title: [Patients with severe dementia living at home].
abstract: Few studies have been devoted to patients with severe dementia living at home. Therefore their rate is difficult to evaluate, and their conditions too heterogeneous to allow a standard management. In these patients, suffering from severe cognitive deficits and psychobehavioral disturbances, interfering pathologies may alter the course of the disease. Environment must be adapted to ensure security, sustain perceptual and physical activity and back up space and time orientation. The role of the main caregiver is crucial for the psychological and physical support of the patient. Thus, he/she must be sustained by giving information about the disease and available practical and financial support, and by listening to his/her suffering. Consequently, the general practitioner is involved not only in medical decisions but also in family support. Too often, the general practitioner is alone to face complex and time-consuming situations. However, the setting of geriatric networks should allow him/her to be included in the elaboration of a global care project with nurses and physiotherapists. Nevertheless, various factors, such as caregivers' exhaustion, major behavioral disorders, or the end of life when coping with pain becomes a priority, can eventually make necessary the patient's transfer into a geriatric facility.
authors.affiliation: Clinique médicale de la Porte Verte, Versailles, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Méret
authors.forename: Marie
authors.initials: M
authors.lastname: Floccia
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000451:nursing* / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D003072:Cognition Disorders / Q000451:nursing / Q000523:psychology; D004552:Elder Abuse / Q000517:prevention & control / Q000523:psychology; D006701:Home Nursing / Q000523:psychology; D006801:Humans; D001523:Mental Disorders / Q000451:nursing / Q000523:psychology; D010348:Patient Care Team; D012307:Risk Factors; D012944:Social Support