Laughter, the physical response to perceived humour, has demonstrated positive effects on physical and psychological well-being. Studies that focus on effects of humour on health and well-being of older adults are scarce. No studies were found that examine what older adults find humourous. The purpose of this descriptive study was to explore the humour stimulus in a population of older adults. One hundred thirty hospital auxiliary personnel aged 50 and older were asked the question What makes you laugh? Content analysis of responses revealed nine themes in two major categories, which were (a) people or animals and (b) situations or events. Children represented the largest category of people (30%), and telling jokes represented the largest category of situations or events (51%). Humour can be used by nurses as an effective therapeutic tool when caring for older adults if appropriate sources of humour are identified and applied.

Humour is a perceptual event connected with one’s sense of self, an expression of a uniquely human capacity to adapt to experiences and situations that may be possible sources of humour. Humour has been described as a sudden shift in cognitive perspective that enables one to experience joy even when facing adversity and serves as a distraction from stress-producing events. Cognitive shifts produced by humour enable a return to previous thoughts with a fresh new look. Studies of the effects of humour on health and wellbeing demonstrate the complex and diverse nature of humour. Both adaptive and maladaptive styles of humour have been identified. Adaptive styles include self-enhancing and affiliative styles that protect the self; maladaptive styles are self-defeating and aggressive, employed to hide negative feelings and to avoid dealing constructively with problems. The following are three major theories of humour:

1. The superiority theory, which claims that people laugh at the misfortune of others to feel superior;
2. The incongruity theory, which claims that a sudden shock or conflict is necessary to produce laughter; and
3. The release theory, which claims that the purpose of humour is to provide relief from tension and social conflict.

The ancient Book of Proverbs describes the relationship between humour and health: “A merry heart doeth good like a medicine but a broken spirit drieth the bone” (17:22). Richman described five ways in which humour is therapeutic. Humour is life affirming, it increases cohesion, it is interactive, and it reduces stress. Although much has been written about the use of humour as a therapeutic tool, humour physiology is a young science. Physical benefits of humour have been compared to aerobic exercise. Humour has demonstrated an ability to increase tolerance of pain.

Humour is a powerful coping mechanism used to decrease fear, anxiety, and psychological stress; to improve the ability to cope with disease and to produce hope in stressful situations. Wooten divided therapeutic humour into three categories:

1. Hoping
   Hoping humour provides the ability to hope for something better in spite of overwhelming circumstances.
2. Coping
   Coping humour helps to change thinking and regain a sense of control.
3. Gallows humour
   Gallows humour recognizes intolerable aspects of a situation and uses humour to transform it into something tolerable.

Professionals who work in situations that are tragic frequently use this type of humour. Johnson described humour’s positive influence on spirituality and coping in breast cancer. As survivors searched for meaning in their illness, some felt that humour helped them to laugh at themselves and at life. Laughter is a behavioral event in response to humour, a smile that engages the entire body. There is a growing body of evidence that supports the health benefits of laughter, such as increases in the number and activity of natural killer cells, activated T cells, IgA antibodies, and gamma interferon and a decrease in stress hormones. Significant increases in mood have been demonstrated even when the laughter was forced without any preceding humourous stimuli. Cousins observed the physiologic effects of laughter in fighting for his own survival, using laughter to help him achieve sleep. Parse’s qualitative studies of laughter and health in persons older than 65 years of age revealed common elements of vitality and mirthful contentment. Participants clearly connected the experience of laughter with health and described the desire to laugh because it lifted their spirits and made them feel good, peaceful, and satisfied with life. Not all situations considered humourous create the effect of laughter in everyone that is exposed to the humour.

Perceptions of health and humour as well as age affect the way people respond to humour. Research has demonstrated that perception of what is humourous is unique to the individual, and personal choice can affect the outcome of laughter. Rotton and Shats found that participants who were allowed to choose the type of humour video they watched took lower doses of pain medication than those assigned a video by the researchers, indicating that personal choice of humour content significantly interacts with expectation. Rotton and Shats concluded that humour preference must be considered when using humour as a therapeutic tool; exposure to material that fails to be funny to the individual can have deleterious effects. Clearly, humour is a subjective perceptual experience. If humour is to be used as an effective therapeutic intervention for older adults, nurses must have an understanding of what this population perceives as humourous. No studies have investigated the source of humour for older adults. Such questions as “What do you find to be humourous?” or “What makes you laugh?” have not been addressed in the literature. The purpose of this pilot study was to determine the events or situations that are considered humourous in adults older than 50 years of age. This knowledge will assist in preparation for a larger study in which humour will be used as an intervention to promote a peaceful death in older adults. Knowing the source of humour that would most likely result in laughter for this population is essential before humour can be used effectively as a therapeutic intervention.

Method

This descriptive pilot study is part of a larger empirical study that examines relationships between humour and health in older adults. A questionnaire was administered to a population of older adults living in a southwest Florida community. The questionnaire included a demographics page and the following scales: the Coping Humour Scale (CHS), the Serenity Scale (SS), the Spiritual Well-Being Scale (FACITSp), and the State Trait Anxiety Inventory (STAI). The instruments demonstrated acceptable internal consistency with a Cronbach’s alpha of .77, .94, .88, and .95, respectively. The open-ended question “What makes you laugh?” was included as part of the questionnaire. All participants answered with one or two sentences written in their own words.

Procedure

University Institutional Review Board approval was obtained for the study. Demographics were included as part of every questionnaire: age, gender, marital status, religious affiliation, and health history. The study sample was 130 older adults living in a southwest Florida community and working as hospital auxiliary volunteers. This sample pool was selected for the following reasons: There are more than 3,000 in number, it was assumed that they would be relatively healthy individuals because they are working as volunteers, and most of them are 50 years of age and older. Questionnaires were mailed to a computer-generated random sample with a cover letter indicating that the first 100 completed and placed in a drop box would receive a gift certificate to the local supermarket. Questionnaires were also distributed to volunteers meeting the inclusion criteria as they signed on and off duty at the hospital.

Data Analysis

Content analysis of the 130 written responses determined the sources of humour for these older adults. Both investigators examined, separately and then together, the written responses to the open-ended question “What makes you laugh?” All written data were considered in the analysis. All responses were then categorized under nine different themes as agreed on by both investigators. These themes were based solely on number of responses. The commonalities among the nine themes were then combined into two major categories.

Results

The majority of the study population (N = 130) was married (72%), female (74.6%), Protestant (52.3%), and reported to be in good health, even though 40% reported that they had been diagnosed with a major illness at some point in their lives. Ages ranged from 50 to 80, with a mean of 63 years. Demographic information is presented in Table 1.

Content analysis of the 130 responses to the question “What makes you laugh?” revealed several themes. From the nine different types of responses, two broad categories were identified as (a) people or animals (n = 83) and (b) situations or events (n = 76). Some of the responses included both categories and some did not fit into either category.

Read Part 2 here.

Source: Journal of Holistic Nursing, Volume 24 Number 3, September 2006, page 188-193