Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta pesquisa busca compreender a construção do percurso identitário do Agente Comunitário de Saúde (ACS) a partir da história de vida. Os objetivos colocados neste estudo foram analisar as formas como se constituíram os princípios e valores que orientam as práticas de cuidado do ACS e de construir uma narrativa que contemplasse como as contingências e os acasos produziram os sentidos para o seu percurso identitário. Para isto, utilizou-se a metodologia qualitativa heterogênea através da abordagem da História de Vida e da Análise de Conteúdo. A primeira - História de Vida, segundo Becker (1994) é a expressão de uma forma de vida, de conhecer crenças, valores e desejos de uma população estudada dentro do contexto da vida destes sujeitos. Para tanto, foram realizadas entrevistas com seis ACS que atuam há pelo menos dois anos no município do Rio de Janeiro. As entrevistas foram gravadas e, parcialmente, transcritas após o aceite e a assinatura do termo de consentimento. Acredito que os agentes podem operar entre si diferentes modos de fazer, uma vez que afetam e sofrem afetamentos, atravessam e ao mesmo tempo são atravessados por diferentes micro redes que geram solidariedade ou individualismo, humanidade ou animosidade nas inter-relações. Neste contexto, o estudo conclui que ainda que a maioria dos entrevistados não escolhesse a carreira de ACS, houve uma disponibilidade para aprender o ofício e um compromisso com as atribuições definidas para o exercício profissional. Aliado a isso, constatou-se também, que a inserção na profissão foi uma forma de conseguir um emprego formal que garanta uma renda fixa mensal. Não há o desejo de permanecer por muito tempo nesta profissão pelo desgaste físico e emocional que é fortemente sentido já no primeiro ano de trabalho. Em relação à construção dos sentidos para o percurso identitário dos ACS, os depoimentos apresentam uma identificação com as ações de ajuda e solidariedade presentes na vida dos sujeitos. E, dentre os valores ou princípios que constituíram a formação de um caráter ou identidade pessoal, que são determinantes para a atuação no cuidado à saúde das pessoas, destacam-se a sensibilidade, a escuta, o afeto, o acolhimento, a ética, a amizade e alteridade. Na discussão sobre a necessidade deste profissional ser morador da área que vai atuar, observou-se, a partir das narrativas, que esta exigência pode facilitar a abordagem. Contudo, a qualidade do cuidado não está diretamente relacionada a este critério que pode gerar distanciamento e desconfiança dos outros moradores. Logo, estudos como este se justificam para que se possa reafirmar a importância de trabalhadores do SUS, em especial, o ACS. Estes representam hoje mais de 200 mil trabalhadores da saúde pública e se espera que sejam profissionais responsáveis por um cuidado em saúde que respeitem as diferenças entre as pessoas, que não sobreponham a doença ao sujeito e não minimizem o sofrimento em função do cumprimento de metas e produção de dados a serem planilhados. Lutem, acima de tudo, pela defesa de qualquer vida.

