• oral stage,
• pharyngeal phase,
• esophageal phase.

Oral Phase:
Properly: Formation of food bolus by chewing. The tongue and palate push the bolus towards the back of the mouth.

Pharyngeal phase:
Properly: swallowing reflex, lowering the epiglottis, pharynx closure, the passage of bolus into esophagus.
Incorrectly: Reflex swallowing delayed or absent, risk of aspiration, airway closure is not assured.
Esophageal phase:
Properly: Phase entirely reflex, it is a final phase of swallowing.
Incorrectly: The food particles that have not been evacuated during swallowing can be inhaled during inspiration.
Swallowing disorder = wrong
Responsible for complications:

• broncho-pulmonary complications,
• Undernutrition progressive
• asphyxiation in cases of obstruction.

Epidemiology:
¼ Meadows residents of a unit of long-term care suffer from these disorders to varying degrees,
Their frequency is related pathologies:
cerebro-vascular
dementia.
Abnormal swallowing several times:
Time to oral feeding (food reflex) of the available therapeutic
difficulty chewing (edentulous, denture inappropriate, fungus, irritation, …)
retention intraoral food (decreased salivation). Saliva lubricates the food bolus.
Pharyngeal Time: ALERT! (Involuntary reflex =)
swallowing cough = => frequent bronchitis, asthma postprandial.
Aggravating
The polypharmacy increases the oral dryness,
As a result the elderly often choose home less food or liquid:
nutrient imbalance,
gradual weakening.
Preventing False roads:
Ensure good oral,
Adapting hydration and nutrition by disorder,
Installing the correct person
Managing the meal
Negotiate with the medical treatment.


Project Team:
Ensure good oral:

• fight against dry mouth,
• hygiene and dental prostheses,
• detect and report any glossitis or gingivitis
• monitor tooth.

Adapter hydration and feeding disorders in the elderly:

• seek a dietician,
• train health care providers to report to the physician any coughing during the ingestion of solid or liquid
• adapting the feeding method: Move to cut the solid end to semi-liquid and knowledge to make the opposite
• promote smooth textures,
  homogeneous, pasty,
• avoid substances that crumble,
• replace fluids by drinking water or gelled.

Properly install the elderly:

• put the patient in sitting or reclining,
• keep your head up, torso leaning slightly forward,
• sit in front of the person in power,
• if total aid, take the time needed.

Manage the meal:

• can serve as a meal in the dining room, which allows stimulation of behavior and better monitoring,
• serve a dish after another
• add the sauce to dry food
• revive gestures
• stimulate chewing and swallowing,
• do u drink and eat in small quantities,
• stimulate swallowing by placing the food in the middle of the tongue,
• observe and analyze the behavior for readjustment.

Negotiate with the medical form and administration of medicines:
refer to specific courses.
Support often in emergency:

• Dental Implants withdrawn
• oral cavity disengaged with fingers hooked,
• Suction airway if swallowed important.

Results of actions:

• obstructive material are expelled,
• The skin is recolorent,
• The agitation is reduced.

In case of failure: practice the Heimlich maneuver as many times as necessary.
If failure of the maneuver:

• cerebral oxygenation,
• anguage maintained by a Guedel airway, the patient is placed supine lateral.
• other functions are monitored:
  • heart rate,
  • blood pressure,
  • consciousness.

Support for indirect effects:

• The occurrence of broncho-pneumonia acute or recurrent,
• The gradual onset of malnutrition …

Pathological aging:
The musculoskeletal system (bones, muscles, joints):
Bones #: 2 types of cells
osteoblasts (bone building)
osteoclasts (bone destroying)
From 20 years age in a loss of bone mass (about 0.5% per year).


Osteoporosis is related to the decrease in frame protein of bones (causing vertebral compression fractures, fractures of the femoral neck, wrists, …)
# Joints: to destroy due to aging U osteoarthritis causes pain, functional impairments, deformities.
The best prevention is to monitor weight, remedy the problem of bone by physical therapy in relieving or pain (s), replacement of bone (osteoplasty).
# Muscles: there is loss of muscle mass.
The nervous system:
There is a decrease in cerebral performance (difficulty of setting new situation, loss of memory, encoding, delay in the execution of actions, …)


