1. ART THERAPY: “CLOWN EFFECT” WITH OLD DEMENTED RESIDENTS IN FRANCE INTRODUCTION METHODS RESULTS CONCLUSION HUVENT-GRELLE D., PAGNIEZ C., HERREMAN P., DELABRIERE I., PUISIEUX F. Centre Hospitalier Régional de LILLE, hôpital Gériatrique Les BATELIERS, 23 rue des Bateliers, 59 037 LILLE- FRANCE Clown services are complementary to, but different from other types of caring such as pet therapy or music therapy. Indeed many hospitals have been promoting those therapies. However Clown Therapy for demented patients, who no longer communicate verbally, has not been widely explored yet. According to our experience, it should be recognized as a complement to conventional therapies. Objective: The state of mental and physical health of our residents fluctuates widely. Our aims are to : Enhance these patients’ quality of life thanks to a creative and sensory therapy which can be stimulating for them. Help reduce their feeling of isolation and their agitation. At first, there was some concern that the presence of clowns in such facility could be perceived as condescending, by treating our residents like children but it is not the case. Clowns remain humble and available in the relationship. The clowns don’t produce a show and don’t provide entertainment. They try to engage in communication with patients individually. The patients who have benefited from the clowns’ skills are more relaxed and less stressed than those who don’t get humour therapy. However further research is needed to clarify the impact of laughter on mental health as it has been done for the control of pain. Clowns are perceived as mediators who can defuse crises. They help AD people feel less anxious. In addition to the therapeutic benefit on our patients the presence of clowns is also rewarding for our experienced nurses. Their visits seem to increase their motivation and pleasure to work with old dementia patients. We interpret our experiment as very positive. We intend to continue with the project in the future providing we can have sufficient funding. We would eventually like to integrate Clowns’ visits into the treatment plans of our Special Care Unit. Design: In the Special Care Unit that we set up in our hospital 13 years ago, 13 old people, 63 to 95 years old, live permanently. They have all reached a severe stage of Alzheimer’s disease with psychomotor agitation and communication disorders. Two clowns come once a month for five hours throughout the year. An average of 8 residents are visited each time by the clowns. DISCUSSION What Clown Therapy is and why it is helpful in Alzheimer’s disease : - Some of our residents are frequently visited by family or friends while others have no visits at all. - Clowns’ visits are eagerly awaited by the care givers. - A prior discussion between nurses and clowns make it possible to identify which residents need company or conversation, to make it easier to approach them and to inform the clowns about any particular disease episode in patients' lives. - The clowns have received training in issues related to illness. - The clowns respect the individuality of each patient. Privacy and confidentiality rules are also respected. After the visits, we found more positive attitudes with AD patients : - Clowns make people think differently about their childhood : “We all have a clown inside our mind” … - The clown considers that it is the other one who knows which is rewarding for the old patient. The clown feels great empathy with the residents. - There is evidence that Clown Therapy influences positively the well-being and the mood of our patients. - In many cases it also stimulates their ability to communicate, brings back memories and allows the emergence of feelings and even pleasure. - The clowns’ visits seem to benefit patients who suffer from AD, creating moments of respite through communication, listening, games, memory resurgence. - Patients and families express very positive reactions to the visits (they approve them) and wish their continuation.