How to consider preventive treatments for opposition to nursing and medical cares in nursing homes?

International audience ; Population: Dementia is very common in elderly people living in retirement homes. Several clinical forms coexist, such as apathy, agitation, wandering and aggressiveness, sometimes combined in complex patterns. Agitation and/or opposition to nursing and medical cares can be difficult for teams, residents and families. My patient, a 92-year-old man, suffers of vascular dementia, high depression after wife passed-out few years ago, and multiple basal cell carcinomas on face, ears, shoulder, torso. He is not a competent person. There is no compliance to nursing and medical cares: for grooming or dressing, for multiples skincare bandage. However, care is essential to prevent pain or erysipelas.Context: Team requested medical treatments to cure pain, anxiety and depression, also to facilitate care for technical gestures, to avoid violence and to secure caregivers. As the situation evolved months after months, drugs doses were increased: more benzodiazepines (oxazepam), antipsychotic (loxapine) in addition of previous antidepressant (sertraline), then morphine before skincare. A year ago, the patient suffered neurological decompensation with coma, probably a iatrogenic one. All drugs were stopped and then reintroduced gradually and carefully. Situation back to previous: difficult balance between waiting and caring.Clinical question: How to consider preventive treatments for opposition to cares?Outcomes: A second 6-days hospitalization in geriatrics has occur in january 2024, in a period of more somnolence and aggressiveness. Treatments revision was a request. Oxazepam was decreased by half, loxapine was switched to clozapine, sertraline and morphine were kept. One month after, patient was less somnolent but situation didn’t elvove positively for cares.Lessons learned: Over-medication escalation as first response to opposition and non-compliance was quite inefficient and iatrogenic. Non-medicated methods and debrescribing to minimal efficiency should be the rule. In this case of non comptent ...