Humor and laughter in persons with cognitive impairment and their caregivers

The enrichment process for family caregivers of persons living with dementia: A grounded theory approach

AIM

Many persons living with dementia (PLWD) reside in the community and are cared for by family members. The aim of this qualitative study was to gain an understanding the enrichment process for family caregivers of PLWD in Taiwan.

DESIGN

A grounded theory approach with face-to-face semi-structured interviews was conducted with family caregivers of PLWD in Taiwan.

METHODS

Interview data from 30 family caregivers of PLWD recruited from dementia clinics or support groups in Taiwan were obtained from the first wave of a larger study conducted from January 2018 to September 2021. Glaser's grounded theory approach with theoretical sampling was used to understand the enrichment process of family caregivers of PLWD.

RESULTS

Analysis indicated the core category that characterized the process of enrichment was 'holding together'. Caregivers were able to maintain their connection to the person with dementia through activities that deepened their relationship and strengthened their bond. 'Holding together' included four components: maintaining continuity, creative interactions, interacting with humour and sharing pleasurable activities. Through these components, family caregivers generated positive interactions and relationships with the person living with dementia and sustained their motivation for caregiving. Three modifying elements facilitated or impeded the process of holding together: 'previous daily interactions', 'caregiving beliefs' and 'filial piety'.

CONCLUSION

Through the enrichment process of 'holding together', family caregivers used different strategies to conduct pleasurable and meaningful activities with the person living with dementia to maintain and improve their relationship and enhance their happiness in life.

IMPACT

To facilitate the enrichment process, health care providers should encourage activities between family caregivers and PLWD that promote continuity, increase interactions, provide humour and foster pleasurable activities.

REPORTING METHOD

This study adhered to the COREQ guideline checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Tailoring cultural offers to meet the needs of older people during uncertain times: a rapid realist review

BACKGROUND

Non-medical issues (e.g. loneliness, financial concerns, housing problems) can shape how people feel physically and psychologically. This has been emphasised during the Covid-19 pandemic, especially for older people. Social prescribing is proposed as a means of addressing non-medical issues, which can include drawing on support offered by the cultural sector.

METHOD

A rapid realist review was conducted to explore how the cultural sector (in particular public/curated gardens, libraries and museums), as part of social prescribing, can support the holistic well-being of older people under conditions imposed by the pandemic. An initial programme theory was developed from our existing knowledge and discussions with cultural sector staff. It informed searches on databases and within the grey literature for relevant documents, which were screened against the review's inclusion criteria. Data were extracted from these documents to develop context-mechanism-outcome configurations (CMOCs). We used the CMOCs to refine our initial programme theory.

RESULTS

Data were extracted from 42 documents. CMOCs developed from these documents highlighted the importance of tailoring-shaping support available through the cultural sector to the needs and expectations of older people-through messaging, matching, monitoring and partnerships. Tailoring can help to secure benefits that older people may derive from engaging with a cultural offer-being distracted (absorbed in an activity) or psychologically held, making connections or transforming through self-growth. We explored the idea of tailoring in more detail by considering it in relation to Social Exchange Theory.

CONCLUSIONS

Tailoring cultural offers to the variety of conditions and circumstances encountered in later life, and to changes in social circumstances (e.g. a global pandemic), is central to social prescribing for older people involving the cultural sector. Adaptations should be directed towards achieving key benefits for older people who have reported feeling lonely, anxious and unwell during the pandemic and recovery from it.

Toward reanimating the laughter-involved large-scale brain networks to alleviate affective symptoms

INTRODUCTION

The practicality of the idea whether the laughter-involved large-scale brain networks can be stimulated to remediate affective symptoms, namely depression, has remained elusive.

METHODS

In this study, 25 healthy individuals were tested through 21-channel quantitative electroencephalography (qEEG) setup upon resting state and while submitted to standardized funny video clips (corated by two behavioral neuroscientists and a verified expert comedian, into neutral and mildly to highly funny). We evaluated the individuals' facial expressions against the valence and intensity of each stimulus through the Nuldos face analysis software. The study also employed an eye-tracking setup to examine fixations, gaze, and saccadic movements upon each task. In addition, changes in polygraphic parameters were monitored upon resting state and exposure to clips using the 4-channel Nexus polygraphy setup.

RESULTS

The happy facial expression analysis, as a function of rated funny clips, showed a significant difference against neutral videos (p < 0.001). In terms of the polygraphic changes, heart rate variability and the trapezius muscle surface electromyography measures were significantly higher upon exposure to funny vs. neutral videos (p < 0.5). The average pupil size and fixation drifts were significantly higher and lower, respectively, upon exposure to funny videos (p < 0.01). The qEEG data revealed the highest current source density (CSD) for the alpha frequency band localized in the left frontotemporal network (FTN) upon exposure to funny clips. Additionally, left FTN acquired the highest value for theta coherence z-score, while the beta CSD predominantly fell upon the salience network (SN).

CONCLUSIONS

These preliminary data support the notion that left FTN may be targeted as a cortical hub for noninvasive neuromodulation as a single or adjunct therapy in remediating affective disorders in the clinical setting. Further studies are needed to test the hypotheses derived from the present report.

Respecting the Old and Loving the Young: Emoji-Based Sarcasm Interpretation Between Younger and Older Adults

The interpretation of sarcasm relies on many cues and constraints. In computer-mediated communication (CMC), paralinguistic cues, such as emoticons and emoji, play an important role in signaling sarcastic intention. Smiling emoji have been claimed to be a marker of sarcasm among Chinese senders. Shared knowledge between the sender and the recipient, such as age and relationship, has a substantial effect on irony or sarcasm interpretation. However, hardly any research has been done to integrate the two factors to explore their joint effect on sarcasm interpretation. The present study investigated the interaction effect of these factors on the interpretation of ambiguous statements accompanied by a smiling emoji. Two experiments were conducted to investigate the differences between younger and older adults in making judgments about ambiguous statements accompanied by a smiling emoji. The results showed that sender age and sender–receiver relationship have disparate influences on younger and older adults’ interpretation of emoji-based ambiguous statements. For younger adults, sender age and sender–receiver relationship were significantly associated with the perceived sarcasm of emoji-based ambiguous statements, whereas for older adults, sender age had a null effect on the sarcastic interpretation of emoji-based ambiguous statements, but relationship was an important cue that might impact their interpretation.

Effect of humour intervention programme on depression, anxiety, subjective well-being, cognitive function and sleep quality in Chinese nursing home residents

AIM

To evaluate the effect of an 8-week humour intervention programme on reducing depression and anxiety and improving subjective well-being, cognitive function and sleep quality in nursing home residents.

DESIGN

A single-blinded and quasi-experimental design with repeated measures.

METHODS

Seventy-four older adults were recruited from May 2018-September 2018, with 37 older adults in the humour group received humour intervention and 37 in the control group received no intervention. The intervention was an 8-week humour intervention programme for older adults to learn to use humour and release their emotions. Primary outcomes include depression, anxiety and subjective well-being and secondary outcomes were cognitive function and sleep quality. Two-way repeated measures ANOVA was used to compare the differences of outcome measures between the two groups. Outcomes were measured at baseline, 8 and 16 weeks.

RESULTS

There was no significant difference between the two groups at baseline. The adherence to the sessions of humour intervention over the 8-weeks was 97.6%. Two-way repeated measures ANOVA revealed significant improvement in depression, anxiety, subjective well-being and sleep quality during the postintervention (8 weeks) and follow-up (16 weeks) periods in the humour group versus the control group. However, a significant time × group interaction for cognitive function was only found during postintervention.

CONCLUSION

The humour intervention programme was effective in reducing depression and anxiety symptoms and increasing subjective well-being, cognitive function and sleep quality in older adults.

IMPACT

Physical and mental health problems are common among older adults in nursing homes. The study demonstrated that humour intervention has feasibility and potential to be used as an effective non-pharmacological intervention in improving well-beings of Chinese nursing home residents.

TRIAL REGISTRATION

ChiCTR1800016148.

Measuring the well-being of people with dementia: a conceptual scoping review

BACKGROUND

Enabling people with dementia to 'live well' is a policy and research priority in many countries. However, instruments for measuring outcomes of psychosocial interventions designed to promote well-being in dementia are often derived from a symptom-focused, loss/deficit approach, or from broad quality of life concepts. A pan-European dementia working group called for research on the development of an alternative asset/strengths-based conceptual framework of well-being in dementia. This paper takes forward this recommendation by developing such a framework and using this to map relevant self-report outcome measures.

METHODS

Three scoping reviews of published studies were conducted iteratively. First, we examined the literature on lived experiences of well-being and quality of life in people with dementia and then the wider dementia literature for application of well-being constructs. The synthesised findings generated conceptual domains of well-being in people with dementia. Corresponding self-report instruments used in dementia research were scoped, categorised within the conceptual framework and their potential value in measuring outcomes for people with dementia was examined.

