Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE): A randomised controlled trial of humour therapy in residential care

INTERVENTION: About 400 residents living in 36 hostels and nursing homes will be randomly assigned (at the level of facility) to receive the SMILE intervention or usual care. The SMILE intervention will comprise a 1‐day training woprkshop for a staff member nominated by the facility to act as the LaughterBoss for that facility. The training session will be run at a central location off‐site in small group experiential learning format, facilitated by an experienced humour therapy practitioner. It will address how to incorporate humour into daily care practices with residents. The LaughterBoss will then partner with an ElderClown (a performer experienced in using humour in health care settings) to engage residents through humour using music, mime, props and other techniques. ElderClowns will visit facilities over 12 weeks for humour therapy sessions lasting 2 hours on each visit, with each facility receiving a minimum of 9 sessions. LaughterBosses will be encouraged to continue to use humour techniques between weekly ElderClown visits and after the program of visits has ceased. SMILE will evaluate whether humour therapy improves resident mood and quality‐of‐life. CONDITION: Agitation, behavioural disturbance and lack of social engagement Depressed mood in dementia Quality of life in residential aged care PRIMARY OUTCOME: Depression will be assessed by the researcher using the Cornell Depression Inventory. The item format will be the same as that adopted in the depression category assessment within the Aged Care Funding Instrument (ACFI; Section 10). The ACFI was introduced by the Australian Government in residential aged care in March 2008 Quality of life wil be assessed using the DEMQOL version 4, using both the self‐report (DEMQOL, 29 item) and informant (DEMQOL‐proxy, 32 item) formats. This measure will completed via interview with an informant, and where possible, the resident. The informant will be a person familiar with the resident's usual behaviour, such as a carer employed at the aged care facility, a legal guardian or family member. Social engagement and agitation will be assessed using the 8‐item social engagement subscale of the 40‐item Multidimensional Observation Scale for Elderly Subjects (MOSES) and the Cohen‐Mansfield Agitation Inventory (CMAI, 29 items). These measures will be completed via interview with an informant. The informant will be a person familiar with the resident's usual behaviour, such as a carer employed at the aged care facility, a legal guardian or family member. SECONDARY OUTCOME: A computer‐assisted tool for real‐time observation of behavioural and social engagement will be used. Developed by the research team, and using some principles of Dementia Care Mapping (DCM) , this behaviour, engagement, and agitation measure (BEAM) will be used by the researchers to record brief observations in three activity profiles for each resident: during a mealtime, a structured activity, and free time. INCLUSION CRITERIA: Permanent residents in Australian Government approved and accredited residential aged/dementia care services providing low or high care for residents with dementia, accessible by sealed road, located in greater Sydney.