Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-14T07:24:59.703Z Has data issue: false hasContentIssue false
  • English
  • Français

Study protocol for a randomized controlled trial of humor therapy in residential care: the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE)

Published online by Cambridge University Press:  14 May 2012

Belinda Goodenough ,
Lee-Fay Low ,
Anne-Nicole Casey ,
Lynn Chenoweth ,
Richard Fleming ,
Peter Spitzer ,
Jean-Paul Bell  and
Henry Brodaty
Belinda Goodenough
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
Lee-Fay Low*
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
Anne-Nicole Casey
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
Lynn Chenoweth
Affiliation:
Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Sydney, New South Wales, Australia South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
Richard Fleming
Affiliation:
NSW/ACT Dementia Training Study Centre, University of Wollongong, Wollongong, New South Wales, Australia
Peter Spitzer
Affiliation:
The Humour Foundation, Chatswood, New South Wales, Australia
Jean-Paul Bell
Affiliation:
Arts Health Institute, Newcastle, New South Wales, Australia
Henry Brodaty
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, New South Wales, Australia
*
Correspondence should be addressed to: Dr. Lee-Fay Low, Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia. Phone: +61 2 93852599; Fax: + 61 2 93852200. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Humor therapy is a non-pharmacological intervention with potential to improve mood and quality of life for institutionalized older persons, including those with dementia. The primary aims of the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) are to examine the effects of humor therapy on residents’ mood, quality of life, social engagement, and agitation.

Methods: SMILE is a single-blinded cluster-randomized controlled trial where 398 consented residents in 35 residential aged care facilities will be allocated to receive humor therapy or usual care. Residents allocated to the intervention group will engage in humor therapy with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine two-hour sessions over 12 weeks as well as engaging humorously with LaughterBosses during the course of daily care. The usual care control group will not engage in any formal humor therapy. Researchers, blind to treatment allocation, will assess residents at baseline (week 0), post-intervention (week 13), and follow-up (week 26). The measurement suite includes the Cornell Scale for Depression in Dementia, the Dementia Quality of Life Scale, the Multidimensional Observation Scale for Elderly Subjects, the Cohen-Mansfield Agitation Inventory, and the Neuropsychiatric Inventory. Observations of residents’ engagement will be recorded at each humor therapy session.

Conclusions: SMILE is the first large rigorous study of humor therapy in aged care.

