The meanings of screams in older people living with dementia in a nursing home

Background: Screaming is common among older persons living with dementia in nursing homes. Research on this population has not provided a useful basis for understanding such behavior that could help determine appropriate interventions. The purpose of this study was to explore the meanings of screams in older people living with dementia and their influencing factors. Methods: Critical ethnography was selected as the research design. Seven triads, each composed of an older person living with dementia who screamed, a primary family caregiver, and one or two formal caregivers, were recruited in a nursing home. Various data collection methods and Spradley's (1979) ethnographic analysis were used. Results: Screaming is related to vulnerability, suffering, and loss of meaning experienced by older persons. This singular behavior also expresses various final outcomes that can be differentiated through modulation criteria. The meanings of screams are influenced by stability and flexibility in the nursing care organization and reciprocal effects between older persons who scream and others in the nursing home environment. Each person's screams constitute a unique language that can be learned. Other influencing factors include respect for the older person's wishes, needs, and personality, shifts in power relations within the triad, and feelings of powerlessness and guilt in family and formal caregivers. Conclusions: This study advances knowledge of the meanings of screams in older persons living with dementia. It has implications for and offers insight on culturally congruent care for older persons living with dementia and the people around them.