Abstract
"Discover comprehensive palliative care strategies for complex gerontopsychiatric patients like Madame Martine, addressing anxiety, agitation, and pain management challenges. Learn how integrated care teams can provide prioritized and adapted support, improving quality of life and care continuity. Explore the importance of a systemic approach in managing complex care needs and the role of palliative care in gerontology."
Extract
[...] However, I find that there is often a lack of structures and support tools for caregivers. Some caregiver colleagues have been able to report a lack of effective communication with the doctor and the care team, a lack of support in managing pain, a lack of psychological support. Regarding physical and medical needs, the medical team has a crucial role to play in the patient's care, but also - although it is not a formal or explicit role - in educating the caregiver intern, as I was. [...]
[...] Some authors consider it a pathological reaction, while others have a different opinion. For example, Chrystel Besche-Richard and Catherine Bungener (2020) estimate that panic is associated with the activation of the parasympathetic system, which can cause tears, screams, or paralysis (muscular stiffening in case of strong vegetative irritation) when flight is impossible and combat is hopeless.4. Instead, anxiety and fear, according to him, are associated with the sympathetic system and trigger flight and combat. In the case of Mrs. Martine, anxiety, fear, and panic are always associated with physiological and cognitive reactions. [...]
[...] Indeed, the latter was described as alcohol-dependent, unfaithful, and violent under the influence of alcohol. His numerous infidelities are described by the patient as causing her great suffering. It is therefore in this context of domestic violence and infidelity that she will begin to develop recurrent depressive disorders, going as far as violent manifestations, such as in 1986 when she shot herself in the chest1. This suicidal context was reinforced both by marital crises, the alcoholic and violent state of her husband. [...]
[...] Finally, the integrated actions of the care team, which necessarily vary according to the individual, must have a global approach to patient care, which takes into account the different dimensions of their life and, given that the effectiveness with which it is addressed inevitably affects the others, the activities must be programmed and coordinated. Reflective Analysis Mrs. Martine will remain hospitalized in our service for two months, then she will be transferred to psycho-geriatrics for suicidal proposals with risks of acting out. I was unable to say goodbye to Mrs. Martine because I was on leave during her transfer. [...]
[...] To this end, I tried - to the extent possible - to enrich her day with some activities such as, for example, doing light physical exercises every day or setting up relaxing rituals in the evening. In this regard, my goal was to establish a calm atmosphere (reduce noise and lights, for example) while ensuring that the room temperature was comfortable. Finally, in conjunction with my colleagues, it was necessary to ensure the maintenance of regular sleep and wake-up times while avoiding naps during the day. In this context, a meticulous management of Mrs. [...]