O objeto da pesquisa foram as relações sociais estabelecidas entre o agente comunitário de saúde ACS e a equipe de Saúde da Família SF em situações concretas de trabalho. A SF é estratégia prioritária para a reorganização da Atenção Básica no Brasil. A profissão do ACS foi regulamentada somente em 2002 e caracteriza-se pelo exercício de atividades de prevenção de doenças e promoção da saúde. A literatura aponta que os ACS desempenham ações preconizadas pelo Ministério da Saúde, mas enfrentam dificuldades para cumprirem com funções de caráter mais político e social, voltadas para mudanças nos modos de se cuidar e para o aumento da participação social. O ACS possui características híbridas e singulares, pois é membro da comunidade e da equipe de saúde, propiciando a ligação entre esses dois atores. Objetivou-se compreender as relações sociais estabelecidas entre o ACS e a equipe de SF a partir do trabalho em equipe na saúde, destacando os aspectos da articulação das ações e da interação entre os trabalhadores. A pesquisa foi de abordagem qualitativa com a realização de 23 observações participantes e 11 entrevistas semi-estruturadas junto a uma equipe de SF em um município do interior paulista, O material empírico foi interpretado segundo a análise temática e compreendeu a história da unidade de saúde e seus trabalhadores, o processo de trabalho da equipe e os ACS na equipe de SF na perspectiva da articulação e da interação. Os resultados mostraram que o ACS está inserido em um processo de trabalho em equipe que é dinâmico. O ACS vive as contradições de modelos de saúde que são diferentes e co-existem em um mesmo espaço. Os ACS são laços de ligação quando desempenham ações articuladas ao trabalho da equipe e interagem com os trabalhadores, construindo planos assistenciais em comum. Um núcleo de competência do ACS pode ser a característica de laço de ligação, aproximando equipe e comunidade e adequando as ações de cuidado às reais necessidades das pessoas. Na prática comunicativa com os trabalhadores; os ACS ao falarem de si, estão falando da própria comunidade, pois é ele seu representante e porta-voz na equipe. Como elos de ligação desenvolvem ações essencialmente operacionais para agilizar o trabalho da equipe e da unidade, tais como, entregar recados e encaminhamentos. As atividades desempenhadas dentro da unidade relacionam-se à cooperação e também estão muito atreladas às ações operacionais e instrumentais do trabalho, inclusive com certo caráter de troca. Concluímos que a inserção do ACS na equipe de SF enfrenta dificuldades e requer a criação de estratégias que favoreçam a relação dialógica entre os trabalhadores. Assim, o trabalho da equipe e a dimensão política e social dos ACS poderão ser potencializados, contribuindo para cuidados mais integrais e acolhedores e para um agir em saúde mais criativo e prazeroso. / The social relations established between the community health agent (ACS) and the health family team (SF) in work situations was the object of this study. SF has been a strategic priority to reorganize Primary Health Care in Brazil. ACS only became a regulated profession in 2002 and comprises activities of disease prevention and health promotion. Literature appoints that ACS develops actions recommended by the Ministry of Health but faces difficulties in complying with functions with a more political and social character focused on changing peoples self-care and increasing their social participation. These professionals possess hybrid and singular characteristics because they are both members of the community and the health team making linkages between them. The study aimed to understand the social relations established between the ACS and SF team as from the work developed by the health team, highlighting connections between actions and interaction between workers. This is a qualitative study with 23 participant observations and 11 semistructured interviews with the SF team in a city in the interior of Sao Paulo, Brazil. The empirical material was analyzed according to the thematic analysis and comprises the history of the health unit and its workers, the teamwork process and the perspective of connection and interaction of the ACS in the SF team. Results revealed that ACS is inserted in a dynamic teamwork process, that is, experiences the contradictions of co-existing different health models. These professionals work as links when they develop actions connected to the teamwork and interact with its workers developing common care plans. The ACS core of competency is characterized by the connection they establish approximating team and community and adapting care actions to peoples real needs. When these professionals talk about themselves during communication with workers, they talk about the community itself because they are its representatives and spokesman in the team. As links, they basically develop operational actions to speed up the team and units work such as delivering messages and referrals. The activities developed inside the unit are related to cooperation and are also very associated to operational and instrumental work, which includes a certain exchange. The conclusion is that the inclusion of the ACS in the SF team is difficult and requires strategies favoring the dialogical relation between workers. This way, the teamwork and the ACS political and social dimensions can be strengthened, contributing to more integral and welcoming care and also to more creative and gratifying work in health.

