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The effects of humor therapy on nursing home residents measured using observational methods: the SMILE cluster randomized trial


Low, Lee-Fay, Goodenough, Belinda, Fletcher, Jennifer, Xu, Kenny, Casey, Anne-Nicole, Chenoweth, Lynn, Fleming, Richard, Spitzer, Peter, Bell, Jean-Paul, Brodaty, Henry


J Am Med Dir Assoc, Volume: 15, No.: 8, Pages.: 564-9

Year of Publication



OBJECTIVES: To evaluate the effects of humor therapy assessed using observational methods on agitation, engagement, positive behaviors, affect, and contentment. DESIGN: Single-blind cluster randomized controlled trial. SETTING: A total of 35 Sydney nursing homes. PARTICIPANTS: All eligible residents within geographically defined areas within each nursing home were invited to participate. INTERVENTION: Professional “ElderClowns” provided 9 to 12 weekly humor therapy sessions, augmented by resident engagement by trained staff “LaughterBosses.” Controls received usual care. MEASUREMENTS: The Behavior Engagement Affect Measure (BEAM) touchpad observational tool was used to capture real-time behavioral data. The tool assesses the duration in seconds of agitation, positive behavior toward others, engagement, and affect (angry, anxious, happy, neutral, sad). RESULTS: Seventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Over 26 weeks, in comparison with controls, the humor therapy group decreased in duration of high agitation (effect size = 0.168 and 0.129 at 13 and 26 weeks, respectively) and increased in duration of happiness (effect size = 0.4 and 0.236 at 13 and 26 weeks, respectively). CONCLUSION: We confirmed that humor therapy decreases agitation and also showed that it increases happiness. Researchers may consider evaluating impacts of nonpharmaceutical interventions on positive outcomes. Computer-assisted observational measures should be considered, particularly for residents with dementia and when the reliability of staff is uncertain.

Bibtex Citation

@article{Low_2014, doi = {10.1016/j.jamda.2014.03.017}, url = {}, year = 2014, month = {aug}, publisher = {Elsevier {BV}}, volume = {15}, number = {8}, pages = {564--569}, author = {Lee-Fay Low and Belinda Goodenough and Jennifer Fletcher and Kenny Xu and Anne-Nicole Casey and Lynn Chenoweth and Richard Fleming and Peter Spitzer and Jean-Paul Bell and Henry Brodaty}, title = {The Effects of Humor Therapy on Nursing Home Residents Measured Using Observational Methods: The {SMILE} Cluster Randomized Trial}, journal = {Journal of the American Medical Directors Association} }


aged, 80 and over, clowns, female, happiness, humans, humour, laughter therapy, male, methods, new south wales, nursing homes, psychiatric status rating scales, psychomotor agitation, quality of life, therapy, treatment outcome, with

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Cluster RCT

Type of Outcomes



Nursing Homes

Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions