Roughly 35% of employed Canadians are currently informal caregivers — defined as “an individual who provides care and/or support to a family member, friend or neighbour who has a physical or mental disability, is chronically ill or is frail” (Williams, Eby, Crooks, Stajduhar, Giesbrecht, Vuksan, Cohen, Brazil, & Allan, 2011, p. 3). These worker-carers are mostly women and often experience negative impacts on their physical, mental, emotional, social, and economic well-being. The impact on employers is also staggering (Fast, Lero, DeMarco, Ferreira, & Eales, 2014). With the number of seniors requiring such care expected to double by 2031, this is a growing issue for Canadians (Williams, et al, 2011). With the assistance of a Technical Committee of experts, chaired by Dr. Williams from McMaster University, the Canadian Standards Association and McMaster University have developed a Standard for Caregiver Inclusive and Accommodating Workplaces. This has been realized through funding provided by the CIHR/SSHRC Partnership Development Grant addressing Healthy, Productive Workplaces. This research seeks to conduct an Enhanced Public Review of the Caregiver Inclusive and Accommodating Standard through the completion of interviews (n=17) with key stakeholders across Canada. Semi-structured interviews were conducted from May to July 2017. After reading a draft of the Standard, interviewees were asked about: the viability of implementation of the Standard; what they liked about it, and what they would change, as well as; how it met with the mandate of their own organization. Interviewees represented the senior leadership of a wide variety of organizations including: human resources; caregiver support; unions; white-collar industry; healthcare, and; municipal governments. Following transcription and coding of the interviews using thematic analysis, five major themes emerged. First, the Standard is a necessary tool in today’s world. Second, though it is an important tool, it is more likely to be used as an educational tool than to be actually implemented by most organizations. Third, organizations are not likely to implement the Standard for a variety of reasons. For example, small to medium sized organizations do not have the resources or capacity to implement and, given that large organizations already have policies in place, they will view the voluntary Standard as superfluous. Fourth, there is a significant divide in perceptions of sex and gender as relevant to the issue of caregiving and the necessity of supports such as the Standard. Finally, organizations may be motivated to implement the Standard and/or use it as an educational tool in exchange for tax breaks or insurance incentives, awards and recognition, or for grants to assist in developing and implementing policies related to the Standard. We conclude that although there are many barriers to implementation of the Standard, it is a useful and timely tool for organizations to use in order to better support their employees who are engaged in carer roles. Incentivizing implementation may encourage more participation in this program and thus greater support for worker-carers. This is especially important as more than half of carers are women, and women in caregiving roles are more likely to spend much more of their time in that role, meaning that this will keep more women engaged in the labour force, prevent burnout, and support better health outcomes (Sinha, 2012). / Thesis / Master of Arts (MA) / People who are caring for an elderly or sick relative or friend (worker-carers) make up a significant portion of the Canadian workforce. The Canadian Standards Association has developed a voluntary standard for employers to provide accommodations that make working more accessible to employees who are balancing their job with their caring responsibilities. This research assesses the necessity of this Standard and the likelihood that it will be implemented by employer across the country.

