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The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes

Journal Article


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Abstract


  • Objectives: To determine whether humour therapy

    reduces depression (primary outcome), agitation and

    behavioural disturbances and improves social

    engagement and quality-of-life in nursing home

    residents.

    Design: The Sydney Multisite Intervention of

    LaughterBosses and ElderClowns study was a singleblind

    cluster randomised controlled trial of humour

    therapy.

    Setting: 35 Sydney nursing homes.

    Participants: All eligible residents within geographically

    defined areas within each nursing home were invited to

    participate.

    Intervention: Professional ‘ElderClowns’ provided

    9–12 weekly humour therapy sessions, augmented by

    resident engagement by trained staff ‘LaughterBosses’.

    Controls received usual care.

    Measurements: Depression scores on the Cornell

    Scale for Depression in Dementia, agitation scores on the

    Cohen-Mansfield Agitation Inventory, behavioural

    disturbance scores on the Neuropsychiatric Inventory,

    social engagement scores on the withdrawal subscale of

    Multidimensional Observation Scale for Elderly Subjects,

    and self-rated and proxy-rated quality-of-life scores on a

    health-related quality-of-life tool for dementia, the

    DEMQOL. All outcomes were measured at the participant

    level by researchers blind to group assignment.

    Randomisation: Sites were stratified by size and level

    of care then assigned to group using a random number

    generator.

    Results: Seventeen nursing homes (189 residents)

    received the intervention and 18 homes (209 residents)

    received usual care. Groups did not differ significantly

    over time on the primary outcome of depression, or on

    behavioural disturbances other than agitation, social

    engagement and quality of life. The secondary outcome

    of agitation was significantly reduced in the intervention

    group compared with controls over 26 weeks (time by

    group interaction adjusted for covariates: p=0.011). The

    mean difference in change from baseline to 26 weeks in

    Blom-transformed agitation scores after adjustment for

    covariates was 0.17 (95% CI 0.004 to 0.34, p=0.045).

    Conclusions: Humour therapy did not significantly

    reduce depression but significantly reduced agitation.

Authors


  •   Low, Lee-Fay (external author)
  •   Brodaty, Henry (external author)
  •   Goodenough, Belinda J.
  •   Spitzer, Peter (external author)
  •   Bell, Jean-Paul (external author)
  •   Fleming, Richard
  •   Casey, Anne-Nicole (external author)
  •   Liu, Zhihui (external author)
  •   Chenoweth, Lynn (external author)

Publication Date


  • 2013

Citation


  • Low, L., Brodaty, H., Goodenough, B., Spitzer, P., Bell, J., Fleming, R., Casey, A., Liu, Z. & Chenoweth, L. (2013). The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes. BMJ Open, 3 (1), e002072 - 1-e002072 - 10.

Scopus Eid


  • 2-s2.0-84873437442

Ro Full-text Url


  • http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1210&context=ahsri

Ro Metadata Url


  • http://ro.uow.edu.au/ahsri/204

Has Global Citation Frequency


Start Page


  • e002072 - 1

End Page


  • e002072 - 10

Volume


  • 3

Issue


  • 1

Place Of Publication


  • United Kingdom

Abstract


  • Objectives: To determine whether humour therapy

    reduces depression (primary outcome), agitation and

    behavioural disturbances and improves social

    engagement and quality-of-life in nursing home

    residents.

    Design: The Sydney Multisite Intervention of

    LaughterBosses and ElderClowns study was a singleblind

    cluster randomised controlled trial of humour

    therapy.

    Setting: 35 Sydney nursing homes.

    Participants: All eligible residents within geographically

    defined areas within each nursing home were invited to

    participate.

    Intervention: Professional ‘ElderClowns’ provided

    9–12 weekly humour therapy sessions, augmented by

    resident engagement by trained staff ‘LaughterBosses’.

    Controls received usual care.

    Measurements: Depression scores on the Cornell

    Scale for Depression in Dementia, agitation scores on the

    Cohen-Mansfield Agitation Inventory, behavioural

    disturbance scores on the Neuropsychiatric Inventory,

    social engagement scores on the withdrawal subscale of

    Multidimensional Observation Scale for Elderly Subjects,

    and self-rated and proxy-rated quality-of-life scores on a

    health-related quality-of-life tool for dementia, the

    DEMQOL. All outcomes were measured at the participant

    level by researchers blind to group assignment.

    Randomisation: Sites were stratified by size and level

    of care then assigned to group using a random number

    generator.

    Results: Seventeen nursing homes (189 residents)

    received the intervention and 18 homes (209 residents)

    received usual care. Groups did not differ significantly

    over time on the primary outcome of depression, or on

    behavioural disturbances other than agitation, social

    engagement and quality of life. The secondary outcome

    of agitation was significantly reduced in the intervention

    group compared with controls over 26 weeks (time by

    group interaction adjusted for covariates: p=0.011). The

    mean difference in change from baseline to 26 weeks in

    Blom-transformed agitation scores after adjustment for

    covariates was 0.17 (95% CI 0.004 to 0.34, p=0.045).

    Conclusions: Humour therapy did not significantly

    reduce depression but significantly reduced agitation.

Authors


  •   Low, Lee-Fay (external author)
  •   Brodaty, Henry (external author)
  •   Goodenough, Belinda J.
  •   Spitzer, Peter (external author)
  •   Bell, Jean-Paul (external author)
  •   Fleming, Richard
  •   Casey, Anne-Nicole (external author)
  •   Liu, Zhihui (external author)
  •   Chenoweth, Lynn (external author)

Publication Date


  • 2013

Citation


  • Low, L., Brodaty, H., Goodenough, B., Spitzer, P., Bell, J., Fleming, R., Casey, A., Liu, Z. & Chenoweth, L. (2013). The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes. BMJ Open, 3 (1), e002072 - 1-e002072 - 10.

Scopus Eid


  • 2-s2.0-84873437442

Ro Full-text Url


  • http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1210&context=ahsri

Ro Metadata Url


  • http://ro.uow.edu.au/ahsri/204

Has Global Citation Frequency


Start Page


  • e002072 - 1

End Page


  • e002072 - 10

Volume


  • 3

Issue


  • 1

Place Of Publication


  • United Kingdom