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Effectiveness of Laughter Therapy on Anxiety Among Older Adults Residing in Old Age Homes, West Bengal
* Corresponding author: Dr. Barkha Devi, Department of Obstetrics and Gynaecological Nursing, Sikkim Manipal College of Nursing, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India. barkha.d@smims.smu.edu.in
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Received: ,
Accepted: ,
How to cite this article: Chettri DK, Pradhan S, Devi B. Effectiveness of Laughter Therapy on Anxiety Among Older Adults Residing in Old Age Homes, West Bengal. J Health Allied Sci NU. doi: 10.25259/JHASNU_108_2025
Abstract
Objectives
Ageing is a natural life process associated with various physiological, psychological, and social changes that may increase the risk of mental health problems among older adults. Anxiety is commonly observed among elderly individuals, particularly those residing in institutional settings such as old age homes, where social isolation and emotional distress may be prevalent. Laughter therapy has emerged as a simple, non-pharmacological intervention that may help reduce stress and improve psychological well-being among older adults. The study aimed to assess the effectiveness of laughter therapy in reducing anxiety among older adults residing in selected old age homes in West Bengal.
Material and Methods
A non-blinded randomised controlled trial with a pre-test and post-test design was conducted among 64 older adults aged ≥50 years residing in selected old age homes. Participants with anxiety scores ≥17 on the Hamilton Anxiety Rating Scale (HAM-A) were randomly allocated into an experimental group (n = 32) and a control group (n = 32). Baseline data were collected using a demographic proforma, health and institutional characteristics checklist, and the HAM-A scale. The experimental group received laughter therapy sessions for 25–30 min daily for 7 days, whereas the control group continued their routine activities. Post-test assessment was conducted on the ninth day. Data were analysed using SPSS version 21 with descriptive and inferential statistics.
Results
At baseline, most participants in both groups had mild to moderate anxiety (experimental: 78.1%; control: 84.4%). After the intervention, anxiety levels significantly decreased in the experimental group compared to the control group. The mean post-test anxiety score in the experimental group (16.59 ± 2.24) was significantly lower than that of the control group (20.50 ± 2.72) (p <0.001). A significant association was observed between pre-test anxiety levels and marital status in the experimental group (p <0.05).
Conclusion
The findings indicate that laughter therapy is an effective, safe, and inexpensive intervention for reducing anxiety among older adults residing in old age homes. Incorporating laughter therapy into routine care practices may help improve the psychological well-being of institutionalised elderly populations.
Keywords
Aged
Anxiety
Depression
Laughter
Loneliness
INTRODUCTION
Population ageing is an inevitable demographic phenomenon occurring worldwide. Improvements in healthcare, better nutrition, and advances in disease management have contributed to increased life expectancy, resulting in a growing proportion of older adults in many countries. Ageing is associated with several physiological, psychological, and social changes that may influence the overall health and well-being of older individuals. During this stage of life, many older adults experience declining physical strength, chronic illnesses, reduced social interaction, and emotional challenges that may predispose them to various mental health problems.[1]
Among the psychological problems faced by the elderly population, anxiety is one of the most common but often under-recognised conditions. Anxiety in older adults may arise due to several factors, such as declining health, loss of independence, financial insecurity, bereavement, and reduced social support. Older adults who reside in institutional settings such as old age homes may be particularly vulnerable to emotional distress due to separation from family members, feelings of loneliness, and adjustment to new living environments.[2]
In India, the elderly population is steadily increasing, and demographic projections indicate that the proportion of individuals aged ≥60 years will continue to rise in the coming decades.[1] With the gradual shift from joint family systems to nuclear families, many older adults are increasingly residing in old age homes or institutional care facilities. Although these institutions provide shelter and basic care, residents may still experience emotional isolation and psychological distress, which can contribute to anxiety and reduced quality of life (QoL).[1,2]
Management of anxiety among older adults traditionally involves pharmacological treatment and psychological interventions. However, pharmacological approaches may sometimes produce adverse effects, particularly in elderly populations who often have multiple comorbidities and are already receiving several medications. Therefore, non-pharmacological interventions that are safe, simple, and cost-effective are increasingly being explored to promote mental well-being among older adults.[3]