Aging and age-related frailty are important public health problems. There is a need to develop rehabilitation interventions to reduce the prevalence and disabling effects of frailty. This thesis reports the rationale and design of two studies and findings of three studies aimed to optimize health outcomes of frail older adults and their caregivers. The second chapter describes the protocol of the first network meta-analysis to determine the comparative effect of interventions targeting the prevention or treatment of frailty. In the third chapter, the results of frailty network meta-analysis were presented and 89 RCTs were included. The review shows that physical activity and medication management are the most effective frailty interventions. The fourth chapter describes a protocol of pilot randomized controlled trial (RCT) to examine a preoperative multi-modal frailty intervention in pre-frail/frail older adults undergoing elective joint replacements. The fifth chapter describes the results of a subgroup analysis of a RCT examining the effect of complex primary care intervention to support caregivers of frail older adults. There were no differences between caregivers of frail older adults and non-caregivers in quality of life, social support, hospitalization, and emergency department visits. The sixth chapter examines the construct validity and discriminative properties of the fracture rating scale (FRS) (a tool designed for fracture risk assessment in long term care (LTC)). The FRS is a valid tool for identifying LTC residents at different risk levels for hip fracture in three Canadian provinces. The work presented in this thesis is proposing and examining the comparative effect of frailty interventions, a preoperative frailty intervention/ model, a primary care intervention to identify and support caregivers, and a predictive tool to optimize care planning of LTC residents. These findings will support the rehabilitation and care program for older adults and their caregivers and improve their health outcomes. / Thesis / Doctor of Philosophy (PhD) / There is a need to develop rehabilitation interventions to reduce the prevalence and disabling effects of frailty. This thesis reports the rationale and design of two studies and findings of three studies aimed to improve health outcomes of frail older adults and their caregivers. The second and third chapters of this thesis describe the protocol and results of a review aims to identify the effect of interventions targeting frailty, the review found that physical activity and medication management are the most effective frailty interventions. The fourth chapter describes a study examining the possibility of comparing a complex intervention to usual care in frail older adults undergoing joint replacements. The fifth chapter showed that a primary care intervention did not improve the caregivers’ health outcome. The sixth chapter presents the fracture rating scale, a valid tool for identifying Long-term care residents at risk of hip fracture in three Canadian provinces. These findings aim to improve the care for older adults and their caregivers.

Applied behavior analysis (ABA) is the gold standard treatment for autism spectrum disorder (ASD), and caregivers can learn to use ABA strategies to teach skills to their children with ASD. However, some families may not be able to access synchronous training due to cost, time, or location. Asynchronous modalities, such as DVDs or internet modules, remove some of these barriers. Other asynchronous options like podcasts need additional efficacy research. We evaluated a brief podcast about positive reinforcement with three caregivers and their children with ASD. We measured correct implementation of positive reinforcement and percentage correct on a multiple-choice quiz. The caregiver's implementation of positive reinforcement was assessed with a confederate and their child before and after listening to the podcast. If the caregiver's performance did not reach the mastery criterion, we provided modeling and coaching. Two of the caregivers implemented positive reinforcement at mastery after listening to the podcast. One caregiver needed modeling and coaching. All three responded correctly to more questions on the quiz after the podcast. These preliminary data suggest that a podcast may teach ABA strategies like positive reinforcement to caregivers of children with ASD, which could reduce some barriers to accessing training.

