Physical therapist Joe Gallagher's patient, a former New York Giants football player now in his 80s, was lying on the floor, stretching to regain flexibility after two total knee replacements. Progress was slow and painful, so Joe went to a reliable resource in his PT toolbox: humor.
"My patient told me he couldn't stand his coach," Joe recalls. "So I said, 'Picture your coach, pretend I'm him -- and give me a big kick.' That got him laughing, then it got him moving."
Laughter has been proven to yield physical benefits -- including releasing endorphins, boosting the immune system, improving stamina and strengthening breathing -- as well as a number of emotional and social benefits, such as reducing depression and anxiety and strengthening bonds with friends and family. It can also be an important tool for caregivers -- both formal and informal -- to strengthen patient-caregiver relationships and to help patients comply with painful, challenging courses of treatment.
"Little by little, through laughter, patients open up to you, they trust you more, and they're more likely to do what you ask them to," explains Joe, who works as a clinical education supervisor for the Visiting Nurse Service of New York. "You're there for a serious reason and people are going through tough times, but you can help them get better one chuckle at a time."
Therapists, nurses, home health aides and other caregivers offer a few dos and don'ts to employing this well-spring of wellness.
DO take your cue from the patient
Humor in home health care begins with listening and careful observation. Joe starts by learning about his patients' backgrounds, work experience, hobbies, family and culture. "The key thing is finding what the person is interested in, then finding the humor in the things they love to do," he says.
For a 70-something patient who was weak and depressed after prolonged bedrest, that passion was baking. Joe got a good laugh out of her when he suggested that she bake him something -- with great urgency. "I'm not exactly a small man," he says. "It got her going when I said, 'Let's get you stronger so you can make me some cookies and make sure I don't go hungry.'" (She did eventually bake him a lemon bundt cake.)
Telehealth nurse Amy Dixon, RN, finds that humor helps patient and caregiver alike navigate the tremendous stress that often accompanies illness and injury. "You really have to listen to another person to come to humor," she explains. "Being aware like that in the moment can be a good self-healing mechanism for caregivers -- helping them cope, build resilience." Inspired by an improvisation class she took, she has written a blog post called "10 Ways Caregivers Can Make a Loved One Laugh."
DO find common ground
Fellow physical therapist Mitchell Rabinowitz carefully observes his patients to find shared personal interests that might yield a good laugh. For one patient, an octogenarian polio survivor with severe arthritis in her shoulders from years of using crutches, pain often brought her to the point of tears. Having noticed the telltale blue-and-orange baseball memorabilia around her house, Mitch quickly distracted her with a joking jab at her beloved Mets. "David Wright went 0 for 3 last night," he joked. "The guy can't hit anything." She continued the exercises until she hit another wall of pain. "Let's see if you can reach a little higher," Mitch implored. "I'm sure Jose Reyes could reach for that ball."
DON'T be afraid to laugh at yourself (or your mother-in-law)
Sources of humor can also come from familiar television programs, books on the shelf, family pictures, or, in a pinch, Joe brings in his own material. "For people who don't have a lot of contact with the outside world, I tell funny stories about my family, my kids, my mother-in-law. She's my go-to source of jokes -- let's just say she has difficulty with boundaries." After a pause, he adds, "I think there's a sitcom in this."
Patients get extra-motivated for physical therapy sessions when Joe's father-in-law is in town. "He does an environmental safety inspection of my house when he visits and makes a list of all the things I need to repair," Joe explains. "Some of my patients can't wait for the next installment. I'll come on Monday and they'll ask, 'So, what did he find this time?'"
DO use humor to break the ice and build community
For seniors facing chronic conditions and the downward spiral of depression, anxiety and isolation, humor also plays another vital role: creating a sense of community. "They might come in feeling isolated, but when they're doing silly things together, it unites them, helps them feel part of the group," says Michele Symler, who runs an exercise class at the VNSNY CHOICE Adult Day Center in Woodside, Queens. "I see their spirits lifting visibly."
For many seniors suffering from a variety of chronic debilitating conditions or recovering from illness or injury, laughter and good-natured humor make the 35-minute class pass remarkably quickly and get a lot of arms and legs moving. "You're like a Rockette," Michele says, drawing a big smile from one patron during the leg-kicking exercises.
With many languages spoken at the day center, Michele often uses physical humor, putting on a purple wig, shaking a rubber chicken and tossing several to the crowd, exaggerating movements or shaking an arm when the Hokey Pokey specifically calls for a leg. "If I'm willing to expose myself and my vulnerabilities and be light about it, it can draw out others," says Michele.
DON'T make the patient uncomfortable
Michele notes, however, that if a participant exhibits the slightest discomfort with a humorous rally, she will quickly pivot focus onto something, or someone, else. Like many things in home health care, humor calls for sensitivity and respect for the patient.
Advises Joe, "You wouldn't want to come in like gangbusters, so leave the clown nose at home. Pay attention to someone's value system and stay within that set of values. There are some things they think are funny and some they don't."
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