixty two studies met the inclusion criteria. Of those 17 focused on older adults in LTCHs. The review found that food security has rarely been examined among older persons living in LTCHs, and has never been examined within the context of cognitive impairment. While a few studies have focused on residents' satisfaction with foods that are provided to them in LTCHs, none have explored the extent of food security in this population. Furthermore, food satisfaction surveys in the LTCH are limited to the assessment of foods that are served to residents, and do not capture residents' food accessibility beyond the food dispensing routines of the organization. Thus, food quality, food preferences, and the traditional meanings and rituals associated with food consumption are not purposefully evaluated. In addition, LTCHs are not required to monitor residents' food satisfaction using a consistent, regular, and standardized approach and there is no regulation in the LTCH Act that requires LTCHs to assess their residents' food security.

CONCLUSIONS

The findings highlight the need for: 1) expansion of food security research to non-community-based settings including LTCHs; 2) re-conceptualization of food security and modification of measurement tools to assess the extent and determinants of food security among older adults in LTCHs; 3) mandatory monitoring of food security via standardized and regular surveys tailored to meet the unique preferences and needs of the older population, particularly those with dementia; and 4) education of healthcare professionals regarding food security and its assessment in LTCHs.

Basic Physical Capability Scale: Psychometric Testing With Cognitively Impaired Older Adults

The purpose of this study was to evaluate the reliability and validity of the Basic Physical Capability Scale when used with older adults having moderate to severe cognitive impairment and consider the utility of the measure in establishing function-focused care (FFC) goals for these individuals. The study was a secondary data analysis using data from 2 intervention studies testing FFC interventions in older adults with moderate to severe cognitive impairment in nursing homes and assisted living settings. Participants included 96 recruited from 4 assisted living facilities and 103 older adults from 4 nursing homes. There was support for validity of the measure based on construct validity and hypothesis testing, internal consistency (Cronbach's α of .79), and utility of the measure. Recommendations are provided for additional items that might help better differentiate individuals with moderate to severe cognitive impairment who are particularly high or low in basic physical capability.

Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults

AIM

This article reports the effects of three evidence-based interventions of varying intensity, each designed to improve outcomes of hospitalized cognitively impaired older adults.

MATERIALS & METHODS

In this comparative effectiveness study, 202 older adults with cognitive impairment (assessed within 24 h of index hospitalization) were enrolled at one of three hospitals within an academic health system. Each hospital was randomly assigned one of the following interventions: Augmented Standard Care (ASC; lower dose: n = 65), Resource Nurse Care (RNC; medium dose: n = 71) or the Transitional Care Model (TCM; higher dose: n = 66). Since randomization at the patient level was not feasible due to potential contamination, generalized boosted modeling that estimated multigroup propensity score weights was used to balance baseline patient characteristics between groups. Analyses compared the three groups on time with first rehospitalization or death, the number and days of all-cause rehospitalizations per patient and functional status through 6-month postindex hospitalization.

RESULTS

In total, 25% of the ASC group were rehospitalized or died by day 33 compared with day 58 for the RNC group versus day 83 for the TCM group. The largest differences between the three groups on time to rehospitalization or death were observed early in the Kaplan-Meier curve (at 30 days: ASC = 22% vs RNC = 19% vs TCM = 9%). The TCM group also demonstrated lower mean rehospitalization rates per patient compared with the RNC (p < 0.001) and ASC groups (p = 0.06) at 30 days. At 90-day postindex hospitalization, the TCM group continued to demonstrate lower mean rehospitalization rates per patient only when compared with the ASC group (p = 0.02). No significant group differences in functional status were observed.

CONCLUSION

Findings suggest that the TCM intervention, compared with interventions of lower intensity, has the potential to decrease costly resource use outcomes in the immediate postindex hospitalization period among cognitively impaired older adults.

Cognitive interventions for older adults: does approach matter?

A group training format was compared to one-to-one training in a cognitive intervention, Reasoning Exercises in Assisted Living (REAL), designed for elderly Assisted Living residents. Change scores on problem solving and functional outcomes were compared between participants in each group. In participants trained individually (n = 29), scores increased post-intervention on the Every Day Problems Test for Cognitively Challenged Elders (EPCCE; d = 3.10, p < 0.01) and the Direct Assessment of Functional Status (DAFS; d = 3.52, p < 0.001), at a cost of $132 per person. Participants (N = 4) in the group format REAL had mean score increases of 2.75 points on the EPCCE and 3.5 on the DAFS, at a cost of $25.60 per person. Additional testing is warranted to verify the group effects due to the limited size of the sample. Relative costs and effects of various training formats are important to consider when developing, testing, and disseminating interventions targeting older adults.

