Titre provenant de l'écran-titre

Ecole(s) Doctorale(s) : École doctorale Sciences de l'éducation, psychologie, information et communication (Lyon)

Partenaire(s) de recherche : Laboratoire Science, Santé, Individu. SIS (Equipe de recherche)

Autre(s) contribution(s) : Lydia Fernandez (Président du jury) ; Isabelle Varescon, Marc Verny, Alain Sagne, Isabelle Boulze (Membre(s) du jury) ; Isabelle Varescon (Rapporteur(s))

Accès réservé aux utilisateurs Lyon 2

Thèse de doctorat Psychologie Lyon 2 2015

Aborder puis accompagner dans les soins des sujets âgés en difficulté avec l'adolescent complexe pour tout soignant : infirmier ou médecin. le maintien d'une prévalence élevée du mésusage d'alcool chez les aînés, associée au vieillissement en cours de la population rendent cette question de plus en plus fréquenté à l'höpital et en établissement d'hébergement pour personnes âgées.le mésusage d'alcool est peu abordé chez les sujets âgés, peut-être moins car il est rare ou difficile à repérer, mais surtout par dénégation des troubles et contre-attitudes soignantes envers ces ainés. afin d'éviter l'âgisme et le rejet des ainés en difficultés avec l'alcool, les attitudes soignantes peuvent être prises en considération. pour cela, une étude d'observation descriptive sera menée en trois chapitres :- etude exploratoire auprès de sujets âgés en difficultés avec l'alcool : décrire les attitudes des soignants.- enquête auprès d'environ 750 soignants (625 infirmiers et 130 médecins de 8 hôpitaux à propos de leurs ressentis, attitudes et habitudes de soins avec des sujets âgés en difficulté avec l'alcool.- etude complémentaire par des entretiens directs d'un échantillon représentatif de soignants.sur ces bases, une réflexion théorique sera conduite autour de la vieillesse, du mésusage d'alcool et des représentations ou croyances des soignants, dans la perspective d'identifier des marqueurs ou facteurs d'attitudes positives et envisager des propositions de recours en prévention de contre-attitudes.

Introduction: Old age and alcohol misuse are only rarely considered together. While the prevalence of alcohol use disorder is located around 10% in the over 65 age bracket and while such situations are encountered daily by hospital or nursing-home caregivers, these elderly people suffering from alcohol misuse are often overlooked. Is it possible to consider this apparent neglect as a translation of negative counter-attitudes on the caregivers’ part?Methods: Two cross-sectional surveys, by means of questionnaires then by research interviews, were conducted among 582 nurses and 116 physicians working in 8 health facilities around Macon. The main objective was to approach the feelings, beliefs and attitudes of caregivers with older individuals who misuse alcohol. These variables were observed according to several socio-professional criteria and to the care provider’s level of knowledge in alcohology. The interviews were recorded and the dialogue was processed by Alceste® software.Results: The 315 completed questionnaires (response rate: 45%) of whom 81% were nurses and 19% physicians and of this number 84% were women. More than nine out of ten agents report meeting elderly alcohol misusers and this number is estimated at 12% of those cared for. The feelings then declared by the care-givers were shared out over 75% to listening or availability, 39% to aid or demonstration of skill, 32% to malaise, weakness or avoidance and 7% to aggression, repression or moralizing. Among the reasons which could oppose the development of appropriate care, only appear lack of training or lack of time. Correlations were objectified between positive attitudes and high level of knowledge, having had a life experience close to a familiar person misusing alcohol or to be himself an alcohol consumer. The 45 research interviews were conducted with 16 physicians and 29 nurses, of whom 69% were women. Discourses analysis has highlighted some specific extracts out of them: a less threatening perception of alcoholized elderly individual, the use of humor appearing specifically when alcohol is mentioned and questioning lack of time or training. The interviews allowed the highlighting of negative feelings and emotions and also emphasized the important role and the favorable impact of familiar experiences with sufferers of alcohol misuse in the life of the care provider.Discussion: Despite the limitations of non-validated questionnaires and the lack of focus groups, these two complementary studies confirm the significant frequency with which caregivers come into care situations with elderly individuals misusing alcohol. This point calls into question the ignorance which surrounds these situations which helps us to better understand their negligence and which may explain the small percentage of skilled addictological help given to the elderly person after early screening. The frequent allegation of lack of time or knowledge (and training) seems to be contradicted during the interviews by levels of knowledge that appear to be good. These claims can be caregivers’ defensive rationalizations concerning situations experienced as difficult. The question of denial may be considered in the same way: often referred to without being wary of its repercussion. Computerized speech analysis has led to crosschecking, studied in the light of several theories about narcissistic identification, dissimilarity / similarity, empathy or attachment.Conclusion: Caregivers’ attitudes about the elderly misusing alcohol appear to be variable, multifaceted, complex, according to the modes of observation, being neither good nor bad. Beyond the phenomenology of attitude, there is the consideration of internal elements of the caregivers’ thinking and those cared for which undergird care providers’ behavior. This approach seeks to promote a psychodynamic regard on the elderly who misuse alcohol trough the care-givers approach.

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