Quand le vieillissement se mêle au handicap : un exemple de prise en charge en médecine générale

We will present the example of the general medical care for a 52-year-old man with cerebral palsy (CP), living in a medicalised care home. Following his medical and social background, we retain the following main antecedents : a mitral insufficiency (Barlow's disease), a neurogenic bladder, a restrictive pulmonary syndrome and a dislocated left hip. Following the observations of the healthcare team concerning episodes of hyperthermia, weight loss, and coxalgia, two problems arise. How to prevent the risk of infectious endocarditis ? How to optimize the functions of swallowing ? We will describe the different vicious circles linking pain, contraction, infections, and nutrition. We will see how the advancing in age of this man with CP complicates his medical care. The general practitioner's role is to identify the main areas of the man's suggested care project using clinical examination, paraclinical data and specialized assessments. It is thus a question of reviewing and treating the outbreaks, of managing the pain by analgesics and installation, of using relaxation techniques at mealtimes in order to maintain adequate nutrition. The main objectives are to safeguard his psychical autonomy and his everyday comfort. Ethical reflection within the multidisciplinary team must be undertaken in order to make the therapeutic decisions that have the best risk benefit profile for patient.