The Arts Health Institute makes people with dementia SMILE

The SMILE study has concluded that humour therapy works just as well as antipsychotic drugs, without the side effects. A new organisation called the Arts Health Institute has been founded to keep the laughs coming.

Above: Jean-Paul Bell as the Humour Valet with one of the Play Up Partners (image: Andrew Siwak).

By Stephen Easton

A unique dementia research project has found that ‘having a laugh’ works just as well as antipsychotic drugs for people with dementia, when it comes to treating the agitation that affects many who have the disease.

The recently completed Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) rigorously tested humour therapy in residential aged care facilities, and found a 20 per cent reduction in agitation compared to a control group who did not receive the intervention (using the Cohen-Mansfield agitation scale).

The idea was the brainchild of Jean-Paul Bell and Dr Peter Spitzer, co-founders of the Humour Foundation, a non-profit organisation that provides clown doctors as humour therapy for sick children.

It became a project of the Dementia Collaborative Research Centre (DCRC) based at the University of New South Wales after Dr Spitzer suggested the idea to the DCRC’s director, Professor Henry Brodaty.

Prof Brodaty and other experts from the DCRC applied for a National Health and Medical Research Council grant, and received almost $1 million to conduct the project, according to the lead researcher, Dr Lee-Fay Low.

But grants don’t last forever, so this week Mr Bell, a professional performer who has spent a long career cheering up the sick and disadvantaged, launched a new organisation called the Arts Health Institute, to raise money and deliver specially taliored humour therapy to aged care facilities around the nation, under the name Play Up.

Above: Jean-Paul Bell shows staff in an aged care facilities how to ‘Play Up’ (image: Andrew Siwak).

He and his long-time friend Dr Spitzer also developed a short training course to turn one member of each facility’s staff into a ‘LaughterBoss’, who is in charge of keeping the fun going after the actor has left the facility.

The pair adapted the child-oriented clown doctor concept to make it more appropriate for aged care residents, which led to the creation of the ‘humour valet’, a character Mr Bell described as “an escaped elevator attendant”.

“The clown doctor model is great for children in hospital but in aged care they’re not really sick in hospital,” he said. “They’re residents living in their own home; therefore that kind of character doesn’t suit the situation.”

“So I created a new character, wearing an Art-Deco costume with brass buttons, epaulets and a fez; it looks like a cinema usher or a valet. A lot of the older generation relate to people in uniforms, and we’re not offending anyone dressed as a clown with a red nose. I can present quite a sombre, neutral character, but on the back of that I can be a silly as any clown; it’s a more presentable face for aged care.

“The 12-week intervention really got them ‘out of themselves’ – to speak quite clearly and build relationships – and it proved [to me] that when you have dementia, you don’t lose everything. You lose some things but what you do have left is capable of learning, growing and adapting. The mind is an incredibly flexible tool, even when under assault from dementia or Alzheimer’s disease.”

Above: Jean-Paul Bell uses humour to connect with older people to lift spirits in aged care facilities (image: Andrew Siwak).

Lead investigator, Dr Lee-Fay Low, described the result as “about the same effect as an antipsychotic but without the side effects”.

The study, she said, showed that humour was an effective way of communicating with people who have dementia, and helping to relieve some of the confusion and discomfort the disease can lead to.

Dr Low is now a firm believer in the value of humour as an effective non-pharmacological treatment for dementia, which she and other experts advocate as a first choice before the use of powerful medications that can have strong side effects. 

“We observed the residents across the 12 weeks of the intervention in some of the facilities and compared to controls, we found that across the 12 weeks, their happiness improved and their positive behaviour improved,” she said. “Not just happiness, but how much they engaged with other residents, how helpful they were and how much they showed affection.

“But once the ElderClown stopped visiting, those things went back to what they were before, back to baseline.”

To help keep the seriously silly characters visiting aged care facilities and brightening the lives of residents, she has also lent her support to the fledgling Arts Health Institute as a member of its board of directors.

A film about the SMILE study and the Play Up program called The Smile Within will be screened this week at three different locations in Sydney; tomorrow at NSW Parliament House, Thursday at the Bondi Pavillion and Friday at the Wesley Centre. Click here for details. 

The film will also be available shortly in a DVD version. Click here for details.

Tags: clown-doctor, dcrc, dementia, non-pharmaceutical-interventions, unsw,

16 thoughts on “The Arts Health Institute makes people with dementia SMILE

  1. I’m very interested in seeing the Film should it come to Brisbane.

    I heard about Smile Therapy on Life Matters yesterday and would like to know more about the Cert IV course when it becomes available.

