Vivre et vieillir à domicile, entre risques vitaux et menaces existentielles

Abstract

-Vivre seule avec d'importantes limites fonctionnelles amène la personne âgée à s'organiser-pratiquement et mentalement-pour se ménager une vie quotidienne en accord avec ses souhaits. Les efforts sont continus, autant pour juguler la douleur physique que pour faire face à la solitude et à la finitude. Cet article s'appuie sur 20 entretiens menés avec des personnes de plus de 80 ans domiciliées dans le canton de Vaud (Suisse) et bénéficiant des services d'aide et de soins à domicile. Les situations concrètes donnent à voir ce que l'« habiter et vieillir » seule à domicile suppose de ressources fonctionnelles et d'astuces, de stratégies pratiques et de raisonnements intimes. En filigrane, les récits évoquent la solitude et l'intégration de la finitude. Les considérations développées sont abordées sous deux angles : la vie qui se déploie entre ses « quatre murs », et habiter son environnement « hors de ses murs ». Nous posons une distinction entre risques vitaux et menaces existentielles et observons que la prévention des premiers est subordonnée au souci de maintenir à l'écart les secondes. La démarche d'enquête inspirée de l'« entretien d'explicitation » ouvre des perspectives de renouvellement du regard pour les soins et l'aide à domicile.

Volition to risk taking in the ordinary activities of daily life of older people living at home alone. A study using explicitation interviews

“…This study aims to explore how OP think about risks throughout their actions and how they manage the concomitant risks that may affect their activities of daily living and their quality of life. The OPs in our study described undertaking activities and taskrelated choices which, even if they were hazardous, seemed to always have underlying motivations rooted in a set of values, such as self-determination (maintaining a sense of control over one's own existence), competence (personal causation, ithat is, a sense of personal capacity and self-efficacy), and identity congruence ('who I am' in my particular life story) (Dale et al, 2012;Ekelund et al, 2014;Piguet et al, 2017;Ryan & Deci, 2000). Our analysis leads us to suggest that if one wishes to remain consistent with one's values, one cannot avoid taking risks -or accepting that one is at risk.…”

“…Risk taking seemed to be closely associated with OP's intimate will to maintain their personal trajectories. Our analysis led us to take into consideration the importance of the motives for action, including the values that appeared to be existential in nature, that is, those which threatened the identity of the self (Piette, 2014;Piguet et al, 2017). It was indeed through this concrete and direct confrontation with reality, and through the act of verbalising what they paid the most attention to, that the participants narrate and illuminated their volitional dimension.…”

“…The challenge that a 98-year-old woman set for herself as she opted for a shortcut instead of staying on the path, as she said to herself, 'Try it again', lets us perceive the two-sided nature of risk: the simultaneous awareness of the actual danger of an action and the pleasure of enjoying the moment as long as you can, knowing that you have the power to decide to give it up. Thus, the 'objective' risks that can be observed and appreciated and that are part of people's daily lives seem to be underpinned by these existential threats (Piguet et al, 2017).…”

“…A large part of the literature underlines the essential and unique place of risk in human life and the positive effects that risk taking and risky behaviour can have in one's life in terms of personal self-development and self-esteem. Thus, many studies show that risks -in the form of exposure to risk, risk-taking or the prevention of risk -play an important role in maintaining meaningful activities, routines and identity (Kaliniecka & Shawe-Taylor, 2008;Laliberte Rudman et al, 2010;Peterson et al, 2010;Piguet et al, 2017). In their study on stroke survivors, Alaszewski and colleagues observed that voluntary risk-taking may be understood as an opportunity to re-establish stroke survivors' social standing (Alaszewski et al, 2006).…”

Explicitation Interview: A Method for Collecting First Person Perspectives on Living Alone in Old Age

“…Based on these findings, we subsequently undertook further research aimed at discovering the implicit logic behind the choices made by OAs living at home alone and subject to health problems during their lived experiences and their daily risk-taking (Piguet, Droz-Mendelzweig, & Bedin, 2017). Furthermore, we purposefully strengthened our comprehensive approach by adopting an ethnographic, existential anthropology approach (Piette, 2014).…”