Alzheimer's, Dementia & Mental Health
Humor May Be Best Medicine for Agitated Dementia Patients
Australian SMILE study tested ‘clown doctors,’ found 20% reduction in agitation - comparable to anti-psychotic drugs
Humor therapy: a playful relationship with residents and staff
in aged care. Photo: Mel Koutchavalis
Sept. 21, 2011 - Humor therapy is as effective as widely used antipsychotic drugs in managing agitation in patients with
dementia and avoids serious drug side effects, says a new study to be presented this week at the National Dementia Research Forum in Sydney,
The first major study of the impact of humor therapy on mood, agitation, behavioral disturbances and social engagement in
dementia patients found both short term and persisting decrease in agitation, according to lead researcher, Dr. Lee-Fay Low, a Research Fellow
at the University of New South Wales, School of Psychiatry.
The SMILE study across 36 Australian residential aged care facilities involved the recruitment and training of a
staff member to act as a “Laughter Boss” who worked with a humor practitioner with comedic and improvisation skills – not unlike “Clown
Doctors” used in hospitals to aid recovery and lift mood in children.
Jean-Paul Bell, the key humor therapist in the SMILE study, has set up the Arts Health Institute (AHI) to train
humor practitioners and aged care staff. The AHI’s core program, Play Up, provides a playful relationship with residents and staff in aged
care, focusing particularly with people with dementia.
The AHI is now focused on translating the knowledge of the SMILE study into residential aged care and continues to
work with UNSW's Dementia Collaborative Research Centre to roll out the program nationally.
Dementia rates are expected to double to in the next 20 years in Australia to about 450,000, mainly due to an ageing
population. About 6.5 per cent of people over 65 and 22 per cent of people over 85 have dementia – an umbrella term used to describe up to 60
different conditions causing similar neurodegenerative changes in the brain.
Between 70 and 80 per cent of people suffering from dementia are troubled by agitation, a problem for both patients with
the disease and their caregivers.
“Agitated behaviors include physical and verbal aggression, wandering, screaming and repetitive behaviors and questions.
This is challenging for staff and often indicates unmet needs and distress in the residents of aged care facilities,” says Dr. Low.
The SMILE study found a 20 per cent reduction in agitation using humor therapy, an improvement comparable to the
common use of anti-psychotic drugs.
“This shows humor therapy should be considered before medication for agitation, particularly taking into account its side
A major 2009 study for the UK Department of Health found serious side effects of antipsychotics, including thousands of
deaths and strokes, linked to the use of these drugs in dementia. The researchers recommended a reduction in medication rates, as well as
special training for care-providers in non-drug therapies.
In the SMILE study agitation decreased not only during the 12 week humor therapy program, but remained lower at 26
week follow up. Happiness and positive behaviors rose over the 12 weeks of the program, however, dropped as soon as humor practitioner visits
The SMILE Study results will be presented at the National Dementia Research Forum 2011 on Thursday and Friday (22-
23 Sept). A documentary film, The Smile Within, produced by Hot Tin Productions and based on the SMILE Study, will also be screened.
A free public talk “Alzheimer’s and You? Prevention and Treatment of Dementia” will be held tonight (Sept 21 at
6.00-7.30pm) at the Wesley Conference Centre, 220 Pitt Street, in Sydney.
Full details can be found
A free screening of The Smile Within will be held at the Bondi Pavilion Seagull Room on Thursday 22 September,
11a.m. The screening will be followed by a short panel discussion.
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