Anne-Nicole Casey

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

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 single-blind 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. Trial registration Australian New Zealand Clinical Trials Registry -ACTRN12611000462987.

Potential benefits to staff from humor therapy with nursing home residents.

Life in residential care can be challenging for residents and staff. Bringing humor into this setting may benefit residents, creating a more productive, enjoyable work environment for staff. The potential effect of exposure to humor therapy on staff, both as active and incidental participants, as part of a randomized controlled trial of the effect of humor therapy for aged care residents was investigated in the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE). The intervention involved a humor program with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine 2-hour sessions over 12 weeks. Methods included a staff survey at three time points, interviews with LaughterBosses, and a satisfaction rating by facility managers. There were significant positive findings for some staff subgroups, including assistants in nursing/personal care assistants and staff older than 45. LaughterBoss interviews and intervention group manager ratings of staff work enthusiasm were positive.

NUMBER OF FACE-TO-FACE CONTACTS PREDICTS VARIANCE IN COGNITIVE FUNCTION IN HEALTHY OLDER ADULTS

Background:People with Alzheimer’s have particular necessities in terms of their pharmacologic and non-pharmacologic management. They demand help with everyday needs (safety, hygiene, feeding and others affairs). Under normal circumstances, these needs present daunting challenges for caregivers. Under emergency situations, such as natural disasters, these challenges become even more daunting. Hurricane Irma and Maria caused catastrophic damage in Puerto Rico (PR). Food, water, electricity, and access to health professionals were unmet for months, forcing caregivers to act drastically to try and meet their needs. We sought to share our experiences as clinicians and caregivers, about the impact of hurricanes, on the health and well-being of people with dementia, and caregivers in PR. The final purpose is to develop a Spanish-language instrument to use in large studies to identify the specific needs patients and caregivers had before, during and after natural disasters minimizing the impact of these events on their quality of life. Methods: The authors systematically gathered observations from clinics and caregiving centers on the impact that these natural disasters had on physical, cognitive and mental health. Results: A massive power outage impacted the whole island for days and as of today thousands of people remain without electricity. A total collapse of the telecommunications and the closing of many roads for weeks was also experienced. The needs of patients from; food, water, medicines, electricity for medical equipment, access to health professionals, to the ability to call for help, went unmet for people with dementia and their caregivers. Changes of mood, increased anxiety, disorientation and rapid decline in memory and attention, were seen in patients. Caregivers demonstrated depressive symptoms, stress and hopelessness. Conclusions:The effect of hurricanes seen on people with dementia and caregivers highlighted the need for better preparation for natural disasters. Caregivers with the government support should plan in advance strategies to minimize impact. Detailed planning after evaluating the needs, limitations and conditions of each individual, is the main point followed by prevention before, during and after the disaster. Resilience training can help caregivers, manage the enormous challenges associated with caring for a person with dementia when natural disasters strike.

Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE): results from a clustered randomised controlled trial

Abstract from the International Psychogeriatric Association Reinventing Aging through Innovation 15th International Congress, 6-9 September 2011, The Hague, Netherlands.Use of prescription medications for various conditions is highly prevalent in older adults, often leading to the use of multiple medications. The resulting polypharmacy is widely recognized as a risk factor for many negative outcomes, but less is known about the risks of specific types of medication upon cognitive functions. Benzodiazepines are commonly prescribed for the treatment of anxiety and insomnia, among other conditions. While dependency with continued use has been the subject of much concern over this type of medication, other literature has suggested an increased risk of cognitive impairment with chronic use of benzodiazepines. The nature of the cognitive changes and the domains of cognitive function most likely to be affected have differed across various studies. Here we describe the associations between measures of various domains of cognitive functioning and benzodiazepine use in 2879 older Canadian adults from the Canadian Study of Health and Aging (CSHA; 64.3% female, mean age 81.0 years, SD=7.44). These people underwent a comprehensive medical and psychosocial evaluation that included a record of medications used, in addition to a complete personal and medical history. The CSHA was a community-based epidemiological study of the prevalence of dementia and its associated risk factors in over 10,000 Canadians. Benzodiazepines were classified according to their half-life: short (under 12 hours), medium (12 to 40 hours) or long half-life (over 40 hours); 35 elderly people were excluded since they were taking more than one class of benzodiazepine. A comprehensive neuropsychological battery that assessed the major domains of cognitive functioning was administered to all participants who completed the CSHA clinical assessment. Neuropsychological test scores for the domains of short- and long-term memory, abstract reasoning, judgement, visuoconstruction, and language formed were the primary independent variables, while gender, age, and years of education were used as covariates in logistic regression models predicting use of each class of drug. Education was not a significant covariate for any analysis. Gender proved to be a significant covariate in the case of the medium-half life drugs, but not for the other two classes. Age was a significant covariate for the majority of test scores for the short and long half-life drugs. After controlling for the covariates, the results showed a broader range of cognitive impairments with the use of short half-life benzodiazepines than with the medium half-life or the long half-life benzodiazepine compounds. Six cognitive measures, assessing abstract reasoning and comprehension, verbal fluency, verbal memory, and visuoconstruction skills (BlockDesign), showed poorer performance among those who used short half-life benzodiazepines, two measures, those of abstract reasoning and comprehension, showed impaired performance by those using medium half-life benzodiazepines, and three measures, for abstract reasoning, verbal memory, and visuoconstruction skills, showed lower performance by those taking long halflife benzodiazepines. Wechsler Similarities, the measure of abstract reasoning, was the only showing significant differences common across all three drug class models. Results are discussed in terms of both the relative extent of lower neuropsychological test scores and the context of increasing evidence of impaired functioning associated with benzodiazepine use.