title: Elder-Clowning in Long-Term Dementia Care: Results of a Pilot Study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Before-and-after study.
  
  
  METHODS
  Nursing home.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
authors.forename: Pia
authors.initials: P
authors.lastname: Kontos
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
authors.forename: Karen-Lee
authors.initials: KL
authors.lastname: Miller
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario.
authors.forename: Romeo
authors.initials: R
authors.lastname: Colobong
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
authors.forename: Luis I
authors.initials: LI
authors.lastname: Palma Lazgare
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.|Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Binns
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: Lee-Fay
authors.initials: LF
authors.lastname: Low
authors.affiliation: Institute for Health and Wellbeing, Leeds Beckett University, Leeds, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Surr
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario.|Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.|Department of Medicine, Baycrest Health Sciences, Toronto, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
mesh_terms: D000369:Aged, 80 and over; D001526:Behavioral Symptoms / Q000517:prevention & control*; D002170:Canada; D003704:Dementia / Q000451:nursing*; D005260:Female; D006801:Humans; D027641:Laughter Therapy / Q000379:methods*; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D011788:Quality of Life; D016896:Treatment Outcome
keywords: arts-based intervention; behavioral and psychological symptoms of dementia; loss of self; person-centered care