Keywords

aged carenursing homedementiabehavioral and psychological symptoms of dementia (BPSD)psychosocial interventions
Type
PROTOCOL-ONLY PAPER
Information
International Psychogeriatrics , Volume 24 , Issue 12 , December 2012 , pp. 2037 - 2044
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopolous, G., Abrams, R., Young, R. and Shamoian, C. (1988). Scale for depression in dementia. Biological Psychiatry, 23, 271–284.Google Scholar
Association for Applied and Therapeutic Humor (2000). Association for Applied and Therapeutic Humor. Available at: http://www.aath.org/general-information; last accessed 20 April, 2012.Google Scholar
Ayalon, L., Gum, A. M., Feliciano, L. and Areán, P. A. (2006). Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Archives of Internal Medicine, 166, 2182–2188.CrossRefGoogle ScholarPubMed
Banerjee, S. et al. (2006). Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia. Journal of Neurology, Neurosurgery and Psychiatry, 77, 146–148.Google Scholar
Bennett, M., Zeller, J., Rosenberg, L. and McCAnn, J. (2003). The effect of mirthful laughter on stress and natural killer cell activity. Alternative Therapies in Health and Medicine, 9, 38–44.Google ScholarPubMed
Berk, R. A. (2001). The active ingredients in humor: psychophysiological benefits and risks for older adults. Educational Gerontology, 27, 323–339.Google Scholar
Boyd, R. and McGuire, F. (1996). The efficacy of humor in improving psychological well-being of residents of long-term care facilities. Journal of Leisurability, 23, 1–15.Google Scholar
Braithwaite, J. (2001). Regulating nursing homes: the challenge of regulating care for older people in Australia. BMJ, 323, 443–446.Google Scholar
Brodaty, H., Draper, B. and Low, L. F. (2003). Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work. Journal of Advanced Nursing, 44, 583–590.CrossRefGoogle ScholarPubMed
Brodaty, H. et al. (2001). Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504–512.Google Scholar
Celso, B. G., Ebener, D. J. and Burkhead, E. J. (2003). Humor, coping, health status, and life satisfaction among older adults residing in assisted living facilities. Aging and Mental Health, 7, 438–445.Google Scholar
Chenoweth, L. et al. (2009). Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. The Lancet Neurology, 8, 317–325.Google Scholar
Cohen-Mansfield, J. (1989). A description of agitation in a nursing home. Journal of Gerontology, 44, M77–M84.Google Scholar
Cullen, D. (2007). The financial impact of entering aged care. Australasian Journal on Ageing, 26, 145–147.CrossRefGoogle Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
DPS Publishing (2010). DPS Guide to Aged Care: NSW & ACT. Adelaide, Australia: DPS Publishing.Google Scholar
Fleming, R. (2011). An environmental audit tool suitable for use in homelike facilities for people with dementia. Australasian Journal on Ageing, 30, 108–112.CrossRefGoogle ScholarPubMed
Galik, E. M., Resnick, B. and Pretzer-Aboff, I. (2009). ‘Knowing what makes them tick’: motivating cognitively impaired older adults to participate in restorative care. International Journal of Nursing Practice, 15, 48–55.CrossRefGoogle ScholarPubMed
Hawkins, D. B. and Graff-Radford, N. R. (2007). The ability to pun may be retained in Alzheimer disease. Neurocase, 13, 50–54.Google Scholar
Hayes, R. J. and Bennett, S. (1999). Simple sample size calculation for cluster-randomized trials. International Journal of Epidemiology, 28, 319–326.Google Scholar
Helmes, E., Csapo, K. and Short, J. A. (1987). Standardization and validation of the Multidimensional Observation Scale for Elderly Subjects (MOSES). Journal of Gerontology, 42, 395–405.Google Scholar
Houston, D. M., McKee, K. J., Carroll, L. and Marsh, H. (1998). Using humour to promote psychological wellbeing in residential homes for older people. Aging and Mental Health, 2, 328–332.Google Scholar
Isola, A. and Astedt-Kurki, P. (1997). Humour as experienced by patients and nurses in aged nursing in Finland. International Journal of Nursing Practice, 3, 29–33.Google Scholar
Jorm, A. F., Mackinnon, A. J., Christensen, H., Henderson, A. S., Jacomb, P. A. and Korten, A. (1997). The Psychogeriatric Assessment Scales (PAS): further data on psychometric properties and validity. International Journal of Geriatric Psychiatry, 12, 93–100.3.0.CO;2-C>CrossRefGoogle ScholarPubMed
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Martin, R. (2004). Sense of humor and physical health: theoretical issues, recent findings, and future directions. Humor, 17, 1–19.Google Scholar
Murray, D. M. (1998). Design and Analysis of Group-Randomised Trials. Oxford: Oxford University Press.Google Scholar
Peacock, L. (2009). Serious Play. Chicago: Intellect.Google Scholar
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google Scholar
Richardson, S. and Martin, B. (2004). The Care of Older Australians: A Picture of the Residential Aged Care Workforce. Adelaide, Australia: The National Institute of Labour Studies.Google Scholar
Ronnberg, L. (1998). Quality of life in nursing-home residents: an intervention study of the effect of mental stimulation through an audiovisual programme. Age and Ageing, 27, 393–397.Google Scholar
Shahidi, M. et al. (2011). Laughter yoga versus group exercise program in elderly depressed women: a randomized controlled trial. International Journal of Geriatric Psychiatry, 26, 322–327.Google Scholar
Shammi, P. and Stuss, D. (2003). The effects of normal aging on humor appreciation. Journal of the International Neuropsychological Society, 9, 855–863.Google Scholar
Snowdon, J. and Fleming, R. (2008). Recognising depression in residential facilities: an Australian challenge. International Journal of Geriatric Psychiatry, 23, 295–600.Google Scholar
Spitzer, P. (2011). The laughterboss. In Adams, T. and Lee, H. (eds.), Creative Approaches in Dementia Care (pp. 32–53) New York: Palgrave MacMillan.CrossRefGoogle Scholar
Thomson, R. (2005). Evaluation of the use of a clown therapy group with dementia sufferers. NHS Borders Psychological Services, 3–4.Google Scholar
Tse, M. Y., Lo, A. P. K., Cheng, T. L. Y., Chan, E. K. K., Chan, A. H. Y. and Chung, H. S. W. (2010). Humor therapy: relieving chronic pain and enhancing happiness for older adults. Journal of Ageing Research, doi: 10.4061/2010/343574.Google Scholar