[From psychiatric care to psychic care, for an ethic of restraint]. / Du soin psychiatrique au soin psychique, pour une éthique de la retenue.

This analysis of the ethical issues raised by the relationship between caregiver and patient is based on the history of psychiatry and sensitivity to the ethical tensions that run through the field of psychiatry and mental health. Taking a step back from the injunction to treat well, not fetishizing it, adopting a holistic approach, equipping ourselves to counter the stigmatization and self-stigmatization that so often accompany psychic and/or psychosocial disability, and inviting reflection on proportionality in mental health are all ethical priorities that are insufficiently invested in psychiatric clinics.

[Care pathways, care of the pathway: the underside of a debate]. / Parcours de soins, soins du parcours : les dessous d'un débat.

The coordinated care pathway consists of entrusting the attending physician with the coordination of care of the patient for the realization of medical follow-up with the ethical concern of a responsible consultation of the caregivers. This, so that medical practices and care devices are turned towards efficient care but also integrative, a qualitative search for life combining continuity of care and promotion of global health. This evolution towards greater respect for patients' rights requires that decisions taken be intelligently regulated in a context where caregiving interventions are still very prevalent and potentially intrusive in regard to the privacy of the persons being cared for.

[The right of elderly people in old people's homes to have a fulfilling emotional and sexual life]. / Du droit des personnes âgées en Ehpad à avoir une vie affective et sexuelle épanouie.

The sexual life of elderly people living in residential institutions for the dependent elderly (Ehpad) is a sensitive subject that is rarely discussed. Particular difficulties sometimes arise when they have cognitive problems. Affectivity and sexuality in old people's homes must be approached with tact and maturity by the carers. Sexuality belongs to private life, but its excesses are difficult to reconcile with collective life. Some proposals can be made on ethical issues and on the relationship with residents and their families.

[The expectations of families in Ehpad]. / Les attentes des famillesen Ehpad.

Taking into account the needs and expectations of families in residential care facilities for the dependent elderly (Ehpad) leads to their satisfaction with the care given to their institutionalized relative. A relational charter participate to prevent conflicts and misunderstandings between the various formal (caregivers) and informal (families) care providers at the bedside of residents. Families must feel invited to the Ehpad and recognized in their place in their role of care, at least relational. Some families, however, remain firmly anchored in an irrefragable hostility. Solidarity in the teams and the robustness of the care project are essential here.

[In old people's homes, carers face Covid-19]. / En Ehpad, les soignants face à la Covid-19.

Many ethical issues were raised by the pandemic crisis. Caregivers were under great pressure and stress in their work in residential care facilities for the dependent elderly (Ehpad), both with residents and their families. The implementation of ethical support tools was only gradual, particularly for the management of residents' deaths. Anxiety has set in among all the people working or living in the Ehpad, blurring interpersonal relations and increasing tensions and professional exhaustion.

[Dignity and access to care in psychiatry]. / Dignité et accès aux soins en psychiatrie.

The notion of dignity is not synonymous with autonomous freedom (autonorma). It has an objective dimension, which is based on the individual's belonging to humanity. This is often neglected in psychiatry, even though it is what leads to the universal prevailing over singular preferences when a value specific to the human condition and to the suffering that inhabits it is at stake. To be of this universality while being a clinic of singularity representes the nobility of psychiatry and its vocation to make mental health live.

[Sexual abuse in elderly]. / Les violences sexuelles faites aux personnes âgées.

Seniors at home and in institutions can be victims of sexual abuse. Older women are more often victims than men. Sexual violence is often accompanied by physical violence and theft of property. More often than among the youngest, the crime is passed over in silence with the authorities. The consequences of the assault are serious, especially when there is cognitive impairment in the victim.

[Cognitive aging apart from dementia]. / Le vieillissement cognitif en dehors de la démence.

Cognitive aging apart dementia results from different genetic programming, different according to individuals. The aging of the various cognitive and very heterogeneous cognitive functions largely depends on the life course of each person. Social factors, in particular the environment in which a person lives, may or may not accelerate the processes of cognitive aging. The slower processing speeds of information from the environment, practical or strategic new acquisitions, and the difficult management of multiple tasks, reflect an age-related hypofrontality. Physical and mental health, social and relational well-being participate in good cognitive aging. Exploration of the different facets of cognitive aging shows its complexity.

[Covid-19 infectious disease is also a psychogeriatric disease]. / L'infection à Covid-19 est aussi une maladie psychogériatrique.

Severe forms of Covid-19 infectious disease often affect the frail elderly. They can induce inaugural psychiatric manifestations or aggravate the underlying psychiatric pathologies. Some of these pathologies persist after the acute episode and require specific management. Doctors and caregivers involved in the care of infected patients are themselves exposed to psychological and even psychiatric difficulties and are looking for collaborative help complementing actions in the somatic care sectors.

[Consent in mental health, between semiotic object and figure of psychiatric care]. / Le consentement en santé mentale, entre objet sémiotique et figure du soin psychiatrique.

Working on the question of consent in psychiatry means studying closely the word given by a patient, who, before being mentally ill, is a person with a real human value. It is a question of eliciting consent, of seeking it tirelessly rather than demanding it, so that it never becomes a procedure imposed by the fact of setting a purely formal condition, at the risk of otherwise abandoning it to the power of the psychiatric doctor. This is all the more important as the criterion of free care, including today both free hospitalization and freely deployed outpatient care, remains as an essential benchmark of the therapeutic alliance, the consent of the patient.

