Près de 80 millions de personnes abusent de l’alcool ou en sont dépendants dans le monde, il s’agit donc d’une préoccupation majeure de santé publique. L’alcoolo-dépendance est une maladie complexe, très hétérogène, dans laquelle sont intriqués des facteurs de risque personnels dont des facteurs génétiques et des facteurs environnementaux. Cette grande hétérogénéité clinique complique les approches thérapeutiques. Y. Le Strat fera le point sur les aspects cliniques de la consommation d’alcool à la lumière des classifications récentes. Le développement de la pharmacologie dans ce domaine a initialement porté sur la prévention ou le traitement du syndrome de sevrage à l’alcool puis sur la réduction de la consommation et du craving, la prévention des rechutes et la prise en charge des troubles psychiatriques associés. Certains pays, dont l’Allemagne, continuent à préconiser l’abstinence complète, d’autres insistent davantage sur la réduction de la consommation et sur des objectifs de soins partagés avec le patient sur cette réduction. Une meilleure connaissance des mécanismes neurobiologiques impliqués dans la dépendance à l’alcool devrait permettre de développer dans un futur proche des thérapeutiques plus ciblées, ce sujet sera développé par M. Hamon. D’ores et déjà, le baclofène a permis de traiter certains patients dépendants, les premiers résultats de l’étude randomisée multicentrique mise en place par les médecins généralistes seront présentés par Ph Jaury (coordonnateur national de l’étude).

This research presents risk factors for abuse and neglect among older adults who accessed health and social service organizations in London, Ontario, 1991. The paper reviews four theoretical perspectives on elder abuse and neglect: the situational model, social exchange theory, symbolic interactionism and a feminist model. Risk factors for physical abuse, chronic verbal abuse, material abuse and neglect were identified for each theoretical model. Each set of risk factors was regressed on each type of abuse in order to determine the efficacy of the theoretical models. The data suggest that the risk factors associated with the situational and feminist model(s) provide the best fit in terms of physical abuse; the symbolic interaction model explains the most variance in chronic verbal abuse; both the symbolic interaction and feminist models explain about the same amount of variance in neglect; and none of the theoretical models adequately explains the variance in material abuse.

Les cliniques « Brown Bag » permettent aux pharmaciens participants de rencontrer les personnes âgées afin d'examiner les médicaments en leur possession et de corriger les situations qui pourraient mener à des réactions toxiques (DRAPEs — drug-related adverse patient events). Cent vingt-trois patients ont été en contact avec 30 pharmaciens lors des cliniques pilotes tenues dans sept communautés de la Colombie-Britannique. En moyenne, chaque patient a apporté plus de neuf médicaments (prescrits ou non-prescrits) et les cliniciens ont identifié 482 problèmes potentiels de médication (les médecins traitants de 39 patients ont été immédiatement contactés). Plus de 80 pour cent des patients ont considéré les cliniques « Brown Bag » comme étant utiles et ont manifesté le désir de participer à nouveau lors de futures cliniques. Les pharmaciens cliniciens, bien qu'en faveur des cliniques, sont cependant réticents à ré-offrir leur services de façon bénévole. Lors des cliniques de rappel conduites de six à 11 mois plus tard, les patients avaient oublié une bonne partie de l'information obtenue lors des premières sessions.

Elder abuse has mainly been studied in the family setting. This research looks at elder abuse in public nursing homes in Quebec. It studies the meaning that middle-management practitioners give to their work. This article shows how the method used to collect the information is directly chosen in regard to epistemological and paradigmatic concerns as well as in accordance with the questions addressed in the research. It exposes specific thoughts regarding this study done by semi-structured in-depth interviews. It presents results gathered by this method. It concludes with a reflexion on qualitative methods as ways of gaining knowledge on the human aging process.

This research examined individual differences in attitudes about elder abuse and other concerns in contemporary social morality. Study 1 was part of a larger investigation intended to identify examples of elder abuse through a survey of 572 seniors and practioners. Using a series of construct validation filters, a unifactorial Elder Abuse Attitude Test (EAAT) was developed that measures individual differences in evaluating examples of elder abuse. The EAAT contains 13 items and had an internal consistency exceeding 9. Study 2 included the EAAT in a survey of attitudes about wider social issues. Data on the EAAT, 31 survey items, and indexes of extremity and agreement set were analysed for 257 respondents. Zero-order and factor analysis showed relationships of the EAAT with extremity set and items stating that society should provide fiscal and other resources towards the prevention and remediation of child, spousal, and elder abuse. Attitude extremity was uncorrelated with four other attitude factors. We conclude that people more prone to attitude extremity have stronger convictions about the responsibility of society to attenuate abusive situations.

A review of gerontological literature on elder abuse and feminist literature on wife assault points to the conceptual and practice divisions that have separated attention to age and gender and, thus, obscured older women's experiences of abuse by their male partners. The first person account of a woman who left her abusive husband in her 70s and the supporting observations of a group of concerned service providers are introduced to bridge these conceptual divisions and to call attention to the social processes that hide and perpetuate wife assault in old age. With a view to developing methodologies and practices that make visible and challenge the conditions that sustain abuse of older women, directions for future approaches to research and service are considered.

This study explored the validity of the Caregiver Abuse Screen (CASE) as a brief measure of abuse/neglect of seniors. A group of abusive caregivers from the community was compared with two contrasting groups of non-abusive caregivers. The CASE distinguished between the abusive and each non-abusive group, while the non-abusive groups did not differ from each other. Higher CASE scores coincided with higher scores on abuse/aggression measures from independent sources; with caregiver personality traits; with appraisals of poorer caregiver/care-receiver relationships and more care-receiver problem behaviours, poorer caregiver health, more caregiver depression and less social support. Findings were interpreted as supporting the CASE's validity as an initial abuse screen for use with caregivers.