This article notes that the rights and freedoms of users of an establishment are deliberately reduced to limit the risk of criminal prosecution. It also aims to clearly define the responsibilities of the establishment’s management and outlines the measures to be taken to protect against such risks. The ultimate goal is to enable th management to act freely for the well-being of the beneficiaries.
Female urinary incontinence is neither inevitable nor a benign condition. This geriatric syndrome is associated with other markers of pathological aging, such as falls, loss of functional independence, and frailty. This review, based on a presentation given at the 12th Broca Scientific Days, presents the epidemiological and clinical features, as well as relevant therapeutic developments for managing female urinary incontinence. Female urinary incontinence, which affects more than a third of older women, requires identification through questionnaires then a primarily a standardized clinical approach. A basic medical history is effective for identification of urinary incontinence and assessment of the underlying mechanism as well. Depending on the type of incontinence and the patient vulnerability and acceptance, non-pharmacological treatments (rehabilitation), surgical interventions (particularly for stress urinary incontinence), or medications may be prescribed to limit the severity of the incontinence.
Precarity refers to a situation of instability and uncertainty affecting several aspects of life (housing, employment, health, and financial resources). It is different from poverty but can lead to it, and it particularly affects older adults, in whom it increases the risk of loss of independence. In the Île-de-France region, the number of elderly people is rising significantly, especially those who are dependent. In certain areas such as Ivry/Vitry, high levels of precarity lead to difficulties in accessing healthcare, worsened by a lack of specialists and appropriate services. To address these issues, two main solutions are proposed: • a dedicated precarity consultation to better assess and support vulnerable older adults, • a specialized geriatric day hospital, allowing comprehensive care in a single day (diagnosis, treatment, and rehabilitation). This approach offers several advantages: avoiding long hospital stays, supporting aging at home, improving coordination between professionals, and ensuring better patient follow-up. In conclusion, these solutions could improve the care of older adults living in precarity and reduce its negative impact on their health and independence.
It took a hundred years between the first description of Diogenes syndrome and the inclusion of Hoarding Disorder in the DSM-V. Diogenes syndrome, first named 50 years ago, combines a pathological relationship with possessions, self-neglect and a non-request for help. Many conditions (neuro-degenerative and/or mental health) are associated with this problem, which could affect up to 2.5% of the population. This narrative review proposes a pragmatic and multidimensional approach to strengthen the health empowerment and access to care of these people, who may find themselves in situations of significant precarity, as well as provide an ethical framework to enhance the professional response to the lack of help-seeking.
Alcohol consumption among residents in nursing homes is often underestimated or overlooked. Yet it exposes residents to significant risks: falls, anxiety, cognitive or psychobehavioral disorders, drug interactions, malnutrition, and more. The study conducted by the Île-de-France Regional Health Agency focuses on alcohol misuse in nursing homes. It was developed based on a questionnaire sent to professionals working in these facilities, supplemented by interviews. The term “alcohol misuse” refers to risky consumption, harmful consumption, repeated abuse, and dependence. The objective of the survey was to determine whether alcohol misuse was occurring among residents, to identify methods for detecting it, to analyze associated risk factors, and finally to develop regional guidelines for support and care in nursing homes. The results show significant alcohol consumption influenced by psychosocial and medical factors. They highlight the need to dedicate a section of nursing home operational plans to responsible alcohol consumption, based on these two pillars: training and screening.
We will have to face the tsunami of over-80s in the next decade, as well as the emergence of a growing population of young elderly people, including “aging disabled” people, people from psychiatric care, and people who have experienced homelessness. Caring for these extremely vulnerable people in their premature aging requires social, medico-social, and health skills, and above all, the appropriation of a common culture – that of exclusion – with the aim of developing and implementing specific best practices. Caring for these people is a challenge that is becoming a part of our daily professional lives. To better understand its components, we offer the perspective of four key witnesses to supporting homeless people. We asked them the following question: “Why this interest in these marginalized people ignored by our society, and what difficulties have you encountered?”
Introduction: In response to the evolving healthcare needs of the elderly, personalized care tailored to their environment is essential. External mobile geriatric teams (EMG EH) are part of this approach, offering their expertise in collaboration with local stakeholders. In 2024, the EMG EH of the CHU of Nice conducted 164 home visits and responded to 434 calls from the Geriatric Hotline, further strengthening their connections with medical-social and healthcare structures within the Nice area, aiming to reinforce the community-hospital partnership in the care of older adults. Objective: We sought to assess the satisfaction levels and needs of general practitioners who had contacted the EMG EH of Nice. The data collected will subsequently be used to adapt the recommendations issued by the EMG EH. Method: A brief six questions survey regarding feedback from primary care physicians after EMG EH interventions was distributed by mail to 82 physicians on May 13, 2025, with responses collected through the end of August 2025. Results: Of the 82 physicians contacted, 41 responded (50%). The majority reported a high level of satisfaction with the interventions, referring to the relevance of multidisciplinary recommendations, the decision-making support provided, and the facilitation of the hospital-community link. The main limitations identified were occasional delays in home interventions and a desire for a 3-month follow-up. A few respondents noted a perceived gap between hospital practices and those in the community, which hindered the implementation of recommendations. Conclusion: The missions of the EMG EH of the CHU of Nice provide a relevant response to the challenges posed by aging. This survey will enable us to refine our recommendations to better align with the needs of healthcare providers.
