Humor is an essential characteristic of every human being. The ability to see humor in ourselves, in situations, and in life is one of the most valuable health assets an individual can have.
One of the most persistent views of humor is that it performs important dynamic functions for an individual, mainly as a result of the laughter that usually accompanies humor. It may release anxiety, tension, or energy, permit the expression of ideas or feelings, and even facilitate coping.1 Moreover, laughter also produces beneficial physiological results. It exercises the heart and lungs, stimulates the circulatory system, and decreases blood pressure.2 Thus, humor may be a significant factor related to well-being.
The purpose of this study was to measure the effect of a humor program on the morale of older adults as a means of enhancing well-being. As older adults continue to increase in age and number, nurses will play an increasingly active role in assessment, care, and health promotion of elderly clients. If nurses can develop the use of humor as a therapeutic strategy that enhances well-being, humor may then become an essential ingrethent in the delivery of nursing care for aged persons.
SIGNIFICANCE OF THE STUDY
The past two decades have seen an increasing emphasis within the health professions on a more humanistic approach to the individual. Nurses recognize each person as a holistic being, each having unique perceptions, motivations, and behaviors. The nurses' response is not just to the body of the client or the illness, but also to feelings, the mind, and every aspect of the person interacting with the environment. Within this humanistic, holistic perspective, humor is an essential phenomenon.
CORRELATION COEFFICIENTS BETWEEN SELF-PERCEIVED HEALTH AND PRETEST SCORES
Paralleling the increase in the aged population has been an increase in gerontological research. The result of this research is an abundance of information about the characteristics and needs of the aged. For example, many studies describing psychosocial characteristics of this population include low self-esteem, low morale, depression, inactivity, and an impaired level of overall adjustment.3 Therefore, there is a need to develop a nursing strategy to improve morale in the older adult.
Being able to resolve conflicts and incongruities through a humorous release of energy may give the aged person a feeling of accomplishment and satisfaction with life. Clients at a California gerontology center, for instance, became more sociable and more active when volunteers reawakened their sense of humor (Newsweek. 1982:74). Skillful use of strategies such as humor appears to promote holistic health behaviors and enhance well-being in the elderly client.
This study was conducted to test the following four hypotheses:
1. Older adults who participate in a humor program will have an increase in morale as compared with a group of older adults who do not participate.
2. Older adults who participate in a humor program will have a decrease in agitation as compared with a group of older adults who do not participate.
3. Older adults who participate in a humor program will have an increase in attitude toward their own aging as compared with a group of older adults who do not participate.
4. Older adults who participate in a humor program will have a decrease in lonely dissatisfaction as compared with a group of older adults who do not participate.
Definition of Terms
The following operational definitions describe the terms used in this study.
Humor program. A program designed for groups of older adults that produces laughter or smiling and a general sense of well-being. The program consisted of six 30- to 45-minute humorous sessions held consecutively twice a week for 3 weeks. Each of the six sessions was characterized by a different humorous stimulus:
* Session 1 : The Honeymooners
* Session 2: / Love Lucy
* Session 3: Disorder in the Court - The Three Stooges
* Session 4: Abbott & Costello Go to Mars
* Session 5: Live Comedian
* Session 6: Puppet Show
Morale. For this study, the sum of the three factor scores on the Philadelphia Geriatric Center (PGC) Morale Scale as revised by Lawton was used as a measure of one's morale.4
Agitation. The component of morale measured by the score on the six questions included in Factor I of the PGC Morale Scale. A high score on the Factor I items indicates a low level of agitation.
Attitude toward own aging. The component of morale measured by the score on the five questions included in Factor II of the PGC Morale Scale. A high score on the Factor II items indicates a positive attitude toward one's own aging.
Lonely dissatisfaction. The component of morale measured by the score on the six questions included in Factor III of the PGC Morale Scale. A high score on the Factor III items indicates a basic satisfaction with life and things as they are now.
