Innovative Illness-Prevention Strategies for Long-Term Care


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.

A short massage can help residents to relax and feel better about themselves. This can lead to increased mental alertness, increased physical activity, and improved socialization. An agitated or anxious resident can be calmed through massage. A myriad of benefits are possible when muscle tension is relieved-improved balance and mobility, more restful sleep, and less pain, to name a few.

Massage techniques that can be easily taught include the basic strokes. Massage is defined as the manipulation of soft tissue through stroking, rubbing, kneading, or tapping. The most common site is the back and common techniques are effleurage and petrissage.

The effleurage technique involves long, light or firm strokes over the spine and back. With the resident on his/her abdomen or side, place your palms on the resident’s lower back, stroke up the spine to the shoulders, out to the deltoid muscles, down the lateral back to the center of the lower back, and repeat. Fingertip effleurage is performed by lightly moving fingers in a circular pattern over one part of the body or in long strokes over the back. In petrissage, muscles are alternately kneaded and stroked.

Residents should be offered a gentle massage or a back rub with daily care. Massage techniques can be used when bathing or applying lotion. Personal preferences and physical condition will help to determine body position and the firmness of the strokes.

For maximum benefits of massage, LTC facilities should develop a program that helps to provide regular opportunities for therapeutic touch. Possibilities range from hiring a professional massage therapist to having staff offer simple bedtime back rubs to residents.

Both massage and humor can help to relieve the negative effects of stress. Residents who exhibit bursts of tears or temper, overeating or undereating, confusion, frequent accidents, feelings of fear, irritability, depression or, in many cases, infection could be experiencing stress. An enjoyable activity that includes humor, followed by a soothing massage, could significantly affect the overall health of residents, families, and staff.

In short, there is much to gain from challenging your staff to come up with creative uses of laughter and relaxation in improving the health of your facility’s residents.

Elizabeth P. Fuss, RN, MS, CIC, is the Senior Infection Control Practitioner at the University of Maryland Medical Center, Baltimore. For further information, phone (410) 328-5757. To comment on this article, please send e-mail to For reprints in quantities of 100 or more, call (866) 377-6454.


1. Cousins N. Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration. New York: W.W. Norton & Company;1979.

2. Berk LS, Tan SA, Fry WF, et al. Neuroendocrine and stress hormone changes during mirthful laughter. The American Journal of the Medical Sciences 1989;298:390-6.

3. Adams P, Mylander M. Gesundheit!: Bringing Good Health to You, the Medical System, and Society Through Physician Service, Complementary Therapies, Humor, and Joy. Rochester, Vt.: Healing Arts Press;1998.

4. Nicoll H. Therapeutic massage for your senior years. Olympia, Wash.: Information for People;1995.

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