The dependence of the elderly • • • • • • • • • • • • • • • • • • • • • • • • DEFINITIONS AND EPIDEMIOLOGY DEMOGRAPHY Dependence Independence FACTORS PROMOTIN G DEPENDENCE problems Vascular

dementia neurodegenerative Nutritional problems f alls Other problems generating dependency GOVERNMENT RESPONSE Background "PSD" T he "ABS" Grid AGGIR THE RESPONSE OF PROFESSIONAL GERONTE The grids derived from the rosette of Nancy Roper (MIF, MDA, rosettes annual ...) Matrix of IADL CHLS O ther grids (Pierre Garraud Vinatier, Danton residence, level of activity Karnofs ky, RAI Ardas, Antoine Charial ...) THE PREVENTION OF DEPENDENCE Causes Preventi on dependence on the elderly DEPENDENCE • "Addiction is the inability to perform only one or more essential activities o f life and to meet its basic needs. At the root of addiction there is the more o ften a handicap. The disability caused by a disease process that caused the loss of function and generated and infirmity or disability. The result for an indivi dual to have difficulty in carrying out its normal role in society ... "[1] • [1 ]" Dependence and autonomy in the elderly, "Theresa GRANGE, Supporting and carin g No. 31-1997 AUTONOMY • Oxford dictionary definition: • "... to decide, for an organization, for an in dividual, compared to a central authority, a hierarchy of authority. "• Definiti on of Petit Robert: •" The capacity of an individual to govern itself " AUTONOMY • It is therefore the ability to make choices is to learn to manage its dependen cies. • "Therefore, as part of aging and out of dementia, DEPENDENCE DOES NOT ME AN LOSS OF AUTONOMY. The conservation of autonomy depends on the ability to reco gnize his disability, find ways to substitutes, and develop compensatory strateg ies: effective interaction between the individual and his environment. [1] • [1] Ibid above CONCLUSION: • Work on building and dependence is a job evaluation, prevention, research is a technical skill appropriate care • In contrast, work on autonomy implies for th e elderly and disabled for the it helps work challenged. It is work that lies at the interface between the elderly, personality, perception of reality, his desi res and his environment. DEMOGRAPHY AND EPIDEMIOLOGY • October 21, 2005 (IPSOS) - France now has 850,000 dependents over 60 years. Gi ven the demographic changes and the lengthening of the average lifetime, this fi gure should exceed one million people in 15 years and continue to grow strongly until 2040. DEMOGRAPHY AND EPIDEMIOLOGY • The dependence of the elderly is the subject of numerous epidemiological and c linical studies. Aging itself is not a source of disability (primary aging), it is only the margin of flexibility that decreases: for example reduction of adapt ation to stress and increase recovery time after exertion. For cons, the cumulat ive disease because of age (secondary aging) may lead to disability. FACTORS PROMOTING DEPENDENCE • • Problems Vascular dementia neuro degenerative diseases (Alzheimer's disease and other dementias) nutrition falls Disorders Depression sensory disorders of c ontinence

• • • • • CONCLUSION: • Care will also include a rehabilitation support broader risk factors: somatic pathology, nutritional status, psychological disorders, sensory deficits compens ation CONCLUSION: • A set of structural support and care are put in place to prevent, treat and OF FSET disability and dependence that occurs with age. Their common goal is to KEE P THE PERSON DRIVING THE POSSIBILITY AGEE HIS LIFE IN ANY FREEDOM AND DIGNITY. CONSEQUENCES OF DEPENDENCE Consequences of dependence on the elderly Consequences of dependence on the elderly • Daily Life: The dependence heard first on the daily lives of the elderly. When home care is possible, dependence requires the presence of people at home. Consequences of dependence on the elderly • Abandonment of domicile: The dependency causes the abandonment of domicile in favor of institutional structures.€The relocation of living must be prepared wit h the older person in progressively structuring a life plan that integrates both the acceptance of loss of home and preparation for new housing. Consequences of dependence on the elderly • Emotional Life: The dependence clearly influence the emotional life of a perso n. The person who became dependent on his entourage reactive modes of relationsh ip or older child. • the need for assistance is experienced as painful or otherw ise during the "secondary gain". Consequences of dependence on the elderly • Gestures of everyday life: When addiction is strong, interesting gestures of e veryday life sometimes intimate, relationship with caregivers may oscillate betw een revolt and servility. Consequences of dependence on the elderly • Risk of abuse: These response patterns must be assessed preferably in a team, to avoid any behavior or rejection projection that some caregivers may feel. CONSEQUENCES OF DEPENDENCE Consequences of dependence on the environment Consequences of dependence on the environment • Changing the look of the entourage • Overinvestment or disinvestment GOVERNMENT RESPONSE • History: - - - - 5th to the 14th Century: THE UNNECESSARY 16th and 17th century: THE PENS IONERS 18th century 19th century CHARITY: THE PREMISES OF RETIREMENT - 20th Cent ury: The Birth of Geriatrics and the third age GOVERNMENT RESPONSE • Important Dates: • June 1975: creation of the compensatory allowance for a thi rd person • 1981: first state secretariat in charge of pensioners and elderly GOVERNMENT RESPONSE • 1986-1993: Numerous reports and five legislative proposals on the management o f dependency no project will be expedited • July 25, 1994: Act No. 94-637: an experimental delivery addiction level department (PED Benefit = Experiment Depen

