Using Comedy Care to Curb Isolation and Loneliness Among Older Adults

Abstract

Dani Klein Modisett’s work with Laughter On Call—an organization she launched that uses laughter to create connection, improve health, ease stress, and contribute to the longevity of older adults with dementia—showcases through research and Modisett’s interactions with dementia patients how laughter can be a critical antidote to loneliness, too. “Comedy care” can be an essential element in addressing older adult isolation, and care providers can use this article’s tips to integrate tools from the comedian’s toolbox.

Key Words:

Laughter On Call, Alzheimer’s, dementia, social isolation, loneliness

I am not doctor. I don’t even play one on TV, and never did in all the years I have been an actor. But having witnessed both my parents pass away after long illnesses—my father from cancer and most recently my mother from Alzheimer’s disease—I know a lot about the loneliness and isolation that can be so common in the third act of life. As a comedian who has spent years teaching, performing, and writing about how to take comedy concepts out of the clubs and into people’s lives to improve communication, I also know a lot about the healing benefits of shared laughter.

Sharing a laugh makes people feel seen, connected, and less alone, and is of great value not only on a personal level, but also could be to our entire healthcare system. According to the AARP Public Policy Institute (Flowers et al., 2017), social isolation among midlife and older adults is associated with an estimated $6.7 billion in additional Medicare spending annually.

Laughter On Call sprung from this knowledge, and is shared here as a new tool to help combat loneliness and isolation, especially in older adults with dementia.

Background

Eight years ago, my mother was diagnosed with Alzheimer’s disease. A few years and many tens of thousands of dollars spent on keeping her in her New York City apartment with home care help, my sister and I decided to move her closer to me in Los Angeles. I found a residential community entirely devoted to memory care. Plus there was an impressive chandelier hanging at the entrance that was reminiscent of an Upper East Side hotel. My husband, two sons, and sister were at the airport to greet us as I wheeled my mother to baggage claim.

My mother’s adjustment to her new home was not nearly as difficult as we had anticipated. Although once she realized she wasn’t leaving she became depressed, withdrawn, and lost interest in food, which previously had been one of her biggest passions. Distraught, I had to do something and almost immediately hit on the idea of hiring a comedian to cheer her up. I mentioned this to my dentist, who, because it’s Los Angeles, also often serves as a life coach.

“You should,” she responded.

And so I did. I posted a request on Facebook, and within minutes my phone rang. A friend of mine knew a comedian in Los Angeles who was interested in working with older adults. She came to meet my mother. She sat down with her at eye level and in a thick New York accent, familiar to my mother, she asked, “You don’t want to talk to me, you’re probably thinking, ‘who is this schmuck just talking to me?’ ”

My mother’s eyes lit up. “Shmuck!” she said, followed by genuine laughter. The comedian, knowing she had struck gold, repeated the word, and then they laughed together. I hired her on the spot, for eight hours a week.

In a remarkably short time, my mother’s whole demeanor changed, even when the comedian wasn’t with her. She started eating heartily, engaging with people, and even singing. The results were undeniable. I wrote an article about the experience for AARP the Magazine (Modisett, 2018) and received hundreds of requests from around the country asking for a comedian for their loved ones. How could I not pursue this? Comedians need day jobs and there is an endless stream of people like my mother whose lives would thrive with this kind of interaction.

Starting Laughter On Call

I began speaking about my mission to bring comedians to people with Alzheimer’s to healthcare professionals, executive directors of residential communities, geriatric care managers, gerontologists, and anyone seated next to me at dinner parties. I told them about my discovery through my mother’s experience of the effectiveness of connecting through shared laughter to improve quality of life. And I embarked on a mission to bring comedy care to as many older adults as possible, to help them and their families contend with the isolation that is far too common for people experiencing dementia. While the initial offering from Laughter On Call included one-on-one comedy care that paired an older adult with a trained comedian, Laughter On Call soon expanded due to the diverse needs of older adults with Alzheimer’s and those who care for them.

