How to facilitate the orientation of elderly subjects with psychical disabilities to a health alternative to hospitalization?

Process of Deinstitutionalization of Aging Individuals With Severe and Disabling Mental Disorders: A Review

“…While the constant increase in the population of APSDMHD is a major public health issue ( 14 , 16 , 21 – 24 ), the number of studies on the deinstitutionalization process toward this population (83 articles) seems very limited ( 8 , 14 , 25 , 26 ). This paucity of data seems to be primarily related to the population concerned.…”

“…In addition, the literature focusing on economic dynamics emphasizes (but is not evidence-based) that despite the proven effectiveness of community-based care for APSDMHD ( 9 ), community-based care could reduce unnecessary costs by being more efficient, better organized, identified, and visible ( 47 , 51 , 52 ). This is to limit costly recourse to hospitalization ( 39 ), rehospitalization ( 21 , 30 , 35 ), or placement in retirement homes ( 8 , 12 , 21 , 34 ). These publications do not however provide precise figures.…”

“…Nowadays, it seems that aging people with severe and disabling mental health disorders who are hospitalized for long periods of time (APSDMHD-H) do not fully benefit from this mechanism ( 8 , 11 , 12 ). Yet, the numerical importance of this population ( 13 , 14 ), the difficulty of institutions to provide an appropriate ambulatory care setting for these individuals ( 15 – 17 ), or the little emergence of new knowledges in this field ( 18 ) shows today the need and urgency to conduct extensive research work in this specific field.…”

The French Integrative Psychosocial Rehabilitation Assessment for Complex Situations (FIPRACS): Modelization of an Adapted Assessment Method Toward Long-Term Psychiatric Inpatients With Disabling, Severe and Persistent Mental Illness

“…LTHIDSPMI) who have been influenced by the iatrogenic consequences of institutionalization. Indeed, given that institutionalized subjects tend to present adaptive processes that are highly inferior to their actual abilities, the practitioners in the field inherently influenced by their specific professional representations may thus underestimate the competencies of certain individuals or subsets of the population (15)(16)(17). The completion of the FIPRACS can hence represent a tool allowing better equity in psychosocial rehabilitation support.…”

“…In some institutions, some inpatients can also be pressured by teams to engage in a deinstitutionalization program where the supported accommodation could not be adjusted to their psychoaffective symptoms, their desires/expectations, and their neurocognitive potentials. Finally, certain patients such as the aged-LTHIDSPMI can be victims of stigmatization and excluded from deinstitutionalization programs (15)(16)(17).…”