dence) THE GOVERNMENT RESPONSE • January 24, 1997: PSD, which was passed too quickly, following pressure from c ouncils who did not want to pay the compensatory allowance for a third party for the elderly, and because of deficit disaster of the SS in 1995. GOVERNMENT RESPONSE • 21st Century: The fourth age DEPENDENCE • So we must take our turn now to the arrival of old age and dependency in our society and find ways to address the 21 st century GOVERNMENT RESPONSE • • • • • • • ABS (Allowance for Custom Self) This new device is retracted into force on 1 January 2002. He meant to overcome the disadvantages of the PSD is: D esire to support the IRM 1,2,3 and 4 funding idea of "personalized care plans" a nd not just a number of hours aideménagère. Rates are national reference (not de partmental) contribution of the state and greater involvement of other financier s. ... GOVERNMENT RESPONSE • • From 1 to IRM IRM 6 The assessment of dependency is conducted from a grid ca lled AGGIR grid "that distributes the APA applicants in six groups, more depende nt on (a IRM) to the autonomous (IRM 6). Only people in the group 1-4 are likely to perceive the APA. GOVERNMENT RESPONSE • • Who evaluates the loss of autonomy? If the elderly person lives with it, thi s mission is for the medico-social department (General Council) composed of at l east one doctor and a social worker. A commission member moves to the home of th e elderly in the month following the registration of his case. GOVERNMENT RESPONSE • • In preparation for the elderly if the elderly live in nursing homes is the m edico-social establishment that is responsible for this evaluation. • The report is forwarded to the Department and the medical officer of health insurance for validation and control. GOVERNMENT RESPONSE • • The grid AGGIR [1] [1] "Matrix AGGIR and nursing process", Nicole MARCHAND, aid healthcare No. 9, October 1997 GOVERNMENT RESPONSE • It is an assessment tool at a point in a given situation, the dependency of th e elderly at home or in institutions. • It was developed by the National Associa tion of Gerontology Clinic after a multidisciplinary work. GOVERNMENT RESPONSE • It consists of two tables of information collection: • A table with respect to 10 discriminating variables (the last 2 on the home only) • a table with 7 illu strative variables (the table is not used for the calculation of IRM) • Note: IR M = Iso Resource Group THE RESPONSE OF PROFESSIONAL • Additional grids, more visual and easier to use by all health professionals, h ad been created before and are still used. THE RESPONSE OF PROFESSIONAL • • • The GERONTE grids derived from the rosette of Nancy ROPER Other grids - Scale activities of daily living (ADL Katz) - According to the scale of instru

mental activities of daily living (IADL Lawton) The prevention of dependency on the old • For cardiovascular problems: - Rules lifestyle modifications - the control of hypertension The prevention of dependency on the old • For Fall: - Maintaining a physical activity - early diagnosis (BMD) and treatment of disea ses that cause problems with walking and balance The prevention of dependency on the old • Regarding continence disorders: - Early diagnosis of the cause - Rehabilitation - Pharmacological The prevention of dependency on the old • Concerning the sensory disorders: - Equipment appropriate - Cataract The prevention of dependence on old • For depression: - Early detection - Processing