B Acad Nat Med Paris
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Two major changes in end-of-life management have occured in recent decades: first, because of the increase in life expectancy and the resulting aging of the population, most deaths now involve old or very old people; second, more than two-thirds of deaths occur in a hospital or an institution. Our fellow citizens are afraid of suffering and death. They wish for a peaceful death, as rapid as possible and, in recent surveys, say they favour euthanasia. ⋯ Palliative care ensures dignity in death, without anxiety of suffering, and is expanding rapidly in France. Léonetti's law of 22 April 2005 ensures the protection of the weakest, who should never be considered unworthy of life, yet is poorly known to the public and even to physicians. It now needs to be applied in practice.
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The homeless population is difficult to define and its number difficult to evaluate. In France, it is estimated that almost 4 million people living in substandard accommodation, and 85,000 homeless people. Most homeless people rarely frequent public spaces. ⋯ A chronic disease is present in 45% of cases. Average life expectancy is only 47.6 years-between 30 and 35 years lower than for the general French population. Medical care can only be fully effective if these patients' social and housing issues are dealt with too.
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Risk factors lead to social exclusion and their accumulation can lead to homelessness. This inevitably contributes to a progressive increase in psychological distress or aggravates a pre-existing mental illness. ⋯ Proactive programs designed to facilitate access to healthcare and welfare have been created in order to offer solutions designed to enable homeless people to leave the street, through access to medical care, accommodation and civil rights. The psychiatric sector has been slow to adapt to the needs of this population, although several teams specializing in mental illness and precariousness have been created These teams explore every possible avenue to help homeless people with mental health issues to recover a psychological balance that allows them to choose a recovery pathway and thus to regain a dignified lifestyle.
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B Acad Nat Med Paris · Feb 2013
[Realities and life projects of homeless people: when the body is the last resource].
In today's society, the most destitute, and particularly those forced to live outdoors, are deprived of everything: work, money, accommodation,family, etc. Their body is the sole and last resource they have, but is subject to over-exploitation in response to the physical and social survival environment in which they live. Many homeless people have a chaotic life trajectory, often starting in childhood, leaving them with little hope for improvement. How can we adapt medical and social care to each individual? All members of society must question their place and function if precariousness is to bedealt with effectively.