An apartment complex for older adults located in north central West Virginia provided the setting for this research study. This complex was a unique residence of 38 efficiency and 24 one-bedroom apartments conveniently located close to stores, a bus line, churches, and medical and banking facilities. Each apartment offered maximum amount of freedom and yet the desired amount of privacy; however, it was expected that the evening meal be shared by all in the dining room. The complex provided an opportunity for gracious living for persons 60 years of age and older of moderate income who were ambulatory and who could adapt to congregate living.
INDEPENDENT t-TEST DIFFERENCES
At the time of this research study, approximately 60 older adults resided in the apartment complex. To be included in this research study, persons had to be able to speak and understand the English language; read the large printed type on the instruments and on the consent form; and leave their room to participate in the humor program. Of the original 32 volunteers, one subject did not meet the inclusion criteria and thus was unable to participate. Therefore, a total of 31 subjects, ranging from 65 to 91 years of age, participated in this project to completion.
After completing the demographic and pretest data, 19 subjects were randomly assigned to the experimental group and 12 subjects were randomly assigned to the control group using the sampling technique of selecting every other subject (uneven groups resulted from individuals who relied on each other to remind and escort them to each session). Once this selection was completed, the experimental group of 2 men and 17 women was asked to participate in the humor program. The 12 individuals in the control group, comprised of 1 1 women and 1 man, were assured that they would have an opportunity to attend the humor program at a later date if they so desired.
One week prior to the actual implementation of the 3-week humor program, the investigator visited the apartment complex and carefully explained me research study to all of the residents who gathered together for the evening meal. Posters were also hung on the bulletin board in the complex to promote awareness of the humor program. Residents were given 1 week to choose whether or not to participate in the study. Participation was strictly voluntary.
All volunteers met with the investigator in the lounge of the complex 30 minutes prior to the beginning of the first humor session. The basic elements and requirements for participation in the study were reiterated and ample opportunity to ask questions of the investigator for further clarification was given. Subjects were informed that confidentiality would be maintained and that they were free to will draw from the study at any time. Each of the individuals desirous of participation was given a consent form to read and sign.
Actual data collection for each subject proceeded with the completion of the demographic background information questionnaire and the PGC Morale Scale. The instruments were prepared with large-printed type to accommodate those individuals with normal age-related visual disturbances. After the initial pretesting with the two instruments, subjects were randomly assigned to the control group and to the experimental group. The experimental group members were then asked to remain in their seats for the first humorous session. Post-testing was completed 3 weeks later with bom groups after the last humor session.
The investigator was present at each of the six humor sessions to set up the films, television shows, etc.; to ensure that the events ran smoothly; and to maintain attendance records. The researcher had no further contact with the control group otfier than the pretesting and post-testing dates. However, much effort was made by the researcher to minimize interaction and socialization with the subjects in the experimental group to reduce me influence of the researcher as an extraneous variable in mis study.
The Humor Program
The humor program was implemented with the experimental group at me apartment complex two consecutive evenings a week for 3 weeks, with each session lasting approximately 30 to 45 minutes. The sessions were held on me same days of each successive week and at the same time to maintain consistency. The lounge of the apartment complex served as an excellent meeting place, wim comfortable chairs and sofas, adequate heat, lighting, and windows with shades that allowed complete darkening of the room during the movies. The doors were closed during the sessions so that the program could progress without outside disturbances. The chairs and sofas were frequently rearranged to provide a clear view and to promote group cohesiveness. However, the group members generally assumed the same seat each week. Attendance was checked at the beginning of each session. Rare absenteeism did occur due to illness, appointments, or other factors during the 3- week program.
The first two sessions of the humor program consisted of old comedy television shows that were randomly selected and recorded on a video cassette. The Honeymooners, starring Jackie Gleason and Art Carney, and / Love Lucy, starring Lucille Ball, were shown at Sessions 1 and 2, respectively. Both comedy shows were black and white and each lasted approximately 25 minutes (commercials were deleted during recording). The large television located in the front of the lounge was elevated on a stand to aid visibility of the shows.