Now Laughter On Call offers a wide range of virtual and in-person services including: caregiver training, family workshops in how to create connection through shared laughter, interactive storytelling shows that actively engage residents, and improv training for older adults. The training pulls from tools I taught at UCLA in a stand-up comedy class. The Improv shows are part Mad Libs and part traditional improvisation. And the myriad older adult comedy classes we teach are customized for the cognitive ability in the room.

What became abundantly clear is that our comedy care is filling a gaping need—a need for innovative ways to address isolation among older adults, particularly those with dementia.

Backed by Research

Although I had the idea to use this approach specifically to reach my mother, the Laughter On Call experience is supported by findings from social scientists who were curious about using humor in this way. A 2019 study in Current Psychology supports the efficacy of using humor to reach people isolated from Alzheimer’s and other dementias, noting that in decline, a sense of humor, “remains a ‘character strength among the elderly.’ Even in patients with severe dementia, the capacities for experiencing and expressing humor still seem to be preserved. The ability to perceive, appreciate and produce humor might be observable throughout all stages of the disease, and persons with dementia even seem capable of using their sense of humor as a strategic means in communication.” (Baumgartner and Renner, 2019).

The Laughter On Call model of using humor to connect with older adults with dementia is backed by years of scientific research. Recent studies have demonstrated the positive effects of laughter on elders. For example, a study by Clark et al. (2016) indicated that sense of humor might be well preserved in early stages of Alzheimer’s disease.

Other studies have noted that even patients with advanced stages of dementia can perceive humorous interactions and remain engaged during clown visits in nursing homes (Baumgartner and Renner, 2019). Moreover, the effects of laughter have been shown to help reduce pain, decrease stress (Mayo Clinic, 2019), and make people feel happier through the release of endorphins (Whiteman, 2017). A study of humor therapists working in residential care reported that humor therapy was as effective as antipsychotics in reducing agitation in dementia patients—without the serious side effects (University of New South Wales, 2011). 

All this research backs up the essence of what Laughter On Call does, emphasizing the power of laughter and how it can improve the quality of life of those battling Alzheimer’s, other dementias, and their side effects like isolation.

All of these studies were conducted on a comedy performance directed toward an audience, which might not fully address the problem of isolation in older adults. This is where Laughter On Call innovates—by offering a unique opportunity for older adults to be active participants with a comedian, and establishing direct connections through these social interactions. This translates into social/shared laughter, helping to improve social bonding and feelings of togetherness (Whiteman, 2017). Therefore, exposing patients to humor might be an alternative form of treatment that can help patients feel better.

Future scientific research might consider exploring this two-way connection between patients and comedians and the therapeutic effect it could derive from social interaction. And in scenarios where this social interaction is not possible we could find ways to compensate for that, especially with vulnerable populations. Other areas of interest for the scientific community can be expanding the population samples of these studies to further validate the use and effectiveness of alternative forms of interventions such as Laughter On Call for Alzheimer’s disease and other dementias.

Impact

The impact of bringing levity, joy, and silliness to older adults, especially those with dementia, has been very moving. One man in Portland, Maine, had early onset dementia and other issues, but, after three months of working with a Laughter On Call comic, was ready to leave his house and join a daycare center nearby. An 84-year-old Italian woman working with a Tony Bennett–inspired comedian became willing to end her isolation and move into a home where she would have company and great care. The comedian made the transition with her, continuing his visits. Another woman, who was a dead ringer for a silent film star, with big greens eyes that followed you across a room, as soon as the Laughter On Call comedian showed up she would burst out laughing at a joke, a song, or even a silly face. These were contagious gales of laughter like someone had tickled her brain, which, in a sense, they had.

During the COVID-19 pandemic, Laughter On Call quickly pivoted to virtual services, creating a daily Lunchtime Laughter session which draws out isolated healthcare workers, communities, couples, and older adults from around the country to connect through learning simple comedians’ tools and laughing together.

In the first year since Laughter On Call launched, we have created a network of 500 comedians, trained hundreds of caregivers in live workshops and webinars, and matched elders with comedy care companions around the country.

