The Darker Side of Humor in Dementia Care
We use humor a lot in dementia care. It is a great caregiver coping tool when things get stressful. Provoking laughter and providing amusement helps us form relationships and bond with patients. Humor can also defuse tensions and enlist the cooperation of people with Alzheimer's to carry out activities of daily living. Humor has the power to do good, but it can also present a number of ethical issues.
Humor can be disrespectful
Humor can be demeaning and disrespectful when it is used inappropriately. One of the primary roles of the caregiver is to preserve the dignity of a person made vulnerable by their illness. Alzheimer's disease causes devastating brain damage which means judgement is affected. Humor must not compromise dignity and it also has to acknowledge that if the patient does not find it funny then caregivers must respect their individuality.
Who is the Butt of the joke?
Laughter is as contagious as yawning and people do, as the psychologist Paul Ekman has pointed out, mirror smile responses and tend to share a smile. People with dementia will not necessarily be able to differentiate between the malevolent and genuine content of jokes and humor. The role of caregiver, especially those in senior positions in nursing care homes and institutions is to point out the difference to untrained and new staff.
In the home, or in institutional care, humor must not make the patient the butt of the joke. You have to know where to draw the line.
Institutional Black Humor
Humor has the power to exclude staff as well as patients. It can be a form of bullying in the workplace and in the home.
Gallows or sick humor is used in most challenging workplaces. Staff describe the use of sick humor as defusing stress, giving staff a distance between them and traumatic aspects of their work such as dealing with death or violence, and fostering social cohesion with other member of the staff team. Yet there is little measurable psychological evidence of well being such as lowering of stress hormones.
Finding out the real message
Laughter and humor can mask real unhappiness and despair. Understanding the message, communicating with people with Alzheimer's and other types of dementia can be more difficult than other members of society and requires greater sensitivity.
The Administration on Aging website has information on their Year of Elder Abuse Prevention**.** It provides links to information on elder rights protection.
Report any acts of suspected abuse to your local social services. Call 911 to report abuse to the police where the resident is in danger. This includes help for people you believe are the victims of all aspects elder abuse- sexual abuse, financial exploitation, injuries that are the result, or you suspect may be the result of physical abuse, and in this case, psychological abuse.
Killick, J. & Allen, K. 2002. Communication and the Care of People with Dementia. Open University Press, Philadelphia.
Moran, C. & Hughes, P. 2006. Coping with Stress : Social work students and humor. Social Work Education, 25(5), 501-517.