Elder-Clowning in Long-Term Dementia Care: Results of a Pilot Study

Pia Kontos; Karen-Lee Miller; Romeo Colobong; Luis I Palma Lazgare; Malcolm Binns; Lee-Fay Low; Claire Surr; Gary Naglie

doi:10.1111/jgs.13941

Elder-Clowning in Long-Term Dementia Care: Results of a Pilot Study

J Am Geriatr Soc. 2016 Feb;64(2):347-53. doi: 10.1111/jgs.13941.

Authors

Pia Kontos^{1

2}, Karen-Lee Miller^{1

2}, Romeo Colobong¹, Luis I Palma Lazgare², Malcolm Binns^{2

3}, Lee-Fay Low⁴, Claire Surr⁵, Gary Naglie^{1

3

6

7

8}

Affiliations

¹ Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario.
² Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
³ Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada.
⁴ Faculty of Health Sciences, University of Sydney, Sydney, Australia.
⁵ Institute for Health and Wellbeing, Leeds Beckett University, Leeds, UK.
⁶ Department of Medicine, University of Toronto, Toronto, Ontario.
⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
⁸ Department of Medicine, Baycrest Health Sciences, Toronto, Canada.

Abstract

Objectives: To assess the effects of elder-clowning on moderate to severe behavioral and psychological symptoms of dementia (BPSD) in nursing home residents with dementia, primarily of the Alzheimer's type.

Design: Before-and-after study.

Setting: Nursing home.

Participants: Nursing home residents with moderate to severe BPSD, as defined according to a Neuropsychiatric Inventory-Nursing Home version (NPI-NH) score of 10 or greater (N = 23), and their care aides.

Intervention: A pair of elder-clowns visited all residents twice weekly (~10 minutes per visit) for 12 weeks. They used improvisation, humor, empathy, and expressive modalities such as song, musical instruments, and dance to individualize resident engagement.

Measurements: Primary outcomes were BPSD measured using the the NPI-NH, quality of life measured using Dementia Care Mapping (DCM), and nursing burden of care measured using the Modified Nursing Care Assessment Scale (M-NCAS). Secondary outcomes were occupational disruptiveness measured using the NPI-NH, agitation measured using the Cohen Mansfield Agitation Inventory (CMAI), and psychiatric medication use.

Results: Over 12 weeks, NPI-NH scores declined significantly (t22 = -2.68, P = .01), and DCM quality-of-life scores improved significantly (F1,50 = 23.09, P < .001). CMAI agitation scores decreased nominally, but the difference was not statistically significant (t22 = -1.86, P = .07). Occupational disruptiveness score significantly improved (t22 = -2.58, P = .02), but there was no appreciable change in M-NCAS scores of staff burden of care.

Conclusion: Results suggest that elder-clowning reduced moderate to severe BPSD of nursing home residents with dementia, primarily of the Alzheimer's type. Elder-clowning is a promising intervention that may improve Alzheimer's disease care for nursing home residents.

Keywords: arts-based intervention; behavioral and psychological symptoms of dementia; loss of self; person-centered care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged, 80 and over
Behavioral Symptoms / prevention & control*
Canada
Dementia / nursing*
Female
Humans
Laughter Therapy / methods*
Long-Term Care
Male
Nursing Homes
Quality of Life*
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding