title: The effects of humor therapy on nursing home residents measured using observational methods: the SMILE cluster randomized trial.
abstract: OBJECTIVE
  To evaluate the effects of humor therapy assessed using observational methods on agitation, engagement, positive behaviors, affect, and contentment.
  
  
  METHODS
  Single-blind cluster randomized controlled trial.
  
  
  METHODS
  A total of 35 Sydney nursing homes.
  
  
  METHODS
  All eligible residents within geographically defined areas within each nursing home were invited to participate.
  
  
  METHODS
  Professional "ElderClowns" provided 9 to 12 weekly humor therapy sessions, augmented by resident engagement by trained staff "LaughterBosses." Controls received usual care.
  
  
  METHODS
  The Behavior Engagement Affect Measure (BEAM) touchpad observational tool was used to capture real-time behavioral data. The tool assesses the duration in seconds of agitation, positive behavior toward others, engagement, and affect (angry, anxious, happy, neutral, sad).
  
  
  RESULTS
  Seventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Over 26 weeks, in comparison with controls, the humor therapy group decreased in duration of high agitation (effect size = 0.168 and 0.129 at 13 and 26 weeks, respectively) and increased in duration of happiness (effect size = 0.4 and 0.236 at 13 and 26 weeks, respectively).
  
  
  CONCLUSIONS
  We confirmed that humor therapy decreases agitation and also showed that it increases happiness. Researchers may consider evaluating impacts of nonpharmaceutical interventions on positive outcomes. Computer-assisted observational measures should be considered, particularly for residents with dementia and when the reliability of staff is uncertain.
authors.affiliation: Dementia Collaborative Research Centre, Centre for Healthy Brain Aging, School of Psychiatry, University of New South Wales Australia, Sydney, New South Wales, Australia. Electronic address: lf.low@unsw.edu.au.
authors.forename: Lee-Fay
authors.initials: LF
authors.lastname: Low
authors.affiliation: Dementia Collaborative Research Centre, Centre for Healthy Brain Aging, School of Psychiatry, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Goodenough
authors.affiliation: Dementia Collaborative Research Centre, Centre for Healthy Brain Aging, School of Psychiatry, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fletcher
authors.affiliation: Dementia Collaborative Research Centre, Centre for Healthy Brain Aging, School of Psychiatry, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Kenny
authors.initials: K
authors.lastname: Xu
authors.affiliation: Dementia Collaborative Research Centre, Centre for Healthy Brain Aging, School of Psychiatry, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Anne-Nicole
authors.initials: AN
authors.lastname: Casey
authors.affiliation: Dementia Collaborative Research Centre, Centre for Healthy Brain Aging, School of Psychiatry, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Lynn
authors.initials: L
authors.lastname: Chenoweth
authors.affiliation: NSW and ACT Dementia Training Study Centre, University of Wollongong, Wollongong, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Fleming
authors.affiliation: Humour Foundation, Chatswood, New South Wales, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Spitzer
authors.affiliation: Arts Health Institute, Newcastle, New South Wales, Australia.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Bell
authors.affiliation: Dementia Collaborative Research Centre, Centre for Healthy Brain Aging, School of Psychiatry, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006240:Happiness; D006801:Humans; D027641:Laughter Therapy / Q000379:methods*; D008297:Male; D009517:New South Wales; D009735:Nursing Homes; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000628:therapy; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Dementia; behavior; long-term care; observational data