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Perte d'autonomie des personnes âgées
Courses of Geriatrics


Ageing, handicap, autonomy and dependence:

The dependence is not a devalued state but a function which varies throughout our life.

It gives place to constant refittings.

Theoretical framework of WHO:


a) Deficiency:

Translated the existence of a physical, psychic or sensory disturbance compared to the biomedical standards.

Person in charge for a reduction in the functions.

b) Incapacity:

It measures the importance of the disturbance.

c) the handicap:

It measures how the incapacity is compensated or not. These concepts make it possible to define the physical dependence.

From Latin “dependere comes”: to be suspended with something.

The concept of dependence physical implies the incapacity to achieve without the assistance of a third person three acts of the everyday life.

One can also define an emotional dependence.

Within the framework of normality, it can get along like a need to communicate and a refusal of loneliness.

One also speaks about psychological dependence: incapacity to control oneself.

There is also often an economic dependence.

All these forms of dependence imply the intervention of a third.


Capacity of an individual to control itself; including managing its dependence.

It is an independence compared to a decision, and not compared to means.

It is to be opposed to heteronomy: another person manages what arrives, without referring about it to the needs and desires of the person concerned.

It is the law of others.

One measures the degree of autonomy using scales:

• Motor activity

• Relational Life

• Nursing

• Psychic State

• Emotional Life

• Emotional Life

Physiological ageing is responsible for a fall of the performances of the various bodies.

It does not involve a fall of the functions being able to be responsible for a physical dependence.

The physical dependence is the consequence of diseases whose frequency increases with the age.

It is more difficult to adapt to a brutal modification of its capacities than to their progressive reduction.

The psychic dependence returns to a loss of autonomy imposed of outside for good reasons that the patient does not measure completely or any more.

That poses problems deontologic.

The attitude of looking after will be determining in the maintenance of a certain degree of autonomy.

The sexuality of the old people:

Old age is associated the fall of all the powers:

• Physical

• Mental

• Social

• Sexual In any event, lowers power does not mean impotence.

Sexuality does not indicate only the activities and the pleasure which depend on the operation of the genital apparatus, but a whole series of excitations and activities present as of the childhood, which presents an irreducible pleasure at the satisfaction of a fundamental physiological need and which is found as component in the form known as “normal” of the sexual love. (Laplanche and Fontalis: dictionary of the psychoanalysis)

The psychoanalysis uses also the concept of impulse:

• Life instinct: Eros

• Death instinct: Thanatos

Sexuality can be intended like the expression of an internal impulse to appease.

has) At the woman:

Physiological ageing does not involve modifications likely to block the sexual intercourse and to prevent from reaching the orgasm.

The menopause decreases secretions ovariennes and can involve:

• Of the urinary disorders: cause painful reports/ratios.

Easy to cure it

• A bad vaginal lubrication

The menopause can involve, because of incapacity to give birth to, can generate psychic disturbances:

• Reached image of oneself

• Intensification of the desires

b) At the man:

The changes are more numerous from the point of view of the sexual activity.

The reduction in the hormones is translated by a slower erection to come and on a later ejaculation.

There are also problems of prostate which have psychological repercussions.

c) Shortage of the male partners:

d) The disease can influence the sexual behavior:

The refusal of the sexuality of the old people belongs to a cultural stereotype.

The old people are perceived like ugly, sick, impotent.

The sexuality of the old men is accepted better than that of the old women.

One sees the old people like our parents.

Their to imagine a sexuality is unbearable for us.

Regressed sexual behaviors:

• Food

• Relational Greed

• Somatic Complaints calling palpation

• Pleasure around the anal zone

• More or less controlled Exhibitionnisme: possibly search of identity

• Sublimation of sexual behaviors: expression of desires and impulses on an intellectualized mode

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