Bakgrund Under 2021 drabbades ungefär 1400 personer i Sverige av en tumör i det centrala nervsystemet, vilket ledde till 675 dödsfall. Hjärntumörer kan orsaka svåra symtom som huvudvärk, aptitförlust, personlighetsförändringar och psykiska problem. Sjuksköterskan ansvarar då för att hjälpa patienten men också att stödja de anhöriga som går igenom en utmanande tid. I och med att patientens självständighet minskar, hamnar anhöriga ofta i en ny roll med ökat ansvar. Detta understryker behovet av att belysa anhörigas upplevelser och stödja dem på ett värdigt sätt. Syfte Syftet med studien var att belysa anhörigvårdarens upplevelser av att vårda en patient med hjärntumör. Metod En icke-systematisk litteraturöversikt baserad på 10 vetenskapliga artiklar. Sökningarna gjordes på PubMed och CINAHL. De valda artiklarna granskades Sophiahemmet högskolas bedömningsmall. En integrerad analys användes för att analysera och sammanställa resultatet. Resultat Fyra kategorier framkom efter analysen av materialet. Dessa var vårdgivarens börda, känslomässiga reaktioner, relationer samt stöd. Resultatet visade att anhöriga hade mycket negativa upplevelser från att ha vårdat sina anhöriga med hjärntumörer. Anhörigvårdare upplevde omfattande förändringar i vardagen, där de fick andra ansvar som de inte haft tidigare vilka krävde tid, energi och tillgänglighet. Denna förändring medförde starka känslomässiga reaktioner, förändringar i relationer och ett stort stödbehov. Slutsats De anhörigas upplevelser var främst negativa och de skulle behöva mer stöd och hjälp för att klara av den befintliga situationen bättre. Litteraturöversikten identifierade att de anhöriga upplevde starka känslomässiga reaktioner, förändringar i relationer, en börda i det ansvar de behöver ta och ett behov av mer stöd. Med denna ökade kunskap och förståelse kan vårdpersonalen hjälpa till och förhoppningsvis också lyckas minska de negativa konsekvenserna. / Background During 2021, approximately 1400 people in Sweden were diagnosed with central nervous system tumors, resulting in 675 deaths. Brain tumors can cause severe symptoms such as headaches, decreased appetite, personality changes and psychological problems. Nurses are responsible to help the patient and supporting the family during this challenging time. As the patient's independence diminishes, relatives often find themselves in a new role with increased responsibilities. This highlights the need to illuminate the experiences of family members and support them in a dignified manner. Aim This study aims to explore family caregivers' experiences of taking care of a patient with a brain tumor. Method A non-systematic review of 10 studies was conducted using PubMed and CINAHL databases. The selected articles were reviewed using an assessment template. An integrated analysis was used to analyze and compile the results. Results Four categories emerged after the analysis of the material. These were caregiver burden, emotional reactions, relationships, and support. The results showed that relatives had very negative experiences from caring for their relatives with brain tumors. Family caregivers experienced extensive changes in their everyday lives, where they were given other responsibilities they had not previously had, requiring time, energy, and availability. This change brought strong emotional reactions, changes in relationships, and a great need for support. Conclusions The family's experiences were mainly negative and they would need more support and help to be able to cope with the situation they have been put in in a better way. The literature review identified that the family experienced strong emotional reactions, changes in relationships, a burden in new responsibilities they got and a need for more support. With this increased knowledge and understanding, the healthcare staff can help and hopefully also succeed in reducing the negative consequences.

<p dir="ltr">ABSTRACT</p><p dir="ltr">Individuals with autism spectrum disorder (ASD) experience deficits in social communication skills, but the literature suggests that addressing early communication at a young age can result in a myriad of positive outcomes later in life. Early intervention and intensive applied behavior analysis therapy have become commonplace for many, but those supports are costly and may not be accessible to all. Additionally, even for those that do have access, an emphasis is being placed on caregiver-mediated interventions (CMIs) that can be implemented outside of sessions with service providers. Research indicates that CMIs can help children generalize skills to routines and contexts within their natural home environment. CMIs that directly target natural play routines, such as Enhanced Milieu Teaching (EMT), have been repeatedly implemented successfully by caregivers to improve both caregiver implementation outcomes and child expressive communication.</p><p dir="ltr">Despite the benefits, most CMI interventions for children with ASD have been delivered primarily to mothers, although fathers have reported that they also want access to supports. Barriers that prevent all caregivers from engaging in CMIs are extensive, but additional hurdles exist for fathers, including providers not prioritizing their access to relevant information, inflexible in-person session hours, and provider biases. Many of these barriers can be addressed through the use of modifications and teleahealth service delivery. This study aimed to explore the effectiveness of a father-mediated telehealth EMT intervention delivered via a collaborative practice-based coaching (PBC) partnership. We incorporated modifications to meet the specific needs and desires of fathers, including short weekly coaching sessions over Zoom, flexible scheduling inside and outside of traditional business hours, initial background