Pathologies: Mental confusion, dementia, (eg Alzheimer’s disease), depression, Parkinson’s disease, rigidity, tremor syndrome shift (48 hours evolving source of 90% of deaths), acute regression syndrome, …
senses:
O Hearing: loss of hearing, presbycusis.
N view: presbyopia, glaucoma (high blood pressure in the eye), cataract, AMD (Macular Degeneration Linked to Age), retinopathy (secondary diabetes).
- Taste does not change with age.
Smell: a little lost with age.
I touch: becoming very important with age and changes a little.
Cardiovascular:
There is risk or onset of hypertension, arteriosclerosis, cardiac arrhythmias, heart failure.
Respiratory:
There is a loss of breathing capacity, risk of chronic bronchitis.
renal Camera:
There are fewer nephrons, the risk of dehydration, drugs are toxic to benefit the body.
Gastrointestinal:
There is a risk of stomach ulcers, decreased pancreatic function.
glandular system:
The thyroid is sensitive to aging (hypothyroidism and hyperthyroidism).
hematopoietic Camera
Appearance of refractory anemia, chronic lymphocytic leukemia (for spontaneous evolution).
Urogenital
In women:
Ménaupose (sterility, stopping hormonal secretions),
No rule,
Flushing,
Depressive state,
Loss of feminization (hair larger and harder)
Osteoporosis,
Dryness of mucous membranes.
In men:
Prostate problem involving dysuria, urinary frequency of,
Adenoma,
Cancer.
Precipitating causes:
Chutes & # Malay (causes may include: seizures, causes cardiac syncope, orthostatic hypotension or external causes unknown).
# Undernutrition.
# Infections (prevention through immunization against tetanus, influenza cons against the pneumococcus).
# Intoxication with alcohol, drugs, other toxic.
# The social environment of the person.

• Even sick, disabled, vulnerable, dependent, or insane, the person retains its rights and FDI guard duties to her.
• The charter was created in 1987 and amended in 1996.
• The elderly in hospital or institution is able to refer to know and claim their rights.

Contents of charter
1. Lifestyle Choices:
Anyone dependent care freedom to choose their lifestyle.
2. Home & Environment:
The place of living of the dependent elderly, home or personal property, must be chosen by it and adapted to their needs.
3. A social life despite disability:
Anyone dependent must retain the freedom to communicate, move and participate in the life of society.
4. Presence and role of family:
The maintenance of family relationships and friendship networks is essential for the frail elderly.
5. Wealth and income:
Anyone dependent must maintain control of his assets and income available.
6. Enrichment activity:
Anyone dependent should be encouraged to maintain operations.
7. Freedom of conscience and religious practice:
Anyone dependent must participate in religious or philosophical choice.


8. Maintaining independence and preventing:
The prevention of addiction is a necessity for the individual ages.
9. Right Care:
Anyone should be dependent, like any other access to care which would be useful.
10. Qualification of players:
The care required by a dependent elderly person must be provided by trained responders in sufficient numbers.
11. Respect for the end of life:
Care and support must be purchased at the senior end of life and family.
12. a priority and a duty:
The multidisciplinary research on aging and dependency is a priority.
13. Exercise of rights and legal protection of the person:
Any person in a position of dependency must see not only protect his property but also his person.
14. Information, best way to fight against exclusion:
The entire population must be informed of the difficulties experienced by the frail elderly.

Effect of Charter

The first article mentions the notion of risk.
This risk-taking is a sign of vibrant life.
Whose risk taking, and what risk is it?
One of the carer or the elderly?

Respect for Persons
The elderly are entitled to courteous and respectful in tone of voice, not childish, to be dressed with clothes all day, refusing a bath, stay in bed longer, take a nap, stay alone in her room if desired.

Refusal of care
This is sometimes a way of expressing a refusal to grow old, being in an institution or to accept dependency. The refusal is a power struggle between two individuals.

Manifestations of denial of care
Refusal to eat,
Refusal to take medication,
Refusal to wash,
Refusal to leave his room
Refusal to comply with the rules of institutional life and collerctives.

Identifications

• The caregiver
• The timing of care,
• The presentation of carefully
• The design of care
• The process is repeated until the complete understanding of the message hidden behind the refusal.

Caregiver Reactions

• Acceptance,
• Submission
• Refusal.

Attitudes of FDI

• Gauntlet,
• Withdrawal of the act in progress,
• Undertake something else or do anything else

Legal protection
There are 3 types of protection:

• safeguarding justice,
• curatorships
• guardianship.

The protective measures within the law of January 3, 1968 reforming the law of incapacitated adults.