Laughter therapy is one such complementary approach that has gained attention as a holistic strategy for promoting psychological health. Laughter is a natural human behaviour that stimulates positive emotions and social bonding. Structured laughter activities combine voluntary laughter exercises with breathing techniques and mild physical movements, which may promote relaxation and emotional expression.[4] Research has suggested that laughter can produce physiological and psychological benefits, including reduction of stress hormones, improvement in mood, and enhanced emotional well-being.[5]
Previous studies have reported that laughter-based interventions can reduce stress, anxiety, and psychological distress among different populations.[6,7] Demir[3] reported that laughter therapy significantly reduced anxiety and stress among university students, while other studies have demonstrated improvements in QoL and emotional well-being following laughter therapy interventions.[7,8] Laughter therapy has also been recommended as a supportive strategy for managing stress-related psychological problems.[5]
Evidence suggests that laughter-based interventions may be beneficial for elderly individuals living in institutional environments, where social isolation and emotional distress are common.[4,9] Comparative studies have also reported higher levels of anxiety and depression among elderly individuals residing in old age homes compared with those living with their families.[10,11] Despite these findings, research focusing specifically on the effectiveness of laughter therapy among institutionalised elderly populations in India remains limited.
Therefore, the present study aimed to assess the effectiveness of laughter therapy in reducing anxiety among older adults residing in selected old age homes in West Bengal.
MATERIAL and METHODS
Study design
The present study adopted a randomised controlled trial (RCT) design with a pre-test and post-test approach to evaluate the effectiveness of laughter therapy in reducing anxiety among older adults residing in selected old age homes in West Bengal. The study followed the general principles of the CONSORT (Consolidated Standards of Reporting Trials) guidelines to ensure transparency and methodological rigor in reporting the research process. The experimental design enabled the comparison of anxiety levels between participants who received the laughter therapy intervention and those who did not receive the intervention during the study period.
Study setting
The study was conducted in four selected old age homes located in Siliguri and Kalimpong districts of West Bengal, India. These institutions provide residential care for older adults who lack adequate family support or require institutional assistance for daily living. These settings were selected because residents often experience psychological challenges such as loneliness, social isolation, and anxiety, making them appropriate settings for evaluating non-pharmacological interventions aimed at improving mental well-being.
Study population
The study population consisted of older adults residing in the selected old age homes. Residents were screened for eligibility using the Hamilton Anxiety Rating Scale (HAM-A) to identify individuals experiencing anxiety symptoms. In the present study, individuals aged 50 years and above were included because early ageing-related physiological and psychosocial changes may begin before the conventional threshold of 60 years, particularly in developing countries and institutionalised populations.[12]
Participants aged ≥50 years residing in selected old age homes during the study period, having an anxiety score >17 on the HAM-A, able to understand and communicate in English, Hindi, or Nepali, and willing to participate with written informed consent were included in the study. Participants who had previously attended formal laughter therapy sessions, were currently participating in any similar intervention study, were bedridden or physically unable to participate in group therapy sessions, diagnosed with severe cognitive impairment or mental retardation, receiving any other relaxation therapy or psychological intervention during the study period, or were unwilling to participate were excluded from the study.
Sample size and sampling technique
A total of 64 older adults who met the eligibility criteria were included in the study. Initially, 117 residents were screened for anxiety levels using the HAM-A. Among them, 64 participants with anxiety scores >17 were found eligible and were included in the study. Participants were selected using a simple random sampling technique. The eligible participants were then randomly assigned to either the experimental group (n = 32) or the control group (n = 32).
Randomisation and allocation procedure
Random allocation of participants into the experimental and control groups was carried out using the sealed envelope technique. Each eligible participant was asked to select a sealed envelope containing a group allocation code. This process ensured random and unbiased allocation of participants to either the experimental group or the control group.