FINDINGS

Six conceptual domains for the measurement of well-being and 35 self-report instruments that have been used with people with dementia were identified. Six instruments were developed specifically for people with dementia, five were derived from the gerontological literature and 24 from the well-being literature. Fifteen instruments and one sub-scale have been examined for psychometric properties amongst people with dementia. To date, 20 have been used as outcome measures, with seven measuring change over time. A number of identified instruments utilise traditional retrospective Likert-scaling response formats, limiting their potential for use with some groups of people with dementia.

CONCLUSION

An assets/strengths-based framework is presented, outlining structural domains for selecting self-report measures of well-being in people with dementia. It provides a foundation for enhancing research into processes and outcomes of psychosocial interventions, including instrument development, more precise matching of intervention aims with outcome measurement, and newer technology-based 'in-the-moment' measurement.

Age-related differences in the ability to decode intentions from non-literal language

Older adults sometimes experience difficulty in decoding non-literal language, such as sarcastic statements where the underlying meaning differs from the literal words used. Given that sarcasm usually communicates a negative message this age effect might be explained by a positivity bias in old age. Here we test this for the first time by looking at age differences in interpreting non-literal compliments made with positive intention. However, another possibility is that older adults may fail to interpret such remarks correctly because these non-literal compliments are rarely encountered in everyday interactions. The aim of this study was therefore to compare younger and older adults' comprehension of positively and negatively valenced non-literal language. Forty younger and thirty-eight older adults read short story scenarios ending with a positive or negative, literal or non-literal evaluative appraisal of an event. Older adults were less likely than young to detect negatively valenced non-literal criticism and there were even more pronounced age-related differences in comprehending positive non-literal compliments. This indicates that age differences in understanding non-literal language are not driven by positivity biases. The relative rarity of non-literal compliments may have made these particularly difficult to interpret for both younger and older adults. Younger adults' performance indicated that non-literal language mutes perceived levels of critique and praise, while older adults' tendency to misinterpret non-literal language means that they may not benefit from this muting function. Potential implications for social interactions in older adulthood are discussed.

A qualitative study of the shared experience of humour between people living with dementia and their partners

Humour is a complex social and emotional experience which could constitute a positive resource for people endeavouring to live well with dementia. However, little is currently known about the shared use and value of humour in dyads where one person has dementia. The purpose of this study was therefore to explore how people with dementia and their care-partners experience, use and draw meaning from humour in relation to their shared experiences of dementia and their ongoing relationships. Ten participant dyads (the person with dementia and their spousal partner) took part in joint semi-structured interviews. Interpretative Phenomenological Analysis revealed eight subthemes that were subsumed under three super-ordinate themes: ‘Humour Has Always Been There (and Always Will Be)’; ‘Withstanding Dementia’ and ‘Renewing the Value of Humour in Dementia’. Overall, the findings suggest that humour, in different forms, can represent a salient and enduring relationship strength that helps dyads maintain well-being and couplehood by providing a buffer against stressors associated with dementia. The findings highlight the potential value of integrating a dyadic perspective with strengths-based approaches in future research into how people live well with dementia.

Are Humor Styles of People With Dementia Linked to Greater Purpose in Life?

Objectives

Little is known about humor and purpose in life in people with dementia. Although having a sense of humor is typically associated with positive psychological outcomes, recent evidence suggests that outcomes may vary depending on whether the humor being used is adaptive versus maladaptive. The goal of this study was to determine whether humor styles are predictive of purpose in life in people with dementia.

Methods

Questionnaires were verbally administered to people with mild-to-moderate dementia to measure humor styles and purpose in life.

Results

Adaptive humor styles were associated with purpose in life whereas maladaptive humor styles were not.

Discussion

Having a sense of humor in dementia may be associated with a stronger sense of purpose in life, but it depends on the type of humor used. Results are discussed in the context of understanding the role of humor in the daily lives of people with dementia and implications for care.

Expressions of Sense of Self Among Individuals With Alzheimer’s Disease

Recent research has challenged the previously held view that people with Alzheimer’s disease (AD) lack a sense of self, with several studies demonstrating that the sense of self is partially preserved, even in late stages of AD. The aim of this study was to examine how people with AD express their sense of self (Self 1–3) using the social constructionist theory of selfhood described by Harré (1998). Personal interviews were analyzed deductively. The participants narrated fragments of their life stories and expressed the fear of becoming a burden to family members and of nursing home placement. They expressed Self 1 (personal singularity or personal identity) without any problems, whereas their Self 2 (self-concept) attributes had undergone changes that they had learned to live with. The participants expressed surprisingly few problems with their narratives of Self 3 (social personae), that is, their accounts of interactions with other people. They reported being received positively when they were open about their diagnosis. These results provide further nuances that broaden our understanding of the process of preserving the sense of self, that is, simultaneously being the same and a different person.