title: [Refusal of application to care in Alzheimer's disease and related diseases: establishment of a mobile unit hospital extra].
abstract: Refusal of care and support in these patients with Alzheimer's disease and related illnesses at home is a cause of accelerated loss of autonomy and increases the risk of a crisis with early institutionalization. Factors contributing to the denial of care are poorly understood and very few epidemiological data exist.
  
  
  METHODS
  we compared age, diagnosis, level of severity of the disease, the type of behavioral, family status of 101 patients living in denial of care and support as seen by a mobile home (group UPEPc) to 136 control patients seen at the memory clinic (group CM). Patients living in denial of care appear to significantly low age [82/80.5, p<0.0001], with more advanced disease [average MMSE 18/22, p<0.0001], the presence family conflicts and behavioral disorders [delirious--hallucination, agitation--aggression, depression, apathy, p<0.05].
  
  
  CONCLUSIONS
  the profile of patients refusing home care is specific and it is important to educate GPs conditions that favor an obstacle to medicalization. The advantage of a mobile extramural to analyze risk factors for refusal of care and propose alternatives should be further investigated.
authors.affiliation: CM2R, CHU de Saint-Étienne, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Collignon
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rouch
authors.forename: Régis
authors.initials: R
authors.lastname: Gonthier
authors.forename: Aude
authors.initials: A
authors.lastname: Corbin-Seguin
authors.forename: Lorraine
authors.initials: L
authors.lastname: Combe
authors.forename: Béatrice
authors.initials: B
authors.lastname: Trombert-Paviot
authors.forename: Bernard
authors.initials: B
authors.lastname: Laurent
authors.forename: Chantal
authors.initials: C
authors.lastname: Girtanner
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis; D057565:Apathy; D006801:Humans; D007326:Institutionalization; D008952:Mobile Health Units; D011595:Psychomotor Agitation
keywords: Alzheimer's disease; dementia symptoms psychobehavioural; descriptive study; home; refusal of treatment