Description of the intervention
Participants in the experimental group received laughter therapy sessions for seven consecutive days, with each session lasting ∼25–30 min and conducted in a group setting within the premises of the old age home. The sessions began with warm-up exercises involving gentle physical movements and breathing techniques to prepare participants physically and mentally. This was followed by structured laughter exercises such as simulated laughter, rhythmic clapping, and playful group interactions aimed at promoting spontaneous laughter and positive emotional expression. Breathing and relaxation exercises were incorporated to enhance relaxation and reduce tension. Each session concluded with cool-down activities, including relaxation and brief social interaction to promote emotional comfort and bonding. The intervention was administered from Day 2–8, with baseline assessment on Day 1 and post-test assessment on Day 9. Participants in the control group continued their routine daily activities during the study period, and laughter therapy was later offered to them after completion of the study as an ethical consideration.
Data collection tools
A semi-structured demographic proforma was used to collect information on socio-demographic characteristics such as age, gender, educational status, marital status, number of children, income, and previous occupation. A structured checklist was used to assess old age homes and health-related characteristics, including source of social support, frequency of family visits, communication with family members, reason for admission, duration of stay, presence of physical illnesses, and ability to perform daily activities. Anxiety levels were measured using the HAM-A, a standardised tool consisting of 14 items rated on a 5-point scale from 0 (not present) to 4 (severe), with total scores ranging from 0–56, where higher scores indicate greater severity of anxiety.
Data collection procedure
Prior to data collection, administrative permission was obtained from the authorities of the selected old age homes. Ethical approval was obtained from the Institutional Ethics Committee of Sikkim Manipal University. Participants were informed about the purpose of the study, and written informed consent was obtained from all participants. Baseline data were collected on Day 1 using the demographic proforma, health-related characteristics checklist, and the HAM-A scale. After baseline assessment, participants were randomly allocated to either the experimental or control group. The experimental group received laughter therapy sessions for seven consecutive days, while the control group continued their routine activities. On Day 9, post-test assessment of anxiety levels was conducted in both groups using the same HAM-A scale.
Data analysis
The collected data were coded, entered, and analysed using the Statistical Package for Social Sciences (SPSS) version 21. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to summarise demographic and health-related characteristics. Inferential statistical tests were used to determine the effectiveness of the intervention. Paired t-tests were applied to compare pre-test and post-test anxiety scores within each group. Independent sample t-tests were used to compare anxiety scores between the experimental and control groups. The Chi-square test and Fisher’s exact test were used to determine the association between anxiety levels and selected demographic variables. A p <0.05 was considered statistically significant.
Ethical considerations
Ethical approval for the study was obtained from the Institutional Ethics Committee of Sikkim Manipal University, Sikkim (Approval No.: SMU/IEC/2022-30 dated 25th May 2022). Administrative permission was obtained from the authorities of the selected old age homes prior to data collection. Written informed consent was obtained from all participants prior to data collection, and confidentiality of the participants was maintained.
RESULTS
Baseline anxiety screening
A total of 117 older adults residing in the selected old age homes were screened for anxiety using the HAM-A. Among them, 64 participants (55%) had anxiety scores >17 and met the eligibility criteria for inclusion in the study. These participants were randomly allocated into two groups: experimental group (n = 32) and control group (n = 32).
Demographic and institutional characteristics
The demographic characteristics of the participants are presented in Supplementary Table S1, and institutional and health-related characteristics are presented in Supplementary Table S2.
In both groups, most participants were aged 50–59 years, and males slightly outnumbered females. Most participants had no formal education and a low monthly income prior to institutionalisation. A considerable proportion of participants were either married or widowed, and many had one or two children.
Regarding institutional characteristics, a large proportion of residents reported limited social support and infrequent contact with family members. Most participants had been residing at the old age homes for >5 years and were able to perform their daily activities independently.