A comedy film entitled Disorder in the Court, starring the Three Stooges, was shown at Session 3. In this 1936, black and white comedy film, the Three Stooges are called on to testify in the case of Who Killed Cock Robin. The comedy runs 25 minutes from beginning to end. Session 4 consisted of anoüier comedy film titled Abbott & Costello go to Mars (1953). In this 20-minute, black and white comedy film. Bud and Lou sail through space, landing on a most earth-like planet.
A live comedian entertained the subjects with mime, magic, and clowning for 45 minutes during Session 5 of me humor program. The comedian was a 20-year-old, junior student at West Virginia University majoring in musical meater.
The last session of the humor program consisted of a puppet show. The show was presented by an assistant professor of theater and puppetry at West Virginia University. A simple stage prop wim red velvet curtains and adequate lighting was used for the show. The subjects were entertained with several short comical episodes using a variety of hand-made puppets and marionettes. The entire puppet show lasted 45 minutes.
Immediately following Session 6, post-testing of the experimental group and the control group was completed.
The demographic characteristics for this sample were described in terms of frequencies, distributions, means, and correlations. The groups were nearly homogeneous with regard to the variables of age, sex, marital status, length of residence, and social activities. The mean age of the experimental group was 76.7 years, and it consisted of 17 women and 2 men. The control group consisted of 1 1 women and 1 man with a mean age of 78.3 years.
The demographic questionnaire also included a statement with regard to individual perception of present health status. Responses were rated on a Likert scale that included four possible choices for health: excellent (score 4); good (score 3); fair (score 2); and poor (score 1). The mean health perception scores for both groups on the Likert ranged from 2.5 to 2.8. These scores indicate a fair to good perception health status. Two subjects, one each in the experimental and die control group, perceived meir health as poor.
A Pearson r correlation coefficient for self-perceived health and age yielded an r of -.46, P = .009 for the entire sample. Thus, as one ages, one's perception of health seems to decrease. Correlation coefficients between self-perceived healtfi and pretest scores for all groups are presented in Table 1.
In testing the hypotheses, an independent I-test was applied to the differences of the pretest and post-test mean scores for total morale and for each factor component. The level of significance was set at alpha equal to or less than .05 for this study. Table 2 summarizes the results of die independent ttest.
Hypothesis 1 was not supported by the data; however, a t of 1.45, P =.078 does indicate a trend in the direction of the hypothesis. Hypothesis 2 was supported by the data. There was a significant decrease in agitation in subjects in the experimental group while the agitation level increased in the control group. Hypotheses 3 and 4 were not supported, as indicated by the t values in Table 2.
Further analyses using a paired-t comparison on agitation (Factor I) mean score differences within the control group revealed a significant increase in agitation (?=2.17, P =.05). Thus, the control group became significantly more agitated over the 3-week period.
Stability, internal consistency, and validity estimates were also determined for the PGC Morale Scale and for each factor component, using Pearson product moment correlations and the Kuder-Richardson formula, 20 (KR-20). The PGC Morale Scale was found to be highly stable and internally consistent except for Factor II, attitude toward own aging. Correlations revealed a high construct validity for all components except Factor II.
Humor Program Information
Attendance records were maintained for the experimental group for the six humor sessions of the 3-week humor program. Seventy-five percent of the participants attended all six of the humor sessions. The least number of sessions attended was four by two of the subjects in the experimental group. Three subjects, or 15.8% of the experimental group, attended five of the six humor sessions.
The investigator observed the reactions of the subjects in the experimental group to each of the humorous events. Responses ranged from a simple smile or chuckle to roaring laughter aloud. The live comedian stimulated the most laughter, with the / Love Lucy show rated second funniest by the investigator's observations of the response. The session that appeared to be the least funny to this group of older adults was the Three Stooges film, Disorder in the Court.