O objetivo deste trabalho foi analisar as características das visitas domiciliares nos programas Agentes Comunitários de Saúde e Saúde da Família e sua possível contribuição para o alcance da integralidade. Em ambos os programas, a visita domiciliar apresenta-se como uma ação emblemática, como evidenciado pela designação de um profissional específico para essa atividade (o agente comunitário de saúde), embora se recomende que seja realizada por todos os profissionais de saúde. A integralidade foi buscada como representando um norte para a atenção primária, através de características do processo de trabalho em saúde. A metodologia adotada foi a pesquisa de tipo qualitativo, sendo os dados empíricos obtidos por meio de entrevistas com profissionais e usuários e pela observação do cotidiano de três equipes de agentes comunitários de saúde e três equipes de Saúde da Família em Campo Grande, MS, de novembro de 2005 a julho de 2006. A análise dos dados aponta que as coordenações estadual e municipal dos programas incentivam as visitas, mas consideram serem necessários critérios para as solicitações de visitas, definição do profissional que as realizará e mecanismos de avaliação, especialmente no que se refere às visitas feitas por profissionais com formação universitária. Na dinâmica de trabalho das equipes pesquisadas, as formas de organização do trabalho são diversas, podendo favorecer ou dificultar a realização das visitas domiciliares. As visitas são solicitadas majoritariamente por agentes comunitários de saúde, respondendo a demandas de usuários, ou decorrem de demandas internas dos serviços, com variados enfoques quanto às finalidades, conteúdos e prioridades. Os profissionais apontam como aspectos positivos das visitas uma leitura ampliada da realidade, das dinâmicas familiares, das condições de vida e das necessidades dos usuários, permitindo implementação de medidas preventivas e assistenciais e o fortalecimento do vínculo entre usuários e equipe de saúde. No entanto, evidenciam-se tensões relacionadas com o tipo de solicitações dos usuários, predominantemente de caráter clínico, muitas vezes requerendo referências secundárias e terciárias, nem sempre presentes. Por outro lado, a pobreza e as precárias condições de vida dos usuários, características das populações cobertas pelos programas, geram demandas de ações de assistência social, moradia, educação e trabalho, entre outras, que muitas vezes também permanecem sem resposta ou são tratadas de forma caritativa. Além disso, existem dificuldades relacionadas a horários, percursos, transporte e abordagem dos moradores durante as visitas, além de situações de resistência, de recusa e de contato com famílias em precárias condições de vida. Constatou-se que para atingir sua potencialidade de estimular a integralidade, a visita requer trabalho em equipe e respeito e singularização dos usuários. As visitas domiciliares constituem uma prática com potencial integrador, favorecendo o desenvolvimento de ações no domicílio, a ampliação do acesso à unidade de saúde, a adoção de medidas preventivas, a adesão ao tratamento, o apoio aos cuidadores e a longitudinalidade. No entanto, apesar de potencialmente aumentarem a visibilidade de problemas de difícil abordagem, como alcoolismo, violência doméstica ou sexualidade, as visitas domiciliares não os tomam como objetos de trabalho, geralmente evitando essas situações nos domicílios. As visitas podem colaborar com a integração com os níveis secundário e terciário, com a abordagem familiar e com o desenvolvimento de ações intersetoriais, sempre que houver incentivo e condições para isso. A atividade é, porém, permeada de tensões, por seu caráter por vezes autoritário e de intromissão na vida privada, pelas frágeis condições de trabalho e por sua utilização como atenuante de deficiências no atendimento nas unidades de saúde e na ação do poder público em problemas estruturais. / The purpose of this study was to analyze the profile of home visits in the Brazilian health care programs \'Community Health Agents\' and \'Family Health\' with regard to their potential contribution toward integrality in health services. In both programs home visits occupy a prominent position, as shown by the assignment of a specific professional to carry out this activity--the community health agent--although performance of the visit is recommended for all health professionals. Integrality was the guiding principle intended for primary care, configuring the features of the work process in the health area. The methodology adopted was that of qualitative research. Empirical data were collected by interviewing health professionals and users and by observing the daily activities of three teams of community health agents and three teams of the Family Health Program in Campo Grande, Mato Grosso do Sul, from November 2005 to July 2006. The activity is encouraged by program coordinators at the state and county level, who recognize the need for developing criteria for defining which newly detected cases should warrant the performance of home visits and which professionals should be assigned to perform them, in addition to mechanisms for evaluation of the activity, particularly in the case of home visits performed by health professionals holding higher education degrees. With regard to the operative dynamics of the teams investigated, workflow was found to be organized in various ways, which may facilitate or hinder the performance of visits. Most home visits are requested by community health agents