information on ASD and the principles of operant conditioning, a focus on typical father-child play routines, asynchronous supports to supplement coaching sessions, and video training models of fathers acting as the intervention agent. Two father-child dyads completed the study, which utilized a multiple baseline across behaviors design with four intervention tiers to teach separate EMT implementation strategies. Fathers uploaded two 5-min videos engaging with their child in a chosen play routine each week, and implementation fidelity and child expressive communication were coded. Visual analysis of father data and descriptive analysis of child communication was used to determine the effects of the intervention. Additionally, father well-being and ASD knowledge were assessed via pretest and posttest surveys.</p><p dir="ltr">Results indicate that fathers can successfully implement the EMT intervention with their children with ASD. As a result of improvements in father implementation, substantial increases in child expressive communication occurred. However, the intervention may not have had an influence on father well-being outcomes, as survey responses improved for one participant but worsened for the other. This study provides evidence that EMT delivered to caregivers–and particularly fathers–via telehealth-based PBC may be ideal to address the needs of children with ASD and their families.</p>

Yes / A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers (Community Occupational Therapy in Dementia (COTiD)) was found clinically and cost effective in the Netherlands but not in Germany. This highlights the need to adapt and implement complex interventions to specific national contexts. The current trial aims to evaluate the United Kingdom-adapted occupational therapy intervention for people with mild to moderate dementia and their family carers living in the community (COTiD-UK) compared with treatment as usual. Methods/Design This study is a multi-centre, parallel-group, pragmatic randomised trial with internal pilot. We aim to allocate 480 pairs, with each pair comprising a person with mild to moderate dementia and a family carer, who provides at least 4 hours of practical support per week, at random between COTiD-UK and treatment as usual. We shall assess participants at baseline, 12 and 26 weeks, and by telephone at 52 and 78 weeks (first 40 % of recruits only) after randomisation. The primary outcome measure is the Bristol Activities of Daily Living Scale (BADLS) at 26 weeks. Secondary outcome measures will include quality of life, mood, and resource use. To assess intervention delivery, and client experience, we shall collect qualitative data via audio recordings of COTiD-UK sessions and conduct semi-structured interviews with pairs and occupational therapists. Discussion COTiD-UK is an evidence-based person-centred intervention that reflects the current priority to enable people with dementia to remain in their own homes by improving their capabilities whilst reducing carer burden. If COTiD-UK is clinically and cost effective, this has major implications for the future delivery of dementia services across the UK. / This is independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0610-10108). The VALID research team acknowledges the support of the National Institute of Health Research Clinical Research Network. This research is sponsored by North East London NHS Foundation Trust (NELFT).

Yes / People living with dementia vary in awareness of their abilities. We explored awareness of the condition and diagnosis in people with mild-to-moderate dementia, and how this relates to quality of life, well-being, life satisfaction, and caregiver stress. This study was a cross-sectional exploratory analysis of data from the IDEAL cohort, which recruited people with dementia living at home and available caregivers from 29 research sites in Great Britain. Our study included 917 people with mild-to-moderate dementia and 755 carers. Low and high awareness groups were derived from self-reported responses to a dementia representation measure. Logistic regression was used to explore predictors of awareness of condition and diagnosis using demographic, cognitive, functional and psychological measures, and the relationship with quality of life, well-being and life satisfaction (‘living well’), and caregiver stress. There were 83 people with low awareness of their condition. The remaining 834 people showed some awareness and 103 of these had high awareness of their condition and diagnosis. Psychosocial factors were stronger predictors of awareness than cognitive and functional ability. Those with higher awareness reported lower mood, and lower scores on indices of living well as well as lower optimism, self-efficacy and self-esteem. Low awareness was more likely in those aged 80y and above, and living in more socially deprived areas. No relationship was seen between caregiver stress and awareness. Awareness of the condition and diagnosis varies in people with mild-to-moderate dementia and is relevant to the capability to live well. Awareness should be considered in person-centered clinical care.