Against a backdrop of an aging homeless population and increasingly complex administrative procedures, Samusocial de Paris, through its Interface and JADE missions, has painted an alarming picture of the situation facing elderly foreign nationals without residence permits. This article offers both an operational and legal perspective, highlighting the value of an interdisciplinary approach in developing concrete solutions for accessing rights and medical and social services.
The admission of formerly homeless individuals –so-called “retired homeless”– into nursing homes (Ehpads) represents a major shift, but does not erase the physical, psychological, and social scars left by long-term precarity. These atypical residents, often younger than average and displaying more unconventional behavioral issues, tend to unsettle geriatric institutions that are ill-prepared to accommodate them. In this context, Mobile Psychiatry Teams for Older Adults (EMPSA) provide valuable support through their ecological approach, their role as neutral third parties, and their capacity for interprofessional mediation. By intervening directly within care facilities, EMPSA teams assess situations “in real-life settings”, assist caregivers in developing tailored care plans, facilitate coordination between various sectors (psychiatric, geriatric, and social), and foster ethical reflection in these often-complex cases. This article explores both the contributions and limitations of these teams in managing the care of “retired homeless” individuals in nursing homes.
Hiding the truth about admission from the parent, making them think they will lose the support of their family, not letting the facility take its place, concealing certain aspects of their history, having too narrow a view of care, not listening enough to the new resident, and treating all families the same are attitudes that can lead to a failed admission in a nursing home. They stem from a difficulty for the family and the institution to integrate the often contradictory emotional meanings of admission to a nursing home.
This article offers a reflection on the distress (Hilflosigkeit) of elderly people with dementia, approached from a psychoanalytical perspective. Based on Freud’s work on primal distress and the helping neighbor, enriched by the contributions of Bion, Winnicott, Green, and Anzieu, we explore the specific role of the clinical psychologist in geriatrics. Beyond assessment, it is a question of supporting individuals whose capacity for symbolization is impaired, by listening attentively to nonverbal modes of expression and providing a containing function where the psychic envelope is fragile.
This article presents how the Île-de-France Regional Health Agency (ARS) has integrated the issue of aging in extreme poverty into PRAPS 3, which is part of the 2023-2028 Regional Health Project. Based on a regional assessment and feedback from the field, it highlights the growing complexity of situations involving loss of independence among homeless people. It reviews the strategic choices made by the Agency to structure an appropriate response to these vulnerabilities: identification, training, intersectoral coordination, and capacity building. The article also highlights the regional conference on “Precariousness in Nursing Homes” organized in December 2024 as a collective workspace promoting the implementation of this policy. The aim is to show how a systemic approach can contribute to developing existing systems and making care pathways more accessible, humane, and equitable.
Healthcare professionals perceive precariousness in various ways, including patients considered “undesirable”, requiring medical, psychological, and social care that is often complex and time-consuming. Cognitive impairments are common among homeless adults, with a higher prevalence than in the general population. These impairments have multiple origins, which complicates their management. Behavioral problems in homeless individuals can be linked to dysexecutive syndromes, psychiatric, cognitive, or somatic conditions, such as Korsakoff’s syndrome, frontotemporal dementia, or Diogenes syndrome. A rigorous and systematic clinical analysis is essential to understanding the problems of older homeless individuals. This includes a thorough etiopathological investigation, memory consultations, cognitive-behavioral units, and mobile teams to establish a relationship of trust. Even in cases of therapeutic impasse, it is crucial to make sense of the problems and refer individuals to the appropriate care. The goal is to offer them a chance to break out of their isolation and regain functional autonomy.
Introduction: A new kind of mobile specialized prevention teams was created in 2020 by the Hauts-de-France’s Regional Health Agency. 13 prevention teams accompany the 586 nursing homes in Hauts-De-France to help them develop customed prevention plans and measures. Objective: To analyse the effective implementation of prevention mesures in nursing homes after the intervention of specialized prevention teams. Methods: We made a before/after statistical analysis of the data found inside a sample of 102 intitals and revised autodiagnosis. Results: We observed a significant impact of the prevention teams on the creation and update of protocols for falls prevention, on post-fall reeducation, on nominating nutrition referents among nurses, on creating partnerships with malnutrition specialized structures, on educating medical staff about malnutrition, on nominating oral hygiene referents among nurses, and on implementing daily oral care for dependent residents. Discussion: Some autodiagnosis were not filled exhaustively, reducing statistical power. Only three themes were analyzed: prevention of falls, undernourishment, and oral hygiene. Conclusion: This study demonstrate the positive impact of specialized prevention teams for implementing key and customed prevention measures in nursing homes.