[From the person receiving care to the subject of care: the I-you relationship in psychiatry]. / De la personne faisant l'objet de soins au sujet de soins : la relation je-tu en psychiatrie.

The subjective recognition by those involved in care, of people with psychiatric disorders, is not self-evident. Caregivers, in the general sense of the term, often find it difficult to recognise the personal freedom and dignity of psychiatric patients. Care is, however, inseparable from the relationship of trust and the mobilisation of the patient's ability to freely express choices and to participate in decisions concerning him; a central ability in the caregiver-patient relationship. Although the objectives of access to care and protection of the patient's rights are clearly stated, the question of the mental patient's freedom of choice, as well as his inner moral freedom, remains open to question, as does the questioning of these same freedoms among care providers.

[Psychogeriatry in the epidemic context]. / La psychogériatrie dans le contexte épidémique.

The development of the coronavirus epidemic is disrupting the organization of medical units and increasing the burden of care for nursing staff. Care facilities for the elderly are particularly exposed. Staff express legitimate fears about this, especially since they are particularly at risk of contracting the virus. Their elderly residents develop severe forms of the disease. To the anxiety generated by the risk of being contaminated, is added the one linked to the physical distancing of visitors made necessary to protect them.

[Accommodation facility for dependent elderly people, ensuring relational proximity after health emergencies]. / Ehpad, pour la proximité relationnelle après l'urgence sanitaire.

The health emergency linked to Covid-19 has been stressful for staff working in nursing home, and doubly painful for residents faced with the risk of infection and the reality of family separation. We explore in this article some psychological consequences resulting from their experience in the waning health crisis, hoping that the experience gained will allow greater efficiency in the event of a resumption of the pandemic.

[Sexuality in the elderly]. / La sexualité des personnes âgées.

Negative stereotypes are often conveyed in the area of older adults' sexuality. Contrary to popular belief, sexual desire persists in elderly. Sexual activity has a positive impact on psychological well-being but it must be adapted to the elderly body because it can be hindered by somatic pathologies or medications. In this article we emphasize the rights to privacy and to sex life in the elderly.

[Representation of intimacy in aging]. / Représentation de l'intimité au cours du vieillissement.

The elderly person has the right to respect for their dignity and privacy. Society needs to change its perception on various aspects regarding seniors, including sexuality. A reflection and specific trainings for caregivers should be systematic.

[Compassion fatigue and empathetic suffering]. / Souffrance compassionnelle et fatigue d'empathie.

Compassion fatigue and empathetic suffering are terms generally applied to health care providers caring for elderly people. An exhaustion accompanied by acute emotional pain results of tension and preoccupation with the suffering of those being helped. Learning to recognize it and to manage its symptoms is the first step toward healing. Compassion is an important care index and a professionalism marker.

[Issues of the delisting of anti-Alzheimer's drugs in France: between the law and ethics]. / Questions posées par le déremboursement des médicaments de la maladie d'Alzheimer : entre droit et éthique.

Going back to the delisting of drugs for Alzheimer's disease under the double prism of the jurisprudence of the State Council and from a sidestep of ethics is a requirement about the persistence of still passionate debates: the patients and their families feel abandoned, practitioners in the field distraught, and learned societies alarming the public authorities and their instances without any response to date. How the only drugs available, in responder patients, to slow down the inexorable progression of Alzheimer's disease, can finally be defunded, after three Superior Health Authority reassessments (2007, 2011, 2016) and therefore virtually removed from the therapeutic panel of physicians, while their beneficial effects, although modest on cognition, remained very actual on other symptoms such as apathy or hallucinations? How can this decision not to be understood as a signal of a disengagement from the state? How to maintain the trusting relationships between the patients, their families and caregivers, made of worry and patience?

[Precariousness, dignity, access to care]. / Précarité, dignité, accès aux soins.

Social and medical precariousness is frequent among the elderly. It is more pronounced in some marginal or migrant populations. Difficulties in accessing care may be linked to the inability to communicate via the French language. It is possible to recall the principles of French law that are the foundations of human dignity.

[Seniors' precariousness, social factors hindering access to care]. / Facteurs sociaux entravant l'accès aux soins des aînés.

The precarity of the elderly is a threat that becomes more and more consistent when diseases, disabilities and handicaps become established. Access to care becomes an imperative. The difficulties of implementing palliative and support measures lead to growing precariousness. Their defects have serious consequences for the quality of life of the elderly, and disturb them in the intersubjective and subjective domains, particularly on the most vulnerable person's affects. We analyze in this paper the mechanisms underlying precariousness, and we propose preventive and palliative measures using semiotic analysis.

[Understanding the suffering of the elderly]. / Appréhension de la souffrance des aînés.

Alzheimer's disease is an organic disease of the brain affecting mainly elderly people. Drawing on patients' imaginations on a daily basis or art therapy allow them, despite the cognitive impairments, to construct symbolic objects, analogues, to help give back meaning to their life. If the use of symbolisation when evoking the real object is not possible, the meaning is therefore constructed using the figurative dimension, an analogue substituting the lost and absent object, too painful to evoke again.