At the end of the entire program, the subjects in the experimental group were asked to write down any comments or remarks about the humor program and to select their favorite show from the six sessions. Categorizing the comments, the comedian was the most favored by six participants. Three people chose the puppet show as their favorite and the I Love Lucy show and The Honeymooners each received a positive comment from two participants.
Thus, it was evident by these remarks that the live shows - the comedian and the puppet show - were enjoyed the most by the subjects in the experimental group. As one person commented, "I enjoyed the mime because he was live and the authence participated."
The purpose of this study was to measure the effect of a humor program on the morale of a group of older adults as a means of enhancing well-being. Following the 3- week humor program, the experimental group had an increase in their post-test total morale scores that statistically supported a trend in the direction of the hypothesis. This trend suggests that perhaps the 3-week humor program was too short of a time span to make a significant impact on the morale of the subjects in the experimental group. Moreover, the type of humorous material identified as the most enjoyable by the participants, namely the live comedian, comprised only two of the six humor sessions. Perhaps using all live comedy shows that are particularly appealing to older adults over a period of 1 to 2 months may indeed increase the level of morale significantly.
Also of particular significance is the marked decrease in agitation in the adults who participated in the humor program as was hypothesized. This suggests that one's level of agitation may be significantly decreased through a humor program. Instead of being called agitation, it might well be called an "old folks manifest anxiety scale," with its combination of dysphoric ideology and symptoms of anxiety - short temper and insomnia in the content of the factor items.5 Laughter is a means of releasing excessive amounts of psychic energy.6 According to Mindness, the most fundamental and most important function of humor is its power to release us from the many inhibitions and restrictions under which we live our daily lives.7 It is because of this cathartic effect that people feel as if excess energy and tension have been drained away following laughter. It is not too far-fetched that laughter is related in several ways to longevity, mainly through the reduction of stress and hypertension.8
In contrast to the decrease in agitation in the adults who participated in the humor program, the subjects in the control group had a dramatic increase in their agitation level and a sharp decrease in total morale with a mean score difference of -.75 over the 3week period. Perhaps the severe, inclement weather (namely snowstorms) preventing the subjects from leaving the apartment complex produced "cabin-fever" accompanied by feelings of anxiety, tension, stress, worry, and frustration. The control group was not afforded the opportunity to release these feelings of agitation and anxiety through humor and laughter.
This finding poses an interesting perspective of humor: the matter of timing. An individual's appreciation of humor is seriously affected by timing, both in the introduction of humorous material and within the material itself.9 In this study, the timing was right. As was noted earlier, humor served as a means of dealing wim me weadierrelated conflicts, tensions, and intergroup relationships. Furthermore, the relationship between humor and timing provides several implications for the nursing profession. Humor used by nurses in delicate situations such as coping with helplessness in caring for the dying patient; decreasing depression associated wim severe disfigurement; or in situations where embarrassing, sensitive, or emotion-laden issues are at hand, timing of humor is a crucial factor. In other words, if the timing is inappropriate, humor can be a destructive rather man a constructive intervention.
Although there was not a statistically significant decrease in lonely dissatisfaction among the participants in die experimental group, the mean raw scores do indicate that there was a decrease in lonely dissatisfaction in me experimental group and an increase in lonely dissatisfaction in die subjects in the control group. Another noteworthy finding is mat the difference in the total morale score (pretest and posttest) correlated most highly wim the experimental group's post-test lonely dissatisfaction scores (r=.647, P =.003). Thus, overall the decrease in the loneliness factor made the biggest impact on the increase in total morale for the experimental group. A possible explanation for this finding may be mat the humor program promoted group cohesiveness and stimulated social relationships and social interaction among the participants. Group cohesiveness is terribly important for the aged who are slowly being stripped of meaningful relationships. The need to talk and share is very important for mese people, and finding persons who will listen and take mem seriously is a problem. Group membership gives such people a chance to communicate with omers and freedom to express many feelings, especially hostile ones.3 A hearty laugh and me personal closeness of group interaction may go a long way to convince older people that they still have a sense of humor and that tfiey belong and are appreciated.