in response to demands of users, but they can also be requested by the service itself, in response to internal demands, and the focus of the activity may vary in terms of purpose, content, and level of priority. According to the professionals interviewed, home visits have a number of positive aspects, as they provide a broader perception of reality, family dynamics, living conditions, and needs of users, in addition to facilitating the implementation of preventive and assistance measures and strengthening the connection between users and health care team. Nonetheless, the activity has inherent tensions, as those related to the type of requests placed by users, mostly of clinical nature, which may require secondary and tertiary care approaches, not always available. On the other hand, poverty and unfavorable living conditions, typical of the population assisted by the programs, generate demands for actions related to social assistance, housing, education and work, among many others, which often are not dealt with at all or are managed with a charitable focus. Additional difficulties involve schedules, transects, transportation, manner of establishing first contact and relating to residents during the visits, situations of resistance or refusal by residents, and the very contact with families living in dire conditions. It was found that in order to exert its potential for promotion of integrality, home visits require not only teamwork, by also respect for users and recognition of their singularity. Home visits have an integrative potential, facilitating the performance of health-related actions in the home setting, promoting broader access to health care units, encouraging adoption of preventive measures, adherence to treatment, and support to caretakers, and fostering the development of longitudinality. However, in spite of their potential for facilitating the perception of issues requiring a more sensitive approach, such as alcohol consumption, domestic violence, or sexuality, home visits do not take these occurrences as their object of action, but usually avoid direct contact with such situations. Visits also aid in the integration with secondary and tertiary levels, are valuable in the establishment of a family-focused approach, and are advantageous to the development of intersectoral actions whenever favorable conditions and incentive are available. The activity, however, is not without tensions. In some instances, its focus is authoritarian and intrusive into private life; working conditions are fragile; and visits play the extra role of lessening deficiencies in services and in the governmental ability to tackle structural issues.

La thèse de doctorat a pour objectif, d'abord, de déterminer la portée de trois obligations imposées par les institutions européennes aux États membres en ce qui concerne leur organisation administrative, de déterminer, ensuite, sur quels points l’autonomie et les particularités des États ont été protégées lors de l’édiction de ces obligations, et d’évaluer, enfin, la conformité de ces dernières aux dispositions des traités garantes de l’autonomie et des spécificités nationales. La thèse qui est soutenue est celle selon laquelle les avancées du droit européen du marché intérieur dans le domaine de l’organisation administrative nationale qui sont analysées ne sont que partiellement conformes aux dispositions des traités qui protègent l'autonomie et les spécificités nationales. La méthode adoptée pour la recherche relève, pour l'essentiel, de la technique juridique. / Doctorat en Sciences juridiques / info:eu-repo/semantics/nonPublished

L’Union européenne conduit une ambitieuse politique de développement des énergies renouvelables, visant à porter à 20 % la part de ces dernières dans la consommation énergétique européenne à l’horizon 2020. A cet effet, le législateur européen sollicite des Etats membres qu’ils mettent en œuvre des soutiens nationaux à la production d’électricité renouvelable, susceptibles de relever du champ de l’interdiction des entraves et des aides d’Etat. Parallèlement, la politique de réalisation du marché intérieur de l’énergie impose aux Etats membres de libéraliser le secteur économique dans lequel s’inscrit l’électricité renouvelable. Par l’observation des règles du marché intérieur, la thèse évalue l’articulation entre ces objectifs visiblement contradictoires. Si la finalité environnementale qui sous-tend le développement de l’électricité renouvelable justifie une inflexion des règles du marché intérieur, elle favorise les cloisonnements nationaux et fait naître une concurrence normative entre les Etats membres. Chacun d’eux use de l’attractivité de son droit pour inciter les opérateurs économiques à exploiter des sources d’énergie nationales, indépendamment de leur répartition naturelle à l’échelle européenne. L’observation empirique de ce phénomène met en évidence les risques qu’il fait peser sur la cohérence globale de l’action de l’Union dans le domaine des énergies renouvelables. En prenant appui sur certaines évolutions du droit positif et de la pratique des acteurs privés sur le marché, la thèse évalue les hypothèses de renouvellement des mécanismes du marché afin qu’il devienne un instrument à part entière de promotion de l’électricité renouvelable dans l’Union européenne. / The European Union is pursuing an ambitious policy to develop renewable energy aimed at increasing its share to 20% in the European energy consumption by 2020. To that extent, the European legislator requests from