Title

Successful Ingredients in the SMILE Study: Resident, Staff, and Management Factors Influence the Effects of Humor Therapy in Residential Aged Care

RIS ID

117874

Publication Details

Brodaty, H., Low, L., Liu, Z., Fletcher, J., Roast, J., Goodenough, B. & Chenoweth, L. (2014). Successful Ingredients in the SMILE Study: Resident, Staff, and Management Factors Influence the Effects of Humor Therapy in Residential Aged Care. American Journal of Geriatric Psychiatry, 22 (12), 1427-1437.

Abstract

Objective: To test the hypothesis that individual and institutional-level factors influence the effects of a humor therapy intervention on aged care residents. Methods: Data were from the humor therapy group of the Sydney Multisite Intervention of LaughterBosses and ElderClowns, or SMILE, study, a single-blind cluster randomized controlled trial of humor therapy conducted over 12 weeks; assessments were performed at baseline, week 13, and week 26. One hundred eighty-nine individuals from 17 Sydney residential aged care facilities were randomly allocated to the humor therapy intervention. Professional performers called "ElderClowns" provided 9-12 weekly humor therapy 2-hour sessions, augmented by trained staff, called "LaughterBosses." Outcome measures were as follows: Cornell Scale for Depression in Dementia, Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and proxy-rated quality of life in dementia population scale. Facility-level measures were as follows: support of the management for the intervention, commitment levels of LaughterBosses, Environmental Audit Tool scores, and facility level of care provided (high/low). Resident-level measures were engagement, functional ability, disease severity, and time-in-care. Multilevel path analyses simultaneously modeled resident engagement at the individual level (repeated measures) and the effects of management support and staff commitment to humor therapy at the cluster level. Results: Models indicated flow-on effects, whereby management support had positive effects on LaughterBoss commitment, and LaughterBoss commitment increased resident engagement. Higher resident engagement was associated with reduced depression, agitation, and neuropsychiatric scores. Conclusion: Effectiveness of psychosocial programs in residential aged care can be enhanced by management support, staff commitment, and active resident engagement.

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Link to publisher version (DOI)

http://dx.doi.org/10.1016/j.jagp.2013.08.005