Dans les centres d’hébergement et de soins de longue durée (CHSLD), jusqu’à 80 % des personnes admises vivent avec une démence (Conseil des aînés, 2007). Parmi ces personnes âgées, plusieurs crient. Ce comportement a fait l’objet de quelques études, mais ces études ne fournissent pas une compréhension des sens de ces cris qui pourrait orienter le choix d’interventions face à ces personnes et leur entourage. À l’aide de la perspective infirmière de Leininger (2001) et de la théorie de la communication et des interactions à l’intérieur de triades d’Adams et Gardiner (2005), le but de cette étude était de décrire les sens des cris de personnes âgées vivant avec une démence et les facteurs les influençant en tenant compte de la perspective des personnes âgées, de leurs aidants familiaux et de leurs soignants. Pour atteindre ce but, l’ethnographie critique a été choisie comme méthode. L’étude s’est découlée dans un CHSLD au sein duquel sept triades, composées de personnes âgées vivant avec une démence qui crient, d’aidants familiaux principaux et de soignants, ont été recrutées selon un échantillonnage théorique. Diverses méthodes de collecte des données ont été utilisées dont l’observation des personnes âgées et du milieu et des entrevues semi-dirigées auprès des aidants et soignants. L’analyse des données a été effectuée à l’aide des quatre approches proposées par Spradley (1979) soit l’analyse : des domaines, taxonomique, componentielle et thématique. Les résultats ont permis d’identifier des thèmes sur les sens des cris et sur les facteurs influençant ceux-ci. Les cris peuvent avoir pour sens la vulnérabilité, la souffrance et la perte de sens vécues par la personne âgée. Ce comportement peut aussi indiquer diverses finalités, par exemple l’expression d’insatisfactions ou d’émotions. Ces finalités peuvent être distinguées à partir de critères de modulation tels que la prévisibilité des cris ou un faciès émotif. Par ailleurs, divers aspects rendent les sens des cris singuliers. La stabilité et la flexibilité dans la façon d’organiser les soins ainsi que l’effet réciproque entre les personnes âgées qui crient et les autres personnes dans le CHSLD se sont dégagées comme étant des facteurs qui influencent les sens des cris. Il s’est aussi révélé que les cris de chaque personne âgée peuvent être considérés comme un langage unique que les aidants et les soignants sont en mesure d’apprendre et qui influence l’interprétation des sens des cris. L’accompagnement de la personne âgée, en tenant compte de ses volontés, ses besoins et de sa personnalité, les fluctuations dans les relations de pouvoir au sein des triades personnes âgées-aidants-soignants et les sentiments d’impuissance et de culpabilité des aidants et des soignants sont d’autres facteurs qui influencent les cris. Les connaissances découlant de cette étude augmentent la compréhension sur les sens des cris des personnes âgées vivant avec une démence. Elles ont des implications pour les divers champs d’activités des infirmières et qui pourront contribuer à offrir des soins culturellement cohérents et caring pour les personnes âgées vivant avec une démence et leur entourage. / Eighty percent of people admitted in nursing homes live with dementia (Conseil des aînés, 2007). Many of these elderly persons scream. Research on this population does not provide a useful basis for understanding this behavior which would enable to guide the choice of appropriate interventions to help the elderly and the people who hear them. The purpose of this research was to describe –with the help of elderly persons, their family and their professional caregivers– the meanings of screams in the elderly with dementia and their influencing factors, using Leininger’s (2001) nursing perspective and Adams and Gardiner’s (2005) theory of communication and interaction within dementia care triads. Critical ethnography was selected as the research design. Seven triads –composed of elderly persons with dementia that scream, primary family caregivers, and formal caregivers– were recruited from a nursing home according to a theoretical sampling procedure. Various data collection methods were used, particularly, the observation of elderly persons and their environment as well as semi-structured interviews with their family and formal caregivers. Spradley’s (1979) four types of ethnographic analysis: domains, taxonomic, componential and themes analysis were used. The results lead to emergent themes on the meanings of screams and on their influencing factors. The meanings of screams can be related to the vulnerability, suffering, and loss of meaning experienced by the elderly. This behavior can also represent various final outcomes, for example, the expression of dissatisfaction or of emotions. These outcomes can be differentiated by modulation criteria such as predictability of screams or emotional facial expressions. Various aspects of the meanings of screams make them singular. Some factors that influence the meanings of screams are the stability and flexibility of nursing care and the effect that the elderly who scream and the persons in the nursing home surrounding them have on each other. The screams of each person also prove to be a unique language that can be learned by family and formal caregivers which can in turn change the interpretation of the screams. Other influencing factors are the respect of the wishes, needs, and personality of the elderly person, fluctuations in power relations within the elderly-family-caregivers triads and feelings of powerlessness and guilt in family and formal caregivers. Knowledge generated by this study increases our understanding on the meanings of screams in elderly persons with dementia. It has implications for research, education, clinical practice and management that could contribute to caring and culturally congruent care for elderly persons with dementia and the people around them.