all Member States that they implement national support for the production of renewable electricity, which may fall within the scope of the ban on restrictions and State aids. In parallel, the policy of achieving the internal energy market requires the Member States to liberate the economic sector in which renewable electricity is used. By observing the rules of the internal market, the thesis evaluates the articulation between these objectives that seem contradictory. While the environmental goal underlying the development of renewable electricity justifies an inflexion of the rules of the internal market, it promotes national separation and gives rise to normative competition between the Member States. Each of them uses the attractiveness of its own laws to persuade the economic operators to exploit national energy sources, independently of their natural distribution on a European scale. The empirical observation of this phenomenon highlights the risks it poses to the overall coherence of the European Union’s action in the field of renewable energies. By using some developments of the positive law and the practice of private actors in the market, the thesis evaluates the hypotheses to renew the market mechanisms so that the market becomes a full instrument for promoting renewable electricity in the European Union.

The purpose of this study was to examine Residential Care Aides’ (RCAs) experiences of good quality dementia care provision. Informed by a political economy perspective, I sought to understand how RCAs conceptualize quality dementia care, whether such conceptualizations are reflected in their daily care practice and how the organizational care context impedes or facilitates such care provision. Drawing on a focused ethnographic approach, I utilized in-depth interviews, participant observation and the review of selected documents to contextualize RCAs’ experiences within the organizational care environment. Over a 12-month period, in-depth interviews with 29 staff (21 RCAs, 3 LPNs and 5 managers) and 239 hours of participant observation were conducted in four small-scale dementia units in two nursing homes in British Columbia, Canada. In-depth interviews yielded information-rich data about RCAs’ care experiences and their relationships with residents, while participant observation afforded the opportunity to strategically link RCAs’ actions and interactions with what was said, a feature missing from much of the previous research examining staff perceptions of quality dementia care. A select review of facility documents and provincial licensing regulations provided additional insight regarding the relevance of the larger structural context for RCAs’ care experiences. In general, RCAs conceptualized, and exhibited in their daily physical care provision, quality dementia care as that which focused on tangible care outcomes (i.e., keeping residents clean, comfortable, calm and happy), on their care approach (i.e., delivering care in a compassionate, patient and affectionate manner) and was guided by family ideology (i.e., invoking of family metaphors). Inherent in their care provision was a sense of role tension, as they sought to incorporate social interaction with task completion and their co-workers’ conflicting expectations. Study findings also illustrated how, in the face of continued disempowerment and organizational constraints, RCAs sought to provide quality dementia care by negotiating their peer and supervisory relationships and selectively breaking formal and informal policies/procedures. Salient to RCAs’ experiences of personhood was the limited recognition and appreciation they received from management and the manner in which work-life balance, staffing coverage, human resource management practices and limited information sharing further devalued them and their work. Study findings draw attention to the importance of: acknowledging the role of structural constraints in the pervasiveness of a task-oriented work culture; attending to (and facilitating) staff personhood; facilitating supportive peer and supervisory relationships and; fostering effective management practices as a means of potentially improving care quality. As such, the study sheds important light on what RCAs require within their work environments to help facilitate resident well-being, reinforcing the assertion that residents’ care conditions are inextricably linked to RCAs’ care work conditions. / Graduate / 0351

M.Cur. (Nursing Management) / Information technology is the management of a computer-based information system, particularly software applications and computer hardware, which are used to handle all aspects of information storage, retrieval, transmittal, protection, and processing information securely. The lack of reliable health information is one of the major obstacles to the effective planning of the health services in South Africa. The existing information systems are fragmented and incompatible; most systems are manually driven with minimal computerisation which results in inadequate analysis, interpretation and the use of data at PHC level. The use of computer information technology in the health facilities will improve service delivery; reduce the cost of providing health care; and enhance the management and control of service. Yet, it seems that nurses are insufficiently using computer information technology at the PHC clinics in the eastern part of Ekurhuleni. It has been observed that nurses do not use Computer Information Technology (CIT) to the