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

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

Author information

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

PMID:
26889843
PMCID:
PMC4846348
DOI:
10.1111/jgs.13941
[Indexed for MEDLINE]
Free PMC Article

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