Le centre de jour interne d’un service de gérontologie

Abstract

In this article is reported the experience of a Gerontology department in the treatment of psychological and behavioral disorders, by means of an internal day care center. Historically, the creation of a day care center, within the Gerontology departement of the Bicêtre hospital (France), was the result of a reflection and experiences carried out for several years, about the difficult care of inpatients with psychological and behavioral disorders. The project was designed to meet the need of creating a place where these disorders might be more completely understood and treated. Given the previous experiences in this department and in others, the day care center had to reach several aims: • to be comforting and to allow affective relations, pleasure and meaning; • to protect and give the desire of being; • to enable analysis and care of behavioral disorders; • to keep or better the cognitive state; • to strengthen the autonomy; • to propose individual care; • to reduce the use of psychotropic medications. The main indications of the day care center are the psychological and behavioral disorders in dementia; these disorders are bound directly to dementia or are symptoms of anxiety, depression or delusion. Limits are imposed by the patient condition, particularly if there is a very severe cognitive impairment, an apathy or certain personality disorders. In the day care center, several therapeutic approaches may be gathered: • psychotherapy techniques individually or in a group; • re-education or re-learning of cognitive functions that is rather a play activity than a school class; • social activities : meetings, meals, outside visits; • body care : massage, relaxation, esthetics; • work therapy, artistic activities : music, cooking… Whatever kind of therapy is used, the affective dimension is the most important. A study of the effectiveness of the day care center had been carried out during the first year of activity (2000–2001). Twenty one patients had been included and they had stayed in the center for six months on average; 11 with Alzheimer dementia, 2 vascular dementia, 2 fronto-temporal dementia, 3 with old psychiatric pathologies and 3 somatic pathologies. The patients state had been assessed by several scales: Mini Mental State Examination, Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression, Activities of Daily Living, Instrumental Activities of Daily Living. The findings of the study were that the condition of certain patients was clearly bettered by the stay in the day care center; these patients had a mild or average cognitive impairment (MMS > 10) or were depressed (Cornell > 10). But the assessment of severe dementia is very difficult, and some psychological improvements in the condition of these patients can't be taken into account by scales. Thus, this day center can take care of many patients including those with severe cognitive impairment and associated disorders; in addition, it must play a role of observation, analysis and research in order to optimize care in the whole department.