benefit of the clients. It was unclear what the perceptions of PHC professional nurses about CIT were. The purpose of this study was to explore and describe the perceptions of primary health care nurses with regard to the use of Computer Information Technology (CIT) with the purpose of recommending the actions to be taken by the nurse manager about computer information technology. In this study a quantitative, exploratory and descriptive design was used in order to obtain factual reasoning and information from professional nurses working at five (5) primary health clinics in the eastern part of Ekurhuleni. The total sample of professional nurses was n = 150. The method of data collection was a self-administered and structured survey- questionnaire that took 30 minutes to complete. Descriptive statistics were compiled by using the Statistical Package of the Social Sciences (SPSS) Version 20 software program. Validity and reliability were ensured by the judgments of the researcher and experts about whether the research instrument had covered the comprehensive set of facets that encompassed the concepts (the use of information technology at primary health care clinics). It also included pre-testing of the instrument to establish the consistency with which participants understood, interpreted and responded to all the carefully formulated questions in the survey-questionnaire. Ethical principles and standards for nurse researchers were adhere to. The findings indicated that there were aspects that need to be addressed in respect of the use of information technology in primary health care clinics. Limitations of study and the recommendations for nursing practice, management and research were discussed. This study determined the perceptions of nurses with regard to the use of computer information technology at the PHC clinics that lead to recommendations on the actions to be taken by the nurse managers about the use of computer information technology at PHC clinics.

Volunteer home-based caregivers are critical role players in South Africa‘s health care system and in the South African government‘s strategy to fight HIV and AIDS. In order to achieve the aims that the government seeks to attain, it is important that the care and treatment provided to patients receiving community home-based care (CHBC) be of a high quality. While the need for quality care is supported by government and civil society, research indicates that it is not clear whether quality care is indeed being provided and therefore there is a need for research into the quality of CHBC. The research aimed to undertake a critical assessment of CHBC programmes to determine the quality of care provided by volunteer caregivers using social capital theory as a theoretical framework. The study examined the quality of CHBC by analysing the context of CHBC, by investigating the support that volunteer caregivers and their clients receive and by discussing the support that volunteer caregivers and their clients still need. The study used one-on-one in-depth interviews and focus groups to obtain relevant data. The participants included volunteer caregivers, clients and supervisors who took part in the one-on-one interviews. The focus groups consisted of key informants and supervisors respectively. The quantitative data consisted of descriptive statistics which helped describe the participants. The qualitative data was coded and themes and sub-themes were developed. The data was also analysed by an independent coder. The results showed that poverty, and the related problems of poor living conditions and a lack of food security affects the quality CHBC. In addition, unemployment and the problem of stipends also affect quality CHBC. Certain socio-economic factors were also found to lead people to choose to become volunteer caregivers and unemployment was found to be an important driving force behind the choice to undertake volunteer caregiving. Furthermore, the volunteer caregivers in the sample received organisational support from their supervisors and their fellow caregivers or peers. They also received social support from their families and their communities. Regarding the clients of the volunteer caregivers, it was found that they received a number of types of support including psycho- iv social counselling, spiritual counselling and care of a holistic nature. In addition, the study found that there is a need for standardised quality training of volunteer caregivers, which will equip them with multiple skills. It was also found that volunteer caregivers require mentoring and quality supervision in order to be able to provide quality CHBC to their clients. Government has the ability to put the necessary systems and structures in place, such as a scope of practice for volunteers, standardised training and monitoring and evaluation, to enable CHBC and its relevant role players to operate at optimum levels. It also has the authority to make the changes and to enforce rules. Furthermore, it has the ability to unite CHBC organisations and can create the necessary conditions that can lead to increased social capital. Furthermore, the study recommends that two additional dimensions of quality care be added to existing dimensions of quality in health care. The first is the holistic approach to caregiving and the second is social support systems, namely supervisor/mentor and peer support and family and community support. This second dimension is also closely linked to social capital and the networks that make up CHBC.

