Abstract
Interventions with Clinic Clowns trained for performing in nursing homes have been explored in several field studies. Until now, however, it has not been sufficiently investigated to which extent and in which ways elderly with dementia (EWD) respond to and engage in humorous interactions. An exploratory study with 17 German dementia care unit residents aimed at narrowing this gap. To assess understanding, appreciation and authorship as well as contextual information we have constructed a behavioral observation and annotation system for humor interaction with the elderly with dementia (ANHIDE) The system was tested for inter-coder agreement and reached kappa values qualified as substantial for humor categories (κ = .685), humor response (κ = .725) and musical contributions (κ = .752). In 9 hours of video recorded interaction, participants contributed almost a third of the annotated humor events with verbal humor being their most frequent way of expression. Benign humor styles prevailed (85%) and aggressive humor was rare (2%). Whenever participants could be addressed successfully, they responded overly positive (89%). Malign humor styles were – if not ignored – answered with disapproval or the attempt to reconcile. Best practice recommendations for addressing and involving the residents with dementia are well-structured contributions and combined use of various stylistic means. Limitations, as well as suggestions for further in-depth research, are discussed, e.g., individual differences in humor response, strategies to encourage participants’ active contribution or fostering humor as a behavioral competence. Overall, this contribution is the first to provide a behavioral observation system for a detailed annotation of humor interactions regarding the elderly with dementia (ANHIDE). We demonstrate preliminary evidence for competencies in humor perception and production in the target group.
Highlights
Clown visits have become an established psychosocial intervention (Linge-Dahl et al 2018) for nursing home residents with dementia
We demonstrate that humor competencies, i.e., perceiving, appreciating, and producing humor, in elderly with dementia (EWD) as well as changes in mood, atmosphere, and positive emotions during the interactions between Clinic Clowns and EWD are observable using the ANHIDE
This study set out to develop and initially validate a behavioral observation and annotation system for humor interaction with the elderly with dementia (ANHIDE) in a sample of 17 German dementia care unit residents that were visited by Clinic Clowns
Summary
Clown visits have become an established psychosocial intervention (Linge-Dahl et al 2018) for nursing home residents with dementia. A sole focus on the output limits our understanding and does not tell us anything about intervention-specific mechanisms that remain unobserved and mostly unknown. Researchers taking field notes or recording interactions during such interventions, emphasize the importance of a friendly, empathetic, playful and soft encounter (Dunn et al 2013), highlight the “reciprocal nature of Clown-resident. Careful behavioral observation and analysis of the performance and interactions between Clinic Clowns and residents are crucial to better understand the mechanisms that lead to desired outcomes, besides to solely relying on the results from staffadministered questionnaires.
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