Les « symptômes comportementaux et psychologiques de la démence » (SCPD) posent, au quotidien du prendre-soin et de l’accompagnement des personnes présentant un syndrome démentiel, des difficultés plus importantes que les autres types de troubles, cognitifs notamment. La littérature et les études consacrées à ces SCPD n’avaient jusqu’à présent pas fait l’objet d’une revue critique permettant de faire le point sur leur définition et leur interprétation de ces troubles, et sur les pistes de prévention et d’apaisement proposées.Le présent travail, se plaçant sous l’égide d’une conception phénoménologique des syndromes démentiels telle que développée par le psychogérontologue anglais Tom Kitwood, suivra plusieurs étapes essentielles pour mieux comprendre les différentes dimensions à l’origine de ces troubles : les modifications des facultés cognitives, les altérations de l’humeur, les facteurs environnementaux et psycho-sociaux (stigmatisation et exclusion notamment).Ces premières étapes conduiront dans un second temps à présenter quelques unes des pistes élaborées par plusieurs auteurs, parmi lesquels Louis Ploton, Tom Kitwood et ses collègues du Bradford Dementia Group, destinées à prévenir ces troubles par l’élaboration d’un prendre-soin adapté et d’un environnement prothétique.Nous reviendrons ensuite au cœur des conceptions et définitions des SCPD. Pour les aborder avec un autre regard et mieux percevoir ce qu’ils expriment, ce qu’ils nous disent, ce qu’ils appellent comme philosophies et approches du prendre-soin. / The “behavioral and psychological symptoms of dementia” (BPSD) present, in the daily care of people with dementia, greater difficulties than other types of disorders, including cognitive. Literature and studies on these BPSD had so far not been critically reviewed to take stock of their definition and interpretation of these disorders and the prevention guidelines and appeasement which are proposed.This work, placing itself under the aegis of a phenomenological concept of dementia as developed by the English social-psychologist Tom Kitwood, will follow several key steps to better understand the different dimensions which are the origin of these disorders: changes in schools cognitive, mood alterations, environmental and psycho-social factors (stigmatization and exclusion in particular).These initial steps will lead a second time to present some of the tracks developed by several authors, including Louis Ploton, Tom Kitwood and his colleagues of the Bradford Dementia Group, to prevent these problems by developing a suitable care and a prosthetic environment.Then back to the heart of conceptions and definitions of BPSD. In order to approach them with a different look and better express what they perceive, what they tell us, what they call as philosophies and approaches of taking care.

La gestion des symptômes comportementaux et psychologiques de la démence [SCPD] est une thématique d’actualité, car la démence affecte 7,1 % des Canadiens (Agence de la santé publique du Canada, 2017). Parmi ceux-ci, environ 40 à 60 % présentent des symptômes tels que l’errance, l’agressivité, l’agitation verbale, etc. (Ministère de la Santé et des services sociaux [MSSS], 2012). Plusieurs publications récentes, basées sur un consensus d’experts, suggèrent les bonnes pratiques à privilégier au sujet de cette problématique (MSSS, 2014), cependant la mise en application de leur contenu est peu documentée à ce jour. Les objectifs du présent mémoire sont, dans un premier temps, de décrire la pratique des ergothérapeutes au Québec auprès des personnes présentant des SCPD. Le second objectif est de décrire comment les ergothérapeutes intègrent les résultats probants dans la pratique auprès de cette clientèle. Une étude de devis mixte simultané avec triangulation (Briand & Larivière, 2014) a été réalisée. Un questionnaire en ligne abordant la pratique des ergothérapeutes auprès des personnes présentant des SCPD a été complété par 86 ergothérapeutes. Également, 12 ergothérapeutes ont participé à des entrevues semi-dirigées, pour enrichir les données sur l’intégration des résultats probants dans leur pratique. Les résultats de l’étude mettent en lumière l’importance qu’accordent les ergothérapeutes à l’évaluation du fonctionnement dans les activités de la vie quotidienne en ayant recours à des observations ou des mises en situation. Les interventions privilégiées concernent principalement les modifications de l’environnement. Les résultats indiquent que les interventions préconisées par les répondants sont celles jugées comme étant les moins efficaces, tel que le fait valoir la recension des écrits. Les résultats montrent que les ergothérapeutes ont recours à des interventions pour lesquelles ils perçoivent qu’ils sont compétents. Les ergothérapeutes privilégient l’expérience clinique et les formations antérieures pour guider leur pratique plutôt que la consultation d’écrits scientifiques. Les résultats de ce mémoire fournissent des pistes de réflexion utiles pour guider la pratique des ergothérapeutes pour la gestion des SCPD. Comprendre les facteurs influençant les ergothérapeutes dans leur choix d’intervention à privilégier permet de proposer des solutions pour optimiser l’intégration des résultats probants dans la pratique. / The management of behavioural and psychological symptoms of dementia [BPSD] is a hot topic as dementia affects 7.1% of Canadians (Public Health Agency of Canada, 2017). Of these, approximately 40-60% experience symptoms such as wandering, aggression, verbal agitation, etc. (Public Health Agency of Canada, 2017). (MSSS, 2012). Several recent publications, based on a consensus of experts, suggest good practices to be favoured regarding this problem (MSSS, 2014), however, implementation is poorly documented to date. The objectives of this master’s thesis are, first, to describe the practice of occupational therapists in Quebec with people with BPSD. The second objective is to describe how occupational therapists integrate evidence-based results into their practice with this clientele. A simultaneous mixed quote study (Briand & Larivière, 2014) was carried out. An online questionnaire addressing occupational therapist practice with individuals with BPSD was completed by 86 occupational therapists. As well, 12 occupational therapists participated in semi-structured interviews to provide additional information on the integration of evidence-based outcomes into their practice. The results of the study highlight the importance that occupational therapists place on assessing functioning in activities of daily living through observation or role-playing. The preferred interventions mainly concern changes in the environment. The results indicate that the interventions advocated by the respondents are those that were considered least effective as indicated by the literature review. The results show that occupational therapists use interventions for which they perceive they are competent. Occupational therapists favour prior clinical experience and training to guide their practice over consulting scientific literature. The results of this master’s thesis provide useful insights to guide the practice of occupational therapists in the management of BPSD. Understanding the factors influencing occupational therapists in their choice of preferred intervention allows us to propose solutions to optimize the integration of evidence-based results in practice.

Bakgrund: Personer med psykisk ohälsa har en ökad risk för metabola sjukdomar till följd aven ohälsosam livsstil. Ett sätt att motverka dessa risker är genom fysisk aktivitet. Det är därförangeläget att undersöka vilket vetenskapligt stöd som finns för hur fysisk aktivitet kan stärkapatienters hälsa inom psykiatrisk slutenvård. Syfte: Studiens syfte var att undersöka förutsättningar och metoder för, samt hälsoeffekter av,egenvård i form av fysisk aktivitet för patienter inom psykiatrisk slutenvård. Metod: Studien är en litteraturöversikt med kvantitativ ansats där 13 vetenskapligaoriginalartiklar granskades och sammanställdes. Resultat: Fem övergripande teman identifierades, Motivation, Stöd, hjälp och råd,Utbildning, Fysiska hälsoeffekter samt Psykologiska hälsoeffekter. Resultatet pekar på mångasomatiska och psykiska fördelar med regelbunden fysisk aktivitet hos patienterna samt attriskfaktorer för metabola sjukdomar minskades. Depressiva och positiva psykotiska symptomminskades. Patienter som var generellt mer fysiskt aktiva vårdades mindre tid i slutenvårdenjämfört med dem som inte var fysiskt aktiva. Slutsats: Fysisk aktivitet har potential att komma till stor nytta för patienterna och det går attstärka deras hälsa på flera olika sätt med hjälp av fysisk aktivitet. / Background: People with mental illness have an increased risk of metabolic diseases as a result of an unhealthy lifestyle. One way to counteract these risks is through physical activity. It is therefore important to investigate what scientific support there is for how physical activity can strengthen patients' health in psychiatric inpatient care. Aim: The aim of the study was to investigate the conditions and methods for, and health effects of, self-care in the form of physical activity for patients in psychiatric inpatient care. Method: The study is a literature review with a quantitative approach where 13 scientific original articles were reviewed and compiled. Results: Five overall themes were identified, Motivation, Support, help and advice, Education, Physical effects and Psychological effects. The results point to many somatic and psychological benefits of regular physical activity in patients and that risk factors for metabolic diseases were reduced. Depressive and positive psychotic symptoms were reduced. Patients who were generally more physically active spent less time in inpatient care compared with those who were not physically active. Conclusion: Physical activity has the potential to be of great benefit to patients and it is possible to strengthen their health in several different ways with the help of physical activity.