    My Mum has advanced Dementia and my family have worked hard to keep her at home as long a possible. Unfortunately she recently went into a home as she can no longer walk following a broken hip and we were having increasing difficulty with lifting her. I have noticed her condition has deteriorated a lot since being there, so any tips on making the daily visits more stimulating would be appreciated.

    We have made a Memory Book and a scrapbook containing all her “letters to the editor” – she was an avid writer and had an opinion on everything – should have been a politician as her ideas were way ahead of their time? We also have a “Silver Memories” radio (a Brisbane radio station especially for the elderly) which plays lots of old music to inspire conversation of the past.

    Hope to hear back from you.

    Regards
    Laura Pantelas

  2. Hello, I saw Jean-Paul Bell on the 7.00pm Report and I would like to arrange a meeting with Jean-Paul. I am a Location Manger for Hurstville and Bondi Junction (Guardian Funerals) and support a number of aged care facilities who cater and care for dementia patients. I would like to explore sponsoring some activities of the Aged Health Institute in my areas.

    I look forward to receiving your email.

    Kind regards

    Ron Alexander
    Location Manager
    Guardian Funerals
    Mob: 0417 605 695

  3. Would love to find out more how to become apart of this program. Is there any training for this wonderful project? I’m in Perth and would love to become involved in some way! Any suggestions would be greatly appreciated!
    Thank you
    Kelli Smith

  4. Good morning
    I sat in amazement to last nights 7pm Project report on humour in a dementia setting. I work as a Diversional Therapist Coordinator with the Bushland Health Group in Taree, NSW. The activities officers have had wonderful responses from the residents residing at Karingal Gardens Dementia Specific Unit when the activities officers dress up as clowns – the best response we have every had.
    Please let me know if there are courses available for laughter/clowns. Unfortunately we live in rural NSW and the course would have to be blocked. Hoping to hear from you soon. Lorraine Fawkner

  5. I am so pleased to see smile therapy recognised for it’s therapuetic value. I have worked on lifestyle programs in residential care years ago and now work with carers in the cummunity and am part of the aged team. I see smile therapy if delivered appropriately and with dignity a real winner for all involved. Great for staff in facilities to lift morale in aged care and add enjoyment to workers duties. If the training comes to Melbourne I would like to hear about it.

    warm regards Helen

  6. Thank you all for your wonderful responses to the article. Jean-Paul’s dream is have Play Up in every residential aged care facility across the country. Having seen the impact first hand, it is a remarkable program. It has an impact on the client as demonstrated in the SMILE Study but also the families and the staff. I really encourage you to go to the film’s website where you can see a short trailer http://www.thesmilewithin.com.au If you would like to pre-order a copy of the film please go to the Arts Health Institute website where you can also download a brochure about the Play Up Program http://www.artshealthinstitute.org.au

    We are in development with the training programs and expect these to be ready for next year however we are running workshops on creative engagement now. Please write to us at ahi.artshealthinstitute.org.au to express your interest.

    Everyone can be a member of the Arts Health Institute now. There is a special Foundation Members fee and we need your support so plesae sign up and spread the word. Please go to the memberhsip page on the Arts Health Institute website http://www.artshealthinstitute.org.au

    We are a national organisation and operate out of Sydney. We welcome the opportunity to establish Play Up Programs in Perth, Melbourne, Brisbane and anywhere there is the need. Please get in touch.

    Thank you also to Ron Alexander for your kind offer – we will be in touch! Sponsors are really needed and phillanthropy so greatfully received. We started the Arts Health Institute in July this year to bring creativity to care. We believe that the arts and creativity are a vital part of life and we need them most when we are ill or frail. I look forward to hearing from you and thank you for your support!!

    Maggie Haertsch (RN, RM, Grad.DipHSc. PhD)
    CEO, Arts Health Institute
    Executive Producer, The Smile Within Film.

  7. Thank you all for your responses to this article. Jean-Paul’s dream is have Play Up in every residential aged care facility across the country. Having seen the impact first hand, it is a remarkable program. It has an impact on the client as demonstrated in the SMILE Study but also the families and the staff. I really encourage you to go to the film’s website where you can see a short trailer http://www.thesmilewithin.com.au and if you would like to pre-order a copy of the film please go to the Arts Health Institute website where you can also download a brochure about the Play Up Program http://www.artshealthinstitute.org.au The first 250 Residential Aged Care Facilities who pre-order the film will receive one free. You will need to complete the form and include your provider number.

