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

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