Le prurit chronique est une cause fréquente de consultation en médecine générale et dermatologie, touchant jusqu’à un tiers des sujets âgés. Ce symptôme, défini par une démangeaison persistante de plus de six semaines, entraîne un retentissement fonctionnel et psychosocial majeur, comparable à celui de la douleur chronique. Chez le sujet âgé, la polymorbidité, la polymédication et le vieillissement cutané, neurologique et immunitaire en compliquent l’évaluation et la prise en charge. L’étiologie est souvent multifactorielle, et près de la moitié des cas demeurent inexpliqués après un bilan complet. L’exploration diagnostique repose sur une anamnèse ciblée, un examen clinique systématique et un bilan biologique standardisé, incluant la recherche de causes systémiques ou iatrogènes. Les mécanismes physiopathologiques associent xérose cutanée, neuropathies, immunosénescence et effets médicamenteux, avec un rôle croissant identifié pour des médiateurs tels que l’IL-31. Les émollients et la photothérapie UVB sont les bases du traitement, complétés par des approches pharmacologiques telles que les gabapentinoïdes, antidépresseurs, les biothérapies ciblées comme le dupilumab ou non médicamenteuses, en particulier l’hypnose. Le prurit chronique représente un enjeu majeur de santé publique dans un contexte de vieillissement démographique, nécessitant une approche globale et multidimensionnelle.
Introduction : L’hypertension artérielle (HTA) est la pathologie chronique la plus fréquente après 75 ans. Son traitement réduit la morbi-mortalité cardiovasculaire mais expose à un risque iatrogène : hypotension orthostatique (HO), chutes, syncopes, déclin fonctionnel et cognitif. La transposabilité des essais pivots (SPRINT, STEP) au sujet fragile reste limitée. Objectif : Synthétiser les données récentes sur l’individualisation des objectifs tensionnels chez le sujet âgé fragile et proposer une stratégie pratique. Méthode : Revue narrative structurée fondée sur six équations PubMed® (2019-2026), complétée par les recommandations HAS, SFGG, ESH/ESC, NICE et la Cochrane Library. Trente-et-une références retenues. Résultats : L’ESH 2023 reconnaît la fragilité comme déterminant de l’objectif tensionnel. Les recommandations récentes encouragent une individualisation des objectifs tensionnels fondée sur une évaluation gériatrique globale intégrant notamment le niveau de fragilité, la tolérance clinique, la multimorbidité et les objectifs de soins. Dans ce cadre, la Clinical Frailty Scale constitue un outil pratique d’aide à la décision parmi d’autres. Chez les sujets très fragiles, aucune cible tensionnelle chiffrée ne peut être recommandée ; un seuil plancher d’environ 120–130 mmHg constitue un repère pragmatique fondé sur les données actuellement disponibles. La mesure systématique de l’HO conditionne la décision. Inhibiteurs calciques et indapamide à privilégier ; alpha-bloquants et antihypertenseurs centraux à éviter. L’essai RETREAT-FRAIL (2025) montre qu’une déprescription protocolisée n’apporte pas de bénéfice de mortalité en Ehpad, plaidant pour une déprescription ciblée. Conclusion : La prise en charge tensionnelle du sujet âgé fragile gagne à intégrer fragilité, tolérance posturale et individualisation, plutôt qu’un objectif uniforme.
The sexuality of elderly people in institutions remains a complex subject for the professionals who care for them, especially when sexual behavior takes on an inappropriate or even disturbing form. Inappropriate sexual behavior in older adults requires clinical exploration, assessment, and monitoring, as well as institutional reflection to ensure a structured framework for all and individualized interventions tailored to the specific issues of the person concerned.
Hospitalized older adults have high protein requirements and are at high risk of malnutrition. To improve the nutrition management process in accordance with the ESPEN guidelines, new strategies based on a patient-centred approach have to be implemented at hospital. In a community hospital, a new enrichment method was developed, based on the addition of a new fortified high-protein high-energy paste directly to hospital-recipes meals. In addition, the healthcare team co-decides the patient’s nutritional intervention by combining patient’s energy and protein requirements with their eating habits, food preferences, and appetite to propose the most appropriate solution. The whole nutrition management process, which combines a new method of food enrichment, a patient-centred approach, with computerized follow-up of energy and protein intakes throughout the hospital stay, is helping to refocus attention on patient malnutrition and, redefine the roles of healthcare professionals.
Emotional and sexual life concerns the private and intimate lives of individuals. Yet, in nursing homes, it can become a subject of discussion, even tension, among staff and with residents’ relatives. Indeed, the emotional and sexual lives of residents can raise questions about their best interests, particularly when they impact their health (risk of falls), about their free choice (capacity for consent), or its impact on community life (disruption among other residents, demands from relatives, responsibility of staff). The “ethics memo” published by the Clinical Ethics Center of AP-HP offers a method for discussing these issues with more serenity and for putting everyone’s subjective projections into perspective. The goal is to focus discussions on the individuals involved, striving to better understand what would be most respectful of them.