For People Living with Dementia (PLwD), wandering behaviour can cause undesired consequences, such as falling, getting lost or even fatalities. For caregivers, taking care of PLwD with wandering behaviours is burdensome. If not intervened early, some wandering behaviours will escalate into crisis events. This design research aims to explore how to convert the wandering behaviour to a guided activity with the minimum input from caregivers by intervening early, that is, engaging PLwD, to avoid potential escalations. Based on Need-driven Dementia-compromised Behaviour (NDB) model, Crisis Development model and via a co-design approach, we developed De-light. De-light is a set of interactive sticks enhanced by light, audio and tactile experiences. Based on the degree of wandering behaviours of PLwD, De-light can be placed by the caregiver in a safe and suitable area in the nursing home to provide a controlled setting for guiding PLwD to perform physical activity. Our design research implies the possibilities of applying NDB model, Crisis Development model, and co- design approach in designing for the wandering behaviours for PLwD.

Bakgrund: För arbetsgivare kan sjuknärvaro anses vara ett positivt beteende men då missas ofta de negativa konsekvenserna såsom de medföljande produktionsförlusterna och även risken för försämrad hälsa hos individen, som kan leda till en längre sjukfrånvaro. Inom företag används ofta nyckeltalet sjukfrånvaro vilket ger en tydlig indikation på medarbetarnas hälsa och välbefinnande, däremot är sjuknärvaro svårare eftersom arbetstagaren befinner sig på arbetsplatsen. Det finns en mängd med kvantitativ forskning om ämnet och de finns även påvisat att sjuknärvaro har negativa konsekvenser för dels arbetstagarna, dels organisationer och dels samhället i stort. Dock finns fortfarande en brist på djupgående forskning om vad som påverkar fenomenet inom organisationskulturen utifrån individernas perspektiv. Syfte och metod: Syftet med studien var att öka förståelsen om hur organisationskulturen och arbetsmiljön kan påverka förekomsten av stressrelaterad psykisk ohälsa och sjuknärvaro. För att infria syftet med studien valdes en kvalitativ ansats med dels fokusgruppsintervju som hölls med fyra individer innehavande ledande roller, dels semistrukturerade intervjuer med 20 respondenter. Resultat och slutsats: Studien visar att det är förhållandevis många faktorer i organisationskulturen samt arbetsmiljön som påverkar upplevelsen av stress på arbetsplatsen, som kan leda till stressrelaterad psykisk ohälsa och sjuknärvaro. Det lyfts även att valet av att sjuknärvara är individuellt och påverkas dels av kulturen dels av individens egen situation och antaganden. / Background: For employers, attending work despite illness can be perceived as a positive behavior. However, the negative consequences are often overlooked, such as losses in productivity and the risk of deteriorating individual health, which in turn can lead to longer periods of sick leave. In corporate environments, the absenteeism rate is commonly used as a guiding indicator of employees' health and well-being. On the other hand, presenteeism poses a more complex challenge, as the employee remains at the workplace despite being unwell. A significant amount of quantitative research exists on this subject, and it has been proven that presenteeism has detrimental effects both at the individual level for employees, at the organizational level, and on society as a whole. However, there is still a lack of in-depth research on what influences the phenomenon within organizational culture from the perspective of individuals. Purpose and method: The aim of the study was to increase the understanding of how the organizational culture and work environment can affect the occurrence of stress-related mental illness and presenteeism. In order to fulfill the purpose of the study, a qualitative approach was chosen, with a focus group interview held with four individuals holding leading roles, and semistructured interviews with 20 respondents. Results and conclusion: The study shows that there are relatively many factors in the organizational culture and the work environment that influence the experience of stress in the workplace, which can lead to stress-related mental illness and presenteeism. It is also highlighted that the choice of presenteeism is individual and is partly influenced by the culture and partly by the individual's own situation and assumptions.