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


Kontos, Pia, Miller, Karen-Lee, Colobong, Romeo, Palma Lazgare, Luis I., Binns, Malcolm, Low, Lee-Fay, Surr, Claire, Naglie, Gary


J Am Geriatr Soc, Volume: 64, No.: 2, Pages.: 347-53

Year of Publication



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.

Bibtex Citation

@article{Kontos_2016, doi = {10.1111/jgs.13941}, url = {}, year = 2016, month = {feb}, publisher = {Wiley-Blackwell}, volume = {64}, number = {2}, pages = {347--353}, author = {Pia Kontos and Karen-Lee Miller and Romeo Colobong and Luis I. Palma Lazgare and Malcolm Binns and Lee-Fay Low and Claire Surr and Gary Naglie}, title = {Elder-Clowning in Long-Term Dementia Care: Results of a Pilot Study}, journal = {Journal of the American Geriatrics Society} }


clowns, engagement, humour, social, therapy

Countries of Study


Types of Dementia

Alzheimer’s Disease, Dementia (general / unspecified)

Types of Study

Cost and service use study, Randomised Controlled Trial

Type of Outcomes

Behaviour, Carer Burden (instruments measuring burden), Depression and Anxiety, Other, Quality of Life of Person With Dementia, Service use or cost reductions (incl. hospital use reduction, care home admission delay)


Nursing Homes

Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Arts and Music Interventions (including Art and Music Therapy)