Safeguarding Justice
This is immediate, there are few repercussions on the life of the person it protects the person alleging acts that could have signed and which might be unfavorable, can otnir their development or their cancellation.
It can be taken at the initiative of the physician, the guardianship judge. It may be extended upon application period of 6 months. It ends after a delay of 2 months for the initial declaration.

Curatorship
A person acting on his behalf but with the assistance of his guardian. It is a system board that is providing assistance to the protected person.
Placed under curatorships after an safeguard justice, immediately following a request from Judge guardianship interested by himself, his spouse, his descendants, his siblings, the family Remote, by friends, social workers, by the physician.

Guardianship

The major trust is treated as a minor. He is relieved of the management of its property, acts passed by an adult under guardianship are zero. He has no civil right.

The guardian may be:

• a family member
• advice of family of 4 to 6 members:
  • sets the conditions for maintenance of major protected
  • appoint a guardian and a guardian ad.
• guardian outside (without family), appointed by the judge and chose from a list available from the Public Prosecutor,
• State when the person agrees to be the guardian.

The burden of guardianship:

• The tutor acts instead of major
• The guardian is legally responsible for its management,
• Any person with a mission guardian can request discharge before a period of 5 years.

Mistreatment
This exercise to someone, either actively or by omission of violence that undermine his person, his integrity corporelleet / or psychological, financial security or freedom.

(Hallo Abuse)

Since 1995 he has been creating ALMA is a network of detection and action on elder abuse.
It is an association of retired volunteers and professional sectors: social, medical, legal, whose role is to: prevent, understand and listen, advise and guide.

Form of abuse
Violence of abuse:

# Physical abuse: slapping, smacking, beating, rape, …
# Psychological abuse: coarse language, mental cruelty, threats, …
# Drug abuse: abuse of neuroleptics, deprived of medicine, …
# Violence Citizenship: violation of civil rights, …
# Violence active: Investment authoritarian confinement, bondage …
# Violence passive neglect, abandonment, …

The predisposing factors in institutions
# Lack of staff
# Exhaustion,
# Aggression, violence in the elderly,
# Regulations abusive or absent,
# Alcohol, drugs,
# No team discussions of problems encountered.

Restraints
ANAES publishes a guide to assessment practice in October 2000 which means “to both improve the security of the person without this practice and to minimize the action.” The contention is made on medical prescription. It is substantiated in the patient record.

Repository practice for restraint
The prescription is made after assessing the risk / benefit for the elderly by the multidisciplinary team.
Monitoring is programmed is transcribed in the patient record.
The elderly and the relatives of the elderly are aware of the reasons and goals of contention.

Profile of Persons Abused by ALMA

Mostly female (77%), widow, 75 years or older, isolated, dependent, “owning” property.

Profile of abuser
# Family member,
# Person directly responsible for care to the person,
# Care professionals, home support,
# Person with a history of domestic violence,
# Consumers of alcohol, drugs,
# Person living on a daily, ongoing.

Why so few complaints
Fears:
# Reprisals,
# To be discontinued,
# To be placed in an institution or lose their place,
# Cause a scandal
# Cause a conflict in the family
# Losing relationships.
Perceptions:
# Do not realize the seriousness of their situation,
# Excuse or justify abusive behavior,
# Ignore the possibilities of assistance and redress,
# Feel guilty about their state of dependence,
# Feel powerless
# Believe “have what they deserve.”
The attitudes of those around
# Denies the problem,
# Minimizes the incident giving rise to the complaint,
# Keep the conflict and retaliation,
# Under pressure to conformity,
# Guilty of existence of resource support,
# Feels obliged to confidentiality.

Act and abuse
New Penal Code (1995): Article 226-13 and Article 226-14.

Rules of professional IDE
Article R4312-2 and Article R4312-25.

The charter of the frail elderly
Article XIII & Anyone experiencing dependence should protect not only property but also his person.

Attitudes Caregivers
Reach out to the patient’s needs & reward.
As if we did not understand what the patient wants punishment.
The caregiver who sits reward.
The caregiver who stands punished.

How?
Always wonder about its care practices: these practices, the routine may ultimately deny the older person and turn it into an object of care.

Care practices
To mitigate the risk of abuse establishment of:
# Care Project,
# vocational training
# thinking as a team.

Care Project
These objectives are:

# Give the teams the means to reflect on the care actions underway
# Introduce new measures, tailored to the demand of the elderly.

Thinking and learning
Word of FDI:
# introduction of group of words
# Each caregiver must be able to speak freely.
Training:
# The caregiver will inform and shape new care practices,
# It takes the distance with respect to its business practices,
# The training is a beneficial break.