We’ve also hosted more than 100 Lunchtime Laughter Sessions, and counting. Care center employees who have hired Laughter on Call comedians to put on group shows say they’ve noticed changes in memory-loss residents who participate in our Interactive Storytelling—noting help not just with the mind, but with mind, body, and soul. When older adults are smiling and engaged, senior facility staff and I have noticed the connection between comedian and older adults seems to slow the progression of dementia (Free, 2019). Across each interaction, the impact of the comedy care model becomes ever more apparent: shared laughter is an important tool in the isolation-prevention toolbox.

Lessons Learned

Drawing from my work teaching comedy at UCLA I came up with a set of tools to help people generate shared laughter in a family or care situation. While the tips below from the comedy toolbox are broadly applicable, they are particularly helpful for staff who provide care for older adults:

• Be honest: We can’t have a sense of humor about something if we’re trying to pretend it’s not happening. Let the person know you see them, acknowledge their feelings to create trust, and laughter is more likely to emerge.
• Let go of the moment that just happened: Every comedian knows not to hang onto a bad moment. Also this is true for interacting with people with Alzheimer’s. Letting go of a bad moment leaves you open to having a joyful connection in the next one.
• Accept that imperfect is good enough: Imperfection is where our humanity lives. Accepting yours, mine, and ours is how we are able to connect and then laugh together. No visit, caregiving situation, day, or conversation is going to be perfect, and by accepting that, you might gain a real connection.
• Don’t be afraid to be silly! When all else fails, you can make a funny face, dance around the room, or sing your favorite song to bring some joy in the room and create connection.

As the numbers of people facing memory loss continue to grow exponentially, it is more important than ever to find innovative ways to reach people and help them to remain connected. It is imperative that we put our attention on this not only to fend off feelings of depression, loneliness, and isolation, but also to protect physical health, as research has proven that these states of mind negatively affect physical health, which, considering demographics, could contribute to public health crisis.

We at Laughter On Call are happy to have found a proven, joyful way to stave off these feelings through connection. We are continuing to develop our services now to reach even more isolated communities with virtual comedy care and training to continue to create shared laughter and connection for those who need it most.

Dani Klein Modisett is the CEO and founder of Laughter On Call in Los Angeles. She is the author of two books on the importance of laughter in family life, “Take My Spouse, Please” (Shambhala Press, 2015), and “Afterbirth . . . stories you won’t read in Parents magazine” (St. Martin’s Press, 2009). She can be contacted at Dani@laughteroncall.com.

References

Anderson, G. O. and Thayer, C. E. 2018. "Loneliness and Social Connections: A National Survey of Adults 45 and Older." Washington, DC: AARP Research. Retrieved May 28, 2020.

Baumgartner, G., and Renner, K. 2019. “Humor in the Elderly with Dementia: Development and Initial Validation of a Behavioral Observation System.” Current Psychology. Retrieved May 28, 2020.

Clark, C. N., et al. 2016. “Altered Sense of Humor in Dementia.” Journal of Alzheimer's Disease 49(1): 111–9. 

Flowers, L., et al. 2017. “Medicare Spends More on Socially Isolated Older Adults.” AARP Public Policy Institute. Retrieved July 15, 2020.

Free.C. 2019. “Comedians Are Being Hired by the Hour to Help Dementia Patients. Their Goal? ‘A Full Belly Laugh.’ ” Retrieved June 1, 2020.

Mayo Clinic 2019. “Stress Relief from Laughter? It’s No Joke.” Retrieved May 28, 2020.

Modisett, D. K. 2018. “Using Humor to Combat Dementia.” Retrieved June 8, 2020.

University of New South Wales. 2011 “Humor as Effective as Medication in Treating Agitation in Dementia.” ScienceDaily. Retrieved May 1, 2020

Whiteman, H. 2017. “Laughter Releases “Feel Good Hormones” To Promote Social Bonding.” Medical News Today. Retrieved May 28, 2020.