A la fois phénomène social et institution juridique, il n’est d’organisation familiale qui échappe à la règle de droit. La place de chacun de ses membres est fixée en fonction d’un statut identifié. De singulière, la famille peut, dans ses rapports avec l’enfant, être plurielle. L’enfant et ses familles, nucléaires et élargies, n’existe que par ses liens familiaux. Son statut hétéroclite l’amène à coexister avec le groupe familial. Les schémas d’existence et de coexistence de l’enfant, de sa naissance à son décès, ne sont pas neutres juridiquement, tant les enjeux extrapatrimoniaux que patrimoniaux sont marqués. / At the same time social phenomenon and legal institution, it is not of family organization which escapes the legal provision. The place of each one of its members is fixed according to an identified statute. Of singular, the family can, in her relationship with the plural child, being. The child and his families, nuclear and widened, exist only by his family ties. Its heteroclite statute leads it to coexist with the family group. The diagrams of existence and coexistence of the child, of his birth to its death, are not neutral legally, as well the extrapatrimonial challenges as patrimonial are marked.

La presbyacousie est une maladie qui concernerait plus de 12 millions de Français mais qui reste peu connue. Si elle n'est pas traitée tôt, elle peut entraîner de graves complications comme des troubles de la communication, de la dépression et des troubles cognitifs. Le constat actuel est que très peu de presbyacousiques sont traités, et lorsqu'ils le sont, le résultat semble insuffisant. L'objet de cette thèse est de proposer à partir des connaissances actuelles, des solutions adaptées aux besoins de ces patients, du dépistage à la réadaptation. Trois études ont été menées : l'étude « AcoumAudio », déclinée en trois volets a montré que l'acoumétrie vocale était un bon test de dépistage de la surdité chez les personnes âgées, d'évaluation du degré de perte auditive et de mesure du gain auditif fonctionnel après réhabilitation ; l'étude 1 intitulée « Privation sensorielle auditive et fonctionnement cognitif chez le sujet âgé (ACADem) » a montré que le port d'un appareillage auditif pouvait préserver d'une dégradation cognitive ; et l'étude 2 intitulée « Faisabilité d'une Réhabilitation Conjointe Audioprothétique et Orthophonique pour les Presbyacousiques (FRéCAOP) » a montré qu'il était possible de proposer une prise en charge plus complète et efficiente de la presbyacousie, dans un circuit de l'audition du GRAPsanté, incluant nécessairement un Aidant / Presbycusis is a disease that occurs in more than 12 million French people, but which is still not well known. If it is not treated early, it can lead to serious complications such as communication disorders, depression and cognitive impairment. The current situation is that very few presbycusic patients are treated, and when they are, the result seems insufficient. The purpose of this thesis is to propose using current data, solutions tailored to the needs of these patients, from screening to rehabilitation. Three studies were conducted: the "AcoumAudio" Study, available in three components showed that the vocal acoumetry was a good hearing test to screen elderly people, to evaluate the degree of hearing disorders and to measure functional auditory gain after rehabilitation; Study 1 entitled "Auditory deprivation and cognitive functioning in the elderly" showed that wearing hearing aids could preserve from cognitive deterioration; and Study 2 entitled "Feasibility of a Conjoint Rehabilitation involving audiology and speech therapy for presbycusis (FRéCAOP)" showed that it was possible to offer a more complete and efficient management of presbycusis, in the hearing circuit of GRAPsanté, necessarily including a caregiver