Successful Ingredients in the SMILE Study: Resident, Staff, and Management Factors Influence the Effects of Humor Therapy in Residential Aged Care
Successful Ingredients in the SMILE Study: Resident, Staff, and Management Factors Influence the Effects of Humor Therapy in Residential Aged Care
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DOI：
10.1016/j.jagp.2013.08.005
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发表时间：
2014-12-01
影响因子：
7.2
通讯作者：
Chenoweth, Lynn
中科院分区：
文献类型：
--
作者：
Brodaty, Henry;Low, Lee-Fay;Chenoweth, Lynn
目的：检验个人和机构层面因素影响幽默疗法干预老年护理居民效果的假设。研究方法：数据来自悉尼多点干预的幽默治疗组的LaughterBosses和ElderClowns，或SMILE，研究，一项为期12周的幽默治疗单盲随机对照试验;在基线，第13周和第26周进行评估。来自17个悉尼住宅老年护理设施的189人被随机分配到幽默疗法干预。专业的表演者“ElderClowns”每周提供9-12次2小时的幽默治疗，由训练有素的工作人员增加，称为“笑老板”。结果测量如下：Cornell痴呆抑郁量表、Cohen-Mansfield激越量表、神经精神量表、老年受试者多维观察量表的戒断子量表和痴呆人群量表的代理评定生活质量。设施一级的措施如下：支持的管理干预，承诺水平的笑老板，环境审计工具得分，和设施水平的护理提供（高/低）。住院医师水平的指标包括参与度、功能能力、疾病严重程度和护理时间。多层次路径分析同时模拟居民参与在个人层面（重复测量）和管理层的支持和工作人员的承诺，幽默疗法在集群水平的影响。结果如下：模型表明流动的影响，管理支持有积极的影响，LaughterBoss的承诺，LaughterBoss的承诺增加居民的参与。住院医师参与度越高，抑郁、激越和神经精神评分越低。结论：在住宅老年护理的心理社会计划的有效性可以提高管理支持，工作人员的承诺，积极的居民参与。
Objective: To test the hypothesis that individual and institutional-level factors influence the effects of a humor therapy intervention on aged care residents. Methods: Data were from the humor therapy group of the Sydney Multisite Intervention of LaughterBosses and ElderClowns, or SMILE, study, a single-blind cluster randomized controlled trial of humor therapy conducted over 12 weeks; assessments were performed at baseline, week 13, and week 26. One hundred eighty-nine individuals from 17 Sydney residential aged care facilities were randomly allocated to the humor therapy intervention. Professional performers called "ElderClowns" provided 9-12 weekly humor therapy 2-hour sessions, augmented by trained staff, called "Laughter-Bosses." Outcome measures were as follows: Cornell Scale for Depression in Dementia, Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and proxy-rated quality of life in dementia population scale. Facility-level measures were as follows: support of the management for the intervention, commitment levels of LaughterBosses, Environmental Audit Tool scores, and facility level of care provided (high/low). Resident-level measures were engagement, functional ability, disease severity, and time-in-care. Multilevel path analyses simultaneously modeled resident engagement at the individual level (repeated measures) and the effects of management support and staff commitment to humor therapy at the cluster level. Results: Models indicated flow-on effects, whereby management support had positive effects on LaughterBoss commitment, and LaughterBoss commitment increased resident engagement. Higher resident engagement was associated with reduced depression, agitation, and neuropsychiatric scores. Conclusion: Effectiveness of psychosocial programs in residential aged care can be enhanced by management support, staff commitment, and active resident engagement.