Le Programme des aides familiales résidantes (PAFR) a été en vigueur de 1992 jusqu’au 30 novembre 2014. Il s’agit d’un programme fédéral canadien par lequel des femmes originaires des Philippines en majorité et ayant obtenu un diplôme d’études postsecondaires migraient partout au Canada. Sous ce programme, celles-ci se retrouvaient avec un statut de migrante temporaire. Elles avaient la possibilité d’obtenir leur résidence permanente après avoir complété 24 mois de travail en tant qu’aides familiales. Elles devaient travailler au domicile privé d’un employeur dont le nom était inscrit sur leur permis de travail, chez qui elles avaient aussi l’obligation de résidence. En travaillant en tant qu’aides familiales résidantes, ces femmes étaient et sont toujours placées dans une situation de déqualification professionnelle inévitable qui semble se prolonger à long terme. Cette situation est notamment attribuable à la non-reconnaissance de leurs qualifications étrangères ainsi qu’à la structure du PAFR. Cette recherche porte donc sur le parcours de requalification professionnelle de ces migrantes, que certaines utilisent comme stratégie pour remédier à cette situation. En plus de s’intéresser à leur période de travail en tant qu’aides familiales résidantes, cette recherche étudie le parcours de requalification professionnelle en quatre étapes : la décision de participer à la formation ; le choix de l’orientation professionnelle ; le déroulement des études ; l’accès à un emploi correspondant à la formation. L’objectif est de connaître l’impact qu’aura le passage de celles-ci par le PAFR, sur leur parcours de requalification. Les résultats obtenus à l’aide de onze entretiens semi-dirigés, avec des femmes étant venues à Montréal par le programme, montrent qu’à long terme, le diplôme obtenu localement peut améliorer une situation professionnelle, mais ce n’est pas une garantie. Des obstacles comme l’isolement ainsi que l’impossibilité pour ces femmes de se construire un capital financier et social persistent et affectent toutes celles ayant migré sous le programme, qu’elles aient fait un retour aux études ou non. / The Live-in caregiver program was in place from 1992 until November 30st 2014. The program is a Canadian federal program whereby women native mainly from the Philippines and who have obtained a post-secondary degree, have migrated across Canada. Under this program, they were granted with the temporary migrants status. They had the possibility of a permanent residency after having completed 24 months of employment as a caregiver. They had to work at a private residency where the name of the employer was indicated on their work permit, where they were required to live. By working as a caregiver, these women were and are always placed in a situation of professional deskilling that seems to extend in long-term. This situation is due partly to the non-recognition of their foreign qualifications and LCP structure. This research therefore focuses on the course of professional requalification of these migrants, that some of them use as a strategy to remedy to the situation. In addition to looking at the period of work as live-in caregivers, this research studies the course of their professional requalification in four stages: decision to undergo training, career choices, training process and access to employment related to that training. The objective of this research is to explore the impact that their path under the LCP will have on the course of their professional requalification. The results obtained from interviews with women having come to Montreal by the program indicate that in the long term, the degree obtained locally can improve their professional situation, but it’s not a guarantee. Obstacles like the isolation created by the LCP and the impossibility for these women to build financial and social capital, affect all of these women, women who have returned to studies and those who have not.