Exergames-based intervention for assisted living residents: a pilot study

The physical and psychosocial benefits of exergames have been reported in various literature. A pre-posttest, single-group design was used to test the effects of an exergames-based intervention on cognition, depression, and health-related quality of life (QOL) in assisted living residents. Bandura's self-efficacy theory was applied. Seven residents (mean age = 86, SD = 5 years) participated in the program two times per week for 8 weeks. Outcome measures included cognition, depression, and health-related QOL. No statistically significant differences were found in any of the outcomes after the intervention. A tendency toward improved cognition occurred, but the outcomes of depression and health-related QOL did not follow a similar trend. However, improved socialization and motivation to exercise were reported. Continued research is needed to investigate the cognitive and psychosocial effects of exergames on this population. Nurses can collaborate with other health care professionals to engage residents in exercise and thus improve residents' QOL.

Nonpharmacological interventions in long-term care: feasibility and recent trends

Numerous studies have found excessive or in appropriate use of antipsychotic drugs in nursing home patients with cognitive impairment or perceived behavioral issues. Inappropriately medicating this vulnerable population can lead to several negative outcomes, including failure to have needs met, injury, illness, and even death. In response to recent literature and government reports highlighting this issue, in 2012, the Centers for Medicare and Medicaid Services (CMS) launched an initiative called the National Partnership to Improve Dementia Care. This article discusses the CMS initiative, as well as the feasibility and recent trends in the use of nonpharmacological interventions that could be implemented when working with patients with cognitive impairment and behavioral and psychological symptoms associated with dementia.

The club concept: targeting behavioral issues in a residential setting for cognitively impaired adults

Behavior and psychological symptoms of dementia are common in residential care facilities. These symptoms not only detract from the quality of life of the resident with dementia, but they can be disruptive to the unit and result in harm to staff and other residents. With the trend away from pharmacological management, other creative psychosocial-environmental strategies are being explored. One innovative approach involves the use of the club concept, where selected agitated residents spend a portion of the day in a separate structured environment. This program combines trained staff and tailored activities that optimize mental stimulation, functional independence, and self-esteem. Benefits include reduced incidents of aggressive behaviors and use of psychoactive medications, as well as enhanced quality of life. Not only do the participants benefit from time spent in this specialized setting, but the therapeutic milieu of the facility is also enhanced. Further evaluation of such strategies is needed to quantify the benefits of targeted behavioral interventions for those with cognitive impairment.

Case study: Transitional care for a patient with benign prostatic hyperplasia and recurrent urinary tract infections

Chronic urologic conditions, including benign prostatic hyperplasia, recurrent urinary tract infections, and urinary incontinence, are common in older adults. This article highlights the urologic and transitional care needs of an elderly, cognitively impaired male during and after an acute hospitalization. Collaboration between the patient, his family, the advanced practice nurse, primary care providers, and outpatient urology office are described. The importance of mutual goal setting and a focused plan for transitional care are discussed.

Do patients with advanced cognitive impairment admitted to hospitals with higher rates of feeding tube insertion have improved survival?

CONTEXT

Research is conflicting on whether receiving medical care at a hospital with more aggressive treatment patterns improves survival.

OBJECTIVES

The aim of this study was to examine whether nursing home residents admitted to hospitals with more aggressive patterns of feeding tube insertion had improved survival.

METHODS

Using the 1999-2007 Minimum Data Set matched to Medicare claims, we identified hospitalized nursing home residents with advanced cognitive impairment who did not have a feeding tube inserted prior to their hospital admissions. The sample included 56,824 nursing home residents and 1773 acute care hospitals nationwide. Hospitals were categorized into nine groups based on feeding tube insertion rates and whether the rates were increasing, staying the same, or decreasing between the periods of 2000-2003 and 2004-2007. Multivariate logit models were used to examine the association between the hospital patterns of feeding tube insertion and survival among hospitalized nursing home residents with advanced cognitive impairment.

RESULTS

Nearly one in five hospitals (N=366) had persistently high rates of feeding tube insertion. Being admitted to these hospitals with persistently high rates of feeding tube insertion was not associated with improved survival when compared with being admitted to hospitals with persistently low rates of feeding tube insertion. The adjusted odds ratios were 0.93 (95% confidence interval [CI]: 0.87, 1.01) and 1.02 (95% CI: 0.95, 1.09) for one-month and six-month posthospitalization survival, respectively.

CONCLUSION

Hospitals with more aggressive patterns of feeding tube insertion did not have improved survival for hospitalized nursing home residents with advanced cognitive impairment.

The use of focus groups to characterize symptoms in persons with multiple sclerosis

Multiple sclerosis is a chronic neurological disease with a myriad of symptoms. Because most work has been quantitative, it is important to capture symptoms as described by patients who experience them, using a qualitative approach. The purpose of our study was to describe and identify symptoms, with emphasis on co-occurrence, using focus groups. Three focus groups were conducted (N = 16) with relapsing-remitting multiple sclerosis patients. Common symptoms, described as both singular and co-occurring, were problems with balance, cognition, vision, and heat intolerance. These findings augment past characterizations of symptoms experienced in persons with relapsing-remitting multiple sclerosis and provide evidence for future studies.

A qualitative analysis of an advanced practice nurse-directed transitional care model intervention

PURPOSE

The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs).

DESIGN AND METHODS

APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An exploratory, qualitative directed content analysis examined 15 narrative case summaries written by APNs and fieldnotes from biweekly case conferences.