Recommendations and Implications
Several limitations have been recognized from mis study mat should be objectively weighed in relation to me findings. Sample size is always a concern in clinical research. This was a small, non-random, convenience sample which, in itself, limits the generalizability of inferences to other populations. The sample was also biased in number toward women. However, this will often be me case in conducting research wim the older population because women live longer man men.
It is recommended mat this study be replicated wim a larger sample in various settings, including adult day care centers, senior citizen centers, hospices, and omer community health programs in which nursing plays an active role.
The study's design limited contact wim me control group to data collection. This limited the means for determining whetiier or not some type of interaction with the control group would have affected the study's findings. Riture study designs should include at least one control group which receives "some attention" to eliminate the biases from the Hawthorne effect. An important consideration in planning die control group would be to control for me effect of the personality of die investigator.
Implicit in the study of humor and aging is the expectation mat there are differences in the perception of humor by young and old. As people age, the differences among them become greater. What one person finds hilarious, another will find offensive, dull, or incomprehensible.10 This study found mat live comedy and everyday humorous situations portrayed in shows such as / Love Lucy and The Honeymooners were particularly appealing to this sample of older adults. Therefore, it is recommended that other types of humor (eg, slapstick, silly, sexual, ethnic) in various forms be implemented in future studies to further explore what kinds of humor the elderly enjoy.
Humor as a therapeutic nursing intervention for older adults was successful in enhancing well-being in this study's sample providing implications for nursing practice. Humor as a holistic nursing strategy can be applied to various health-care settings as a means to cope with stress and anxiety, to reduce depression, to dispel anger and aggression, to facilitate communication and strengthen relationships, and to deal with insensitive or intimate subjects. There is some clinical evidence supporting the therapeutic benefits of laughter in facilitating the healing process. Norman Cousins' remarkable recovery from a serious collagen disease demonstrated what laughter and positive emotions can do to help overcome illness.11 Moreover, mirth and laughter can be specifically employed to reduce stress and hypertension and to improve respiratory and cardiovascular function.
Nurses can be encouraged to explore the role of humor to help prevent or reduce me bum out phenomenon: to cope wim the stress, pressure, and depression inherent in me nursing profession. Not only can this intervention be used by professional nurses, but nurses can also teach paraprofessionals to apply the strategy wim populations of all ages.
- 1. McGhec PE. Humor: Its Origin and Development. San Francisco: Witt-Freeman; 1979.
- 2. Peter LJ. Dana B. The Laughter Prescription. New York: Ballantine Books; 1982.
- 3. Burnside I. Working with the Elderly: Group Process Techniques. Belmont, Calif: Wadsworth; 1984.
- 4. Lawton MP. The Philadelphia Geriatric Center Morale Scale: A revision. J Gerontol. 1975; 30:85-89.
- 5. Lawton MP. The dimensions of morale. In: Kent D, Kastenbaum R, Sherwood S, eds. Research Planning and Action for the Elderly. New York: Behavioral Publications; 1972.
- 6. Freud S. Int J Psychoanal. 1928;9:1-6.
- 7. Mindness H. Laughter and Liberation. Los Angeles: Nash; 1971.
- 8. Goldstein, JH, Harman J, McGhee PE, Karasik R. Test of an information processing model of humor: Physiological response changes during problem-and-riddle-solving. Journal of General Psychology. 1975; 92:59-68.
- 9. Seltzer M. Timing: The significant common variable in both humor and aging. In: Nahemon L, McCluskey K, McGhee P, eds. Humor and Aging. New York: Academic Press; 1986:121-134.
- 10. Nahemow L, McCluskey K, McGhee PE. Humor and Aging. New York: Academic Press; 1986.
- 11. Cousins N. Anatomy of an Illness as Perceived by the Patient: Reflections on Healing. New York: Norton; 1979.
CORRELATION COEFFICIENTS BETWEEN SELF-PERCEIVED HEALTH AND PRETEST SCORES
INDEPENDENT t-TEST DIFFERENCES