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Innovative Illness-Prevention Strategies for Long-Term Care

October 1, 2004
by root
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Sometimes what you need is a good laugh by Elizabeth P. Fuss, RN, MS, CIC

As an infection control nurse, I know that residents of LTC facilities would make any infection control practitioner's list of people at risk for infection. Advanced age, chronic illness, immobility, depression, and communal living all can contribute to an increased risk of infection, making prevention vital. Much has been written about the tried-and-true principles of hand hygiene, isolation, and immunizations. This article focuses on two less frequently mentioned infection-prevention strategies-humor and massage.

And the good news is that the health benefits of these extend far beyond infection control. Author Norman Cousins was an early advocate for the healing power of humor. Cousins' book Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration, is his account of a debilitating illness he suffered, during which he asked and answered questions about the beneficial effects of positive emotions on body chemistry. Cousins reports that "we began the part of the program calling for the full exercise of the affirmative emotions as a factor in enhancing body chemistry. It was easy enough to hope and love and have faith, but what about laughter? Nothing is less funny than being flat on your back with all the bones in your spine and joints hurting."1 Cousins gathered favorite funny movies like vintage Marx Brothers films, watched Candid Camera classics, and had books of humor read to him. "It worked," he concluded. "I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep." Cousins' doctor also documented drops in his sedimentation rate, showing that "there is a physiologic basis for the ancient theory that laughter is good medicine."

Since Cousins' illness in 1964, much research has been done about humor's effects on the body. Humor itself can't easily be evaluated, but its effects can be. We now know that laughter benefits the cardiovascular system, the respiratory tract, and the musculoskeletal, endocrine, nervous, and immune systems. Laughter increases the secretion of energizing catecholamines and endorphins, increases oxygenation of the blood, and decreases residual air in the lungs. As the arteries relax, heart rate and blood pressure are lowered and peripheral circulation is improved. Physiological evidence has also been shown that laughter relaxes muscles, and the relaxation response can last up to 45 minutes after a hearty laugh.2

Humor has perhaps been touted most effectively by Patch Adams, MD, who believes that humor has positive effects on mental as well as physical health. Adams says, "I have reached the conclusion that humor is vital in healing the problems of individuals, communities, and societies. I have been a street clown for thirty years and have tried to make my own life silly, not as that word is currently used, but in terms of its original meaning. 'Silly' originally meant good, happy, blessed, fortunate, kind, and cheerful in many different languages. No other attribute has been more important. Wearing a rubber nose wherever I go has changed my life. Dullness and boredom melt away."3

While injecting humor into medical settings can be difficult, Adams says it can be accomplished with the support of administration and staff. "Once the medical establishment has agreed to accept more humor, people at all levels of employment will be willing to take steps in this direction."

Some guidelines and suggestions for sharing humor in LTC:
  • Get to know residents and develop a sense of their interest in and receptivity to humorous situations.

  • Avoid ethnic, religious, and sexual humor.

  • Provide live entertainment that includes humor, such as clowns and magicians.

  • Provide printed and audiovisual resources that contain jokes, cartoons, and humorous sayings.

  • Display "Laugh of the Day" cartoons and jokes on doors, meal trays, dining hall tables, etc.

  • Encourage staff members to include humorous stories in their conversations with residents.

  • Plan events such as "Classic Laughs Night," where comedy films from various times are shown. A good resource for such films is, where the American Film Institute lists its top 100 film comedies of all time.

  • Add your own ideas for your facility!
As with humor, LTC residents also benefit from the caring touch of caregivers. Since the days of Greece and Rome, massage has provided relaxation and healthful benefits. In our modern world, scientific research has shown that therapeutic massage provides not only relaxation, but also improved circulation of blood and lymph, improved skin tone, relief from headaches and back pain caused by muscle tension, and improved immune system activity. Massage encourages the release of endorphins, our body's own natural painkillers, and can increase serotonin, which acts as an antidepressant.4

Professional specialists in therapeutic massage provide the benefits of manual techniques and manipulations. However, every caregiver can and should provide basic caring touch to their residents.