Dans les centres d’hébergement et de soins de longue durée (CHSLD), jusqu’à 80 % des personnes admises vivent avec une démence (Conseil des aînés, 2007). Parmi ces personnes âgées, plusieurs crient. Ce comportement a fait l’objet de quelques études, mais ces études ne fournissent pas une compréhension des sens de ces cris qui pourrait orienter le choix d’interventions face à ces personnes et leur entourage. À l’aide de la perspective infirmière de Leininger (2001) et de la théorie de la communication et des interactions à l’intérieur de triades d’Adams et Gardiner (2005), le but de cette étude était de décrire les sens des cris de personnes âgées vivant avec une démence et les facteurs les influençant en tenant compte de la perspective des personnes âgées, de leurs aidants familiaux et de leurs soignants. Pour atteindre ce but, l’ethnographie critique a été choisie comme méthode. L’étude s’est découlée dans un CHSLD au sein duquel sept triades, composées de personnes âgées vivant avec une démence qui crient, d’aidants familiaux principaux et de soignants, ont été recrutées selon un échantillonnage théorique. Diverses méthodes de collecte des données ont été utilisées dont l’observation des personnes âgées et du milieu et des entrevues semi-dirigées auprès des aidants et soignants. L’analyse des données a été effectuée à l’aide des quatre approches proposées par Spradley (1979) soit l’analyse : des domaines, taxonomique, componentielle et thématique. Les résultats ont permis d’identifier des thèmes sur les sens des cris et sur les facteurs influençant ceux-ci. Les cris peuvent avoir pour sens la vulnérabilité, la souffrance et la perte de sens vécues par la personne âgée. Ce comportement peut aussi indiquer diverses finalités, par exemple l’expression d’insatisfactions ou d’émotions. Ces finalités peuvent être distinguées à partir de critères de modulation tels que la prévisibilité des cris ou un faciès émotif. Par ailleurs, divers aspects rendent les sens des cris singuliers. La stabilité et la flexibilité dans la façon d’organiser les soins ainsi que l’effet réciproque entre les personnes âgées qui crient et les autres personnes dans le CHSLD se sont dégagées comme étant des facteurs qui influencent les sens des cris. Il s’est aussi révélé que les cris de chaque personne âgée peuvent être considérés comme un langage unique que les aidants et les soignants sont en mesure d’apprendre et qui influence l’interprétation des sens des cris. L’accompagnement de la personne âgée, en tenant compte de ses volontés, ses besoins et de sa personnalité, les fluctuations dans les relations de pouvoir au sein des triades personnes âgées-aidants-soignants et les sentiments d’impuissance et de culpabilité des aidants et des soignants sont d’autres facteurs qui influencent les cris. Les connaissances découlant de cette étude augmentent la compréhension sur les sens des cris des personnes âgées vivant avec une démence. Elles ont des implications pour les divers champs d’activités des infirmières et qui pourront contribuer à offrir des soins culturellement cohérents et caring pour les personnes âgées vivant avec une démence et leur entourage. / Eighty percent of people admitted in nursing homes live with dementia (Conseil des aînés, 2007). Many of these elderly persons scream. Research on this population does not provide a useful basis for understanding this behavior which would enable to guide the choice of appropriate interventions to help the elderly and the people who hear them. The purpose of this research was to describe –with the help of elderly persons, their family and their professional caregivers– the meanings of screams in the elderly with dementia and their influencing factors, using Leininger’s (2001) nursing perspective and Adams and Gardiner’s (2005) theory of communication and interaction within dementia care triads. Critical ethnography was selected as the research design. Seven triads –composed of elderly persons with dementia that scream, primary family caregivers, and formal caregivers– were recruited from a nursing home according to a theoretical sampling procedure. Various data collection methods were used, particularly, the observation of elderly persons and their environment as well as semi-structured interviews with their family and formal caregivers. Spradley’s (1979) four types of ethnographic analysis: domains, taxonomic, componential and themes analysis were used. The results lead to emergent themes on the meanings of screams and on their influencing factors. The meanings of screams can be related to the vulnerability, suffering, and loss of meaning experienced by the elderly. This behavior can also represent various final outcomes, for example, the expression of dissatisfaction or of emotions. These outcomes can be differentiated by modulation criteria such as predictability of screams or emotional facial expressions. Various aspects of the meanings of screams make them singular. Some factors that influence the meanings of screams are the stability and flexibility of nursing care and the effect that the elderly who scream and the persons in the nursing home surrounding them have on each other. The screams of each person also prove to be a unique language that can be learned by family and formal caregivers which can in turn change the interpretation of the screams. Other influencing factors are the respect of the wishes, needs, and personality of the elderly person, fluctuations in power relations within the elderly-family-caregivers triads and feelings of powerlessness and guilt in family and formal caregivers. Knowledge generated by this study increases our understanding on the meanings of screams in elderly persons with dementia. It has implications for research, education, clinical practice and management that could contribute to caring and culturally congruent care for elderly persons with dementia and the people around them.