Humour therapist Jean-Paul Bell has many faces. This one scares butterflies...
Humour therapist Jean-Paul Bell has many faces. This one scares butterflies...

Laughter is best dementia medicine

The Australian population is ageing.

We've all heard that, but there are real consequences. Though our privileged lifestyle has increased the number of years our bodies live, that gives our brains more time to deteriorate. Dementia is on the rise.

I'm thinking about this as I drive to the Whiddon Group Aged Care Facility in Casino. I'm meeting Jean-Paul Bell, a high-profile comedian, mime artist, clown doctor and now creative director of the Arts Health Institute (AHI) based in Newcastle.

Since co-founding the Humour Foundation and its Clown Doctor program in 1996, Jean-Paul has been putting into practice the concept that laughter really is the best medicine. In 2010 he wrote Laughter is the Best Medicine which chronicles the experiences of a number of clown doctors as they do their rounds in children's hospitals around Australia.

Jean-Paul also took his physical comedy to war-ravaged countries like Afghanistan and East Timor, as shown on the ABC documentary Honeymoon in Kabul.

More than 280,000 Australians are living with dementia. This disease touches the lives not only of the sufferers but also of those people's family, friends and carers.

Each week there are 1600 new cases diagnosed.

The aged care facility is tucked away in Casino. As I walk through the lounge I see many old folk. Some are very obviously suffering from dementia. Some of them are lucky enough to have a family member visiting. Others don't. The television flickers away and the staff buzz around busily.

Generally, we are a culture that doesn't have the older generation living with us. We're into nuclear families. Our older folk live in their own place until they can no longer cope, then they move into an institution. Some younger people look after their older folk but it's very difficult if they have dementia. And heartbreaking.

Aged care facilities can help.

The Whiddon Group aged care facilities in northern NSW are introducing a new form of therapy to help improve the life of those with dementia. It's called 'Play Up' and it's a humour therapy program.

This is where Jean-Paul Bell comes in.

Play Up is an initiative of AHI and is being introduced into 17 of The Whiddon Group's aged care facilities including those in Casino, Kyogle, Grafton, McLean and Newcastle. Staff from these facilities are receiving training today (Friday, February 3) from Jean-Paul to become Play Up partners. They'll work with other specially-trained AHI humour therapists (called Play Up performers).

These pairings of performers and aged care staff will create long-lasting, playful relationships with residents in the aged care facilities - particularly with those living with dementia.

I spot Jean-Paul talking to a group of trainee Play Up partners as they take a break from their training. Some wear a fez; one wears a sombrero; a few have ukuleles in hand. Jean-Paul sees me and suddenly there's that trademark smile that's almost wider than his face. Jean-Paul has one of those faces that is so flexible you think it must be made of rubber. It was made for mime. It has entertained people all over the world. Jean-Paul and I talk about what he's doing here.

"We started the Play Up program here in Casino nine weeks ago," Jean-Paul says. "We had a workshop here for Play Up partners. The Play Up partners are employees of The Whiddon Group. Usually they come from the leisure and recreation area of the facility. A few of them are registered nurses."

The Play Up performers, with whom these partners will work, come from the AHI.

"We're providing professional performers to partner with professional aged care workers," Jean-Paul says. "Our aim is to provide what is now being coined 'humour therapy' for selected clients within the facility. They're usually dementia patients.

"The idea of the Play Up program is to bring the clients out of themselves; to engage with them in a creative way and see if we get a positive response," he says.

"Second choice is to get any response at all," he smiles, and that face splits in two again.

Play Up was developed using the results of The SMILE Study conducted by the Dementia Collaborative Research Centre at the University of NSW. They ran a study which looked into the effects of humour therapy on 400 residents in 36 Australian aged care facilities between 2008 and 2011. The study showed humour therapy was as effective as widely used anti-psychotic drugs in managing agitation experienced by people living with dementia. Agitation levels decreased by an average of 20% during the 12-week study and remained lower at a 26-week follow up. This was significant.

Happiness and positive behaviour levels

rose while the humour therapy was in place but decreased again after it ceased. Jean-Paul did most of the humour therapy, visiting the residents at the facilities during the study.

"We set up the AHI in July last year and implemented the Play Up program for aged care, adopting The SMILE Study findings," Jean-Paul says. "Previously any kind of entertainment in the facilities was just random and mostly volunteer. This is a program that employs professional performers on a regular basis coming on a weekly visit for 12-week periods."

"Aged care facilities should consider this as standard practice for caring for people with dementia," AHI CEO Dr Maggie Haertsch tells me.

Jean-Paul and I walk out into the courtyard where we meet up with Hinke Van Well seated in her wheelchair enjoying the sun on her face and the attention of Play Up performer Helen Quinlan.

Helen is dressed in a maroon jacket with epaulets and brass buttons and wears the fez that defines a Play Up performer. Quite fetching, I think.

"Play Up performers dress up in a way which is a bit of a memory lane for residents," Jean-Paul explains. "They look a bit like cinema ushers of the 1940s and 50s. The uniform presents a bright clean image to the aged care resident and is a memorable costume. It helps with getting to know the performer. We think it's a better approach than using clown costumes, a la clown doctors, where I thought the red nose suited that environment. I don't think the red nose is effective for aged care."

Helen and Hinke share a giggle as I take some photos.

"The skills I have acquired (as a clown doctor) are perfect for working here," Helen says. "Hopefully I can help make this a better place for when my son puts me here."

We all laugh.

"We're using a lot of comedy, creating a lot of laughter because that's what creates the engagement, the connection," Jean-Paul says. "But empathy is the key. One of the great things about this kind of intense connection with people is they don't often get that same intense attention in institutionalised care. The staff are far too busy. We've got the advantage of coming in and specifically focusing on a particular resident for as long as they wish.

"The baby boomer generation makes up the majority of the performers we're engaging. They're very good at dealing with this current generation because that's the generation they grew up with, and they pretty much know their values and their approach to life. It's really good to be serving in a loving kind way this generation because you're going to be the next cab off the rank replacing them in these facilities in 15 to 20 years time."

A film following Jean-Paul Bell as he delivers humour therapy in aged care facilities during The SMILE Study, called The Smile Within, will screen on ABC1's Compass program on March 4 at 6.30pm.

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