RESULTS

Three central themes emerged: patients and caregivers having the necessary information and knowledge, care coordination, and the caregiver experience. An additional category was also identified, APNs going above and beyond.

IMPLICATIONS

APNs implemented individualized approaches and provided care that exceeds the type of care typically staffed and reimbursed in the American health care system by applying a Transitional Care Model, advanced clinical judgment, and doing whatever was necessary to prevent negative outcomes. Reimbursement reform as well as more formalized support systems and resources are necessary for APNs to consistently provide such care to patients and their caregivers during this vulnerable time of transition.

An overview of nonpathological geroneuropsychology: implications for nursing practice and research

One aspect of successful aging is maintaining cognitive functioning, which includes both subjective cognitive functioning and objective cognitive functioning even in lieu of subtle cognitive deficits that occur with normal, nonpathological aging. Age-related cognitive deficits emerge across several domains including attention, memory, language, speed of processing, executive, and psychomotor, just to name a few. A primary theory explaining such cognitive deficits is cognitive reserve theory; it posits that biological factors such as demyelination and oxidative stress interfere with neuronal communication, which eventually produces observable deficits in cognitive functioning. Therefore, it is important to maintain or improve cognitive reserve to augment cognitive functioning in later life. This article provides a general overview of the principles of geroneuropsychology along with implications for nursing practice and research.

Proactive primary care of carers of people with cognitive impairment: a feasibility study

BACKGROUND

Over 250 000 Australians live with dementia, and it is estimated that this number will more than double by 2030. Many people with dementia or cognitive impairment are cared for at home by family carers who may themselves be frail older adults or who may suffer from chronic conditions. There is evidence that caring has adverse impacts on carers; however, many do not seek or delay seeking appropriate health care.

AIM

To explore the feasibility of a protocol to identify the unmet healthcare needs of carers of people with cognitive impairment.

METHOD

This feasibility study used a mixed-methods approach. Data were collected through a set of three wellbeing questionnaires, and interviews with carers and one general practitioner. Carers were recruited through government-funded adult day care centres in Perth, Western Australia. General practitioners were nominated by the carers. The sample included 15 carers and one general practitioner.

RESULTS

Carer participants in this study experienced varying degrees of care burden. Insomnia, fatigue and pain were the most prominent symptoms. Their overall health status was lower than that of the general population, with physical functioning and bodily pain obtaining the lowest scores. Carers found the protocol useful and the questionnaires easy to complete; they reported specific outcomes resulting from the implementation of the protocol aimed at addressing their healthcare needs.

CONCLUSION

The study results demonstrate the feasibility of adopting a protocol to identify and address carers' unmet healthcare issues, and warrant further research. In the context of an ageing population, the growing number of carers of people with cognitive impairment and dementia need to receive adequate support to enable them to continue to provide care.

Nurse-Enhanced Memory Intervention in Heart Failure: the MEMOIR study

BACKGROUND

Many patients with heart failure (HF) have cognitive deficits, including memory loss.

OBJECTIVES

The aim of this study was to evaluate the efficacy of a cognitive training intervention on memory (primary outcome), working memory, psychomotor speed, executive function, and performance of cognitive activities and instrumental activities of daily living (IADLs).

METHODS AND RESULTS

Forty patients with HF were randomly assigned to the computerized plasticity-based cognitive training intervention called Brain Fitness or to the health education active control intervention. Advanced practice nurses made weekly home visits to assess symptoms and monitor intervention adherence. Patients completed demographic and clinical data (baseline), neuropsychologic tests (baseline and 8 and 12 weeks), and measures of cognitive and IADLs performance (baseline and 12 weeks) and satisfaction (12 weeks). Linear mixed models analyses indicated a significant group by time interaction for delayed recall memory (P = .032) and a significant time effect for total (list learning) (P < .001) and delayed (P = .015) recall memory, psychomotor speed (P = .029), and performance of IADLs (P = .006). Intervention adherence and patient satisfaction were high.

CONCLUSIONS

To our knowledge, this was the first test of Brain Fitness in HF. Although it was a preliminary study with limitations, results support the need for a larger randomized controlled trial to determine whether the memory loss of HF is amenable to plasticity-based interventions.

[Failure of a mourning ritual and reactive depression]

In some African societies, mourning rituals are a way of isolating death from the territory of the living and to allow the bereaved to regain, after a certain time, their place in society. However, for a young educated woman confronted with the brutal death of her sister, the traditional ritual to which her family subjected her resulted in a prolonged reactive depression combined with cognitive disorders..

[Cognitive disorders in elderly patients at night]

The feelings of nursing staff towards working nights in nursing homes are little known, both with regard to the difficulties encountered in their activity as well as to the effects on their own life and health. Their practice is often complicated by the existence of behavioural disorders accentuated at night and which affect numerous residents.

[Psychomotor therapy in paediatric palliative care]

Present for around ten years in specialised paediatric departments, most psychomotor therapists have already been confronted with children approaching the end of life. In this context, psychomotor therapy takes into account the individuality of each child within his/her family dynamics, for global and personalised support.