Approaches of psychoanalysis in the care of the elderly: an integrative review

Abstract Objective: to map publications about the clinical psychoanalytical care of the elderly and describe their characteristics. Method: an integrative review was carried out, considering the period 2008 to 2017 using the following databases: Index-Psychology, LILACS, MedLine, PubMED, SciELO and RedALyC, irrespective of language. The terms Elderly (Idoso), Aging (Envelhecimento) and Psychoanalysis (Psicanálise) were used. The guiding question was: what scientific literature exists about the elderly and psychoanalytical clinical care? A total of 33 articles were considered. Results: five categories were constructed: "Elderly clinical care with a psychoanalytical approach" (15), "Psychoanalytical Approaches in old age” (9), "Psychoanalytical Interventions in long-term care facilities" (6), "Representations of old age for health professionals in the light of psychoanalysis" (2) and "Generationality and psyche" (1). The concern of psychoanalysis for the elderly is incipient and precedes epistemological issues, meaning that production regarding clinical practice is greater; in turn, there are fewer research studies, as most of the articles are reflective in nature. Conclusion: the published studies indicate the possibility of employing psychoanalysis with the elderly, as the unconscious does not age and symptoms are continuously updated. The timidity of psychoanalysis in contrast to the increase in the numbers of elderly persons may be criticized. It is also emphasized that the losses, the effects on the body and the reduction of social ties require adjustments in clinical care, such as the inclusion of group activities and activities beyond the analytical setting, especially hospitals, homes and LTCFs.研究目的：旨在梳理有关老年人临床精神分析护理的相关文献，并阐明其研究特征。 研究方法：本研究开展整合性综述，检索时限为2008年至2017年，检索数据库包括Index-Psychology、LILACS、MedLine、PubMed、SciELO以及RedALyC，不限文献语言。检索词包括老年人（Elderly，葡萄牙语原文：Idoso）、衰老（Aging，葡萄牙语原文：Envelhecimento）与精神分析（Psychoanalysis，葡萄牙语原文：Psicanálise）。本研究的核心问题为：现有哪些关于老年人与精神分析临床护理的科学文献？最终共纳入33篇文献。 研究结果：共构建出5类研究主题：①采用精神分析方法的老年人临床护理（Elderly clinical care with a psychoanalytical approach），共15篇；②老年期精神分析取向（Psychoanalytical Approaches in old age），共9篇；③长期护理机构中的精神分析干预（Psychoanalytical Interventions in long-term care facilities），共6篇；④精神分析视角下卫生专业人员对老年期的认知表征（Representations of old age for health professionals in the light of psychoanalysis），共2篇；⑤代际性与心理（Generationality and psyche），共1篇。精神分析领域对老年群体的关注尚处起步阶段，且该关注早于认识论层面的议题布局，即临床实践相关的研究产出更为丰富；与之相对，实证类研究相对匮乏，且多数文献以反思性内容为主。 研究结论：已发表的研究表明，对老年人开展精神分析干预具备可行性，因为无意识不会随年龄衰老，且临床症状始终处于动态更新之中。相较于老年人口规模的持续扩张，精神分析领域对此的研究投入仍显不足，这一现状可被批评与反思。此外需强调，老年群体所经历的丧失体验、躯体功能变化以及社会联结的弱化，均要求临床护理模式作出调整，例如纳入团体活动以及突破传统精神分析咨询设置的干预形式，尤其适用于医院、养老机构以及长期护理机构（LTCFs）。