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Some thoughts on the care needs of demented patients. Part I

Published online by Cambridge University Press:  11 October 2011

Alberto Spagnoli  and
Ennio Cocco
Alberto Spagnoli*
Affiliation:
Laboratorio di Neuropsichiatria Geriatrica, Istituto di Ricerche Farmacologiche «Mario Negri», Milano
Ennio Cocco
Affiliation:
Unità Operativa di Psichiatria, USSL 64 della Regione Lombardia, Monza, Milano; Laboratorio di Neuropsichiatria Geriatrica, Istituto di Ricerche Farmacologiche «Mario Negri», Milano
*
Indirizzo per la corrispondenza: Dr. Alberto Spagnoli, Istituto di Ricerche Farmacologiche «Mario Negri», Via Eritrea 62, 20157 Milano. Fax (+39) 02-39001916
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Summary

Objective - In view of the lack of both a tradition and research, or systematic reflections, on the issue of health care for demented patients, and taking into account the many initiatives set up also in Italy to search for new models of care for old demented people, we feel it can be of some interest to suggest some thoughts on the issue. The ultimate objective of this paper is to stimulate a debate and further contributions on the eveluation of psychogeriatric services and effective «styles of care». Method - A review of the literature (MEDLINE) starting from 1980 with the keywords quoted below has been performed. Then, due to the need for tackling (or, at least, listing) a wide range of subjets — from the organisation of the internal space in the institutional setting, to the interpersonal aspects and the use of psychotropic drugs — we referred to other various sources of information. Results and conclusions - Reflections on care needs of elderly demented people identify, first of all, a priority: in psychogeriatrics, more studies on services are needed. Secondly, the crucial role of the interpersonal domain and of the spatial organisation comes up. Finally, it is clear that the valuable anti-institutional strategies and culture produced by the social psychiatry need, for psychogeriatrics, to be reframed especially regarding the value of the autonomy of the patient (vs the dignity of disability), of his/her involvement in an active life (vs the «respect of apathy») and his/her re-socialisation (vs a different balance between stimulation and protection).

Riassunto

Scopo - Data la mancanza di una tradizione e di studi o riflessioni sistematiche sul problema dell'assistenza ai pazienti dementi, ed in considerazione delle numerose esperienze avviate anche in Italia per esplorare modi innovativi di assistenza agli anziani affetti da demenza, abbiamo ritenuto interessante formulare alcune riflessioni sull'argomento. Il vero obiettivo di queste riflessioni è in realtà quello di iniziare, e sollecitare, un discorso sulla valutazione dei servizi psicogeriatrici. Metodo - È stata condotta una ricerca su MEDLINE a partire dal 1980, utilizzando le parole chiave qui riportate. Data la necessità di affrontare (o, se non altro, elencare) un ampio spettro di argomenti, che va dal ruolo giocato dalla distribuzione degli spazi interni nelle istituzioni, agli aspetti relazionali o agli psicofarmaci, abbiamo integrato la ricerca bibliografica attingendo da altre fonti molto diversificate. Risultati e conclusioni - La riflessione sui bisogni assistenziali degli anziani dementi suggerisce prima di tutto la necessità di impiegare il metodo epidemiologico anche per la descrizione e la valutazione dei servizi, e degli «stili assistenziali», dove il termine assistenza è da intendersi nell'accezione più comprensiva di health care. In secondo luogo, emerge l'importanza degli aspetti relazionali, di accoglimento e, per i pazienti istituzionalizzati, della distribuzione degli spazi interni e, ancora, la necessità che argomenti tanto (apparentemente) disparati trovino sintesi ed ospitalita in riviste lette da chi si occupa di assistenza. Infine, è evidente che la preziosa cultura anti-istituzionale prodotta dalla psichiatria sociale richiede, in psicogeriatria, una revisione che individui i punti di adesione e di distanza da strategic fondate sull'affermazione dell'autonomia del paziente (vs la dignità della disabilita), sul suo coinvolgimento in una vita più attiva (vs il «rispetto dell'apatia») e sul suo recupero alia vita sociale (vs nuove forme di equilibrio tra stimolazione e protezione).

Keywords

demenzamalattia di Alzheimerassistenzaserviziunità specialidementiaAlzheimer's diseasehealth careservicesspecial units
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 3 , Issue 3 , December 1994 , pp. 171 - 179
Copyright
Copyright © Cambridge University Press 1994

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