    We are in development with the training programs and expect these to be ready for next year however we are running workshops on creative engagement over the next months. Please write to us at ahi.artshealthinstitute.org.au to express your interest.

    Everyone can be a member of the Arts Health Institute now. There is a special Foundation Members fee. We need your support as we build an arts and health community so please sign up and spread the word. Go to the membership page on the Arts Health Institute website http://www.artshealthinstitute.org.au We are a national organisation and operate out of Sydney. We welcome the opportunity to establish Play Up Programs in Perth, Melbourne, Brisbane and anywhere there is the need particularly in rural and regional areas.

    Thank you also to Ron Alexander for your kind offer – we will be in touch! Sponsors are really needed and philanthropy so gratefully received. We started the Arts Health Institute in July this year to bring creativity to care. We believe that the arts and creativity are a vital part of life and we need them most when we are ill or frail.

    Maggie Haertsch (RN, RM, Grad.DipHSc. PhD) CEO, Arts Health Institute and Executive Producer, The Smile Within Film.

  8. I had the plesure of working with JP on the smile study and he is an incredible, wonderful human being who can make the biggest grump smile or laugh. He bought out the best in our residents and me. Thankyou JP!

  9. Dear Jean-Paul, I have just watched an amazing program on Compass on the work you are doing. You are a very special person, but I’m sure you know that. Very few are as gifted as you are with empathy for dementia sufferers. I send you huge hugs and would wish with all my heart that if you are in Adelaide at any time you would allow me to have you as my guest at a lunch at my home. My dear 90 year old Mum has dementia, but the best kind apparently, I guess this is why the program touched me so much. Well done isn’t good enough, Bravo and encore, encore. I’m so pleased I saw what you are doing

  10. Well done- humour and distraction are certainly key methods of dealing with dementia both for the carer and the resident – hopefully this may allow a reduction in the use of antipsychotics

  11. Was so excited & enthused while watching the Compass presentation of “The Smile Within” last night. It touched my heart, made me laugh & cry.
    John Paul-Bell is a wonderfully creative, imaginative gentleman, with such care & empathy.
    All we need now are thousands of J P-B clones & the Dementia in Aged Care industry would be a lighter, happier environment. – It has begun!
    Three of my mothers brothers & sisters are suffering with varying degrees of dementia. Unfortunately one uncle in particular, has recently been placed into a nursing home (aged early 70’s – so young) due to a mixture of T.I.A’s, dementia & Parkinson disease. My heart is heavy on seeing this wonderful man in such confusion & angst.
    Programs like John Paul-Bells’ can only help to relieve the mental torture that so many suffer.
    THANKYOU is not a good enough word. My heart is full.

  12. I just saw the show on ABC & was astounded.Mum (90years) is in an aged care facility.How I would love to be able to have some proper interaction with her again & to see her smile & laugh again. I am going to speak to management at the facility about this programme.

  13. Thankyou everybody for your inspiring thoughts and support.
    I am so grateful and just feel a change is happening on how to celebrate aging
    and our Elders!
    Where we can we have to support the people who care for our loved ones and
    involve ourselves in our aged care homes like we do with our kids in school.
    Aged Care Homes are full of real national living treasurers!
    Jean-Paul

  14. Hello JeanPaul

    Thank you for caring for people with Dimentia.
    My dad has a great sense of humour and goes to respite regularly at the Garden City Respite Centre Upper Mt Gravatt.

    What can I do to arrange for you to travel there please? I know it will probably be too late for you to get there from 27-31 march as this will beDad’s first overnight stay there. My brother and I are nervous about how he may cope.

    Anyway if you can help could someone please contact me with some suggestions.

    Sincerely

    Chris Eyers

  15. Hello
    I am an executive committee member of an aged care association in New Zealand and very much believe that their is not enough laughter in our sector. I have read with interest your profiles and what you do and wonder if there is a chance of having Jean-Paul Bell giving a presentation at our conference in June in Auckland New Zealand?
    If so I will be pelased to further discuss this.

    Looking forward to your positive reply,
    kind regards
    Jessica

  16. I am proud to say I attended the “Play Up Workshop” yesterday and I am so looking forward to Implementing all I will be learning at my place of work. You are very Inspirational Jean-Paul. Thank You!

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