The comparison of pre-test and post-test anxiety scores within the experimental and control groups is shown in Table 1. In the experimental group, the mean anxiety score significantly decreased from 22.15 ± 2.39 at pre-test to 16.59 ± 2.24 at post-test. The mean difference was 5.56, and the reduction was statistically significant (t = 9.953, df = 31, p <0.001).
| Groups | Comparison anxiety | Mean | SD | Mean D | t value | df | p value |
|---|---|---|---|---|---|---|---|
| Experimental group (n = 32) | Pre-test | 22.15 | 2.39 | 5.56 | 9.953 | 31 | 0.001* |
| Post-test | 16.59 | 2.24 | |||||
| Control group (n = 32) | Pre-test | 21.0 | 2.75 | 5.0 | 0.641 | 31 | 0.526 |
| Post-test | 20.50 | 2.72 |
In contrast, the control group showed only a slight decrease in anxiety scores from 21.00 ± 2.75 to 20.50 ± 2.72, with a mean difference of 0.50, which was not statistically significant (t = 0.641, df = 31, p = 0.526).
The comparison of anxiety scores between the experimental and control groups is presented in Table 2. At baseline, there was no statistically significant difference in anxiety levels between the two groups (t = 1.789, df = 62, p <0.001), indicating comparability between the groups before the intervention. However, after the intervention, the experimental group demonstrated significantly lower anxiety scores (16.59 ± 2.24) compared to the control group (20.50 ± 2.72). The difference between the groups was statistically significant (t = 6.264, df = 62, p <0.001).
| Comparison | Experimental group (n = 32) mean ± SD | Control group (n = 32) mean ± SD | Mean D | t value | df | p value |
|---|---|---|---|---|---|---|
| Pre-test | 22.15 ± 2.39 | 21.0 ±2.75 | 1.15 | 1.789 | 62 | 0.178 |
| Post-test | 16.59 ± 2.24 | 20.50 ± 2.72 | 3.90 | 6.264 | 62 | 0.001* |
The association between pre-test anxiety levels and selected demographic variables is shown in Table 3. Among the demographic variables examined, marital status was found to have a statistically significant association with anxiety levels in the experimental group (p <0.05). Participants who were married or widowed showed higher baseline anxiety levels compared to other marital status categories. Other variables such as age, sex, religion, educational status, number of children, occupation, and income were not significantly associated with anxiety levels in either group.
| Sl. No. | Demographic variables | Experimental group | Control group | ||||
|---|---|---|---|---|---|---|---|
| χ2/F test | df | p value | χ2/F test | df | p value | ||
| 1 | Age in years |
0.467 0.788 |
3 |
0.938 1.000 |
4.280 5.412 |
3 |
0.229 0.133 |
| 2 | Sex |
0.839 0.867 |
1 |
0.318 0.318 |
3.809 | 1 |
0.074 0.074 |
| 3 | Religion |
1.069 1.242 |
3 |
0.873 0.873 |
0.395 0.480 |
2 |
1.000 1.000 |
| 4 | Educational qualification |
0.987 0.963 |
3 |
0.909 0.909 |
2.243 1.689 |
2 |
0.365 0.473 |
| 5 | Marital status |
9.667 8.227 |
4 |
0.046* 0.040* |
3.399 3.914 |
4 |
0.456 0.456 |
| 6 | No. of children |
4.164 3.786 |
3 |
0.292 0.292 |
0.904 1.306 |
3 |
0.908 0.908 |
| 7 | Source of income before/after institutionalisation |
6.250 4.998 |
5 |
0.287 0.413 |
6.225 4.607 |
3 |
0.163 0.214 |
| 8 | Monthly income before institutionalisation |
0.598 0.429 |
2 |
1.000 1.000 |
6.667 4.930 |
2 |
0.063 0.095 |
| 9 | Occupation before institutionalisation | NA | NA | NA |
5.574 3.896 |
NA |
0.156 0.156 |
p <0.05 level of significance, df: Degree of freedom, NA: Not available.
The association between anxiety levels and institutional characteristics is presented in Table 4. No statistically significant association was observed between anxiety levels and factors such as social support, frequency of family visits, communication with family members, reason for admission to the old age home, duration of stay, or frequency of illness (p >0.05).
| Sl. No. | Variables | Experimental group | Control group | ||||
|---|---|---|---|---|---|---|---|
| χ2/F test | df | p value | χ2/F test | df | p value | ||
| 1 | Social support |
0.927 0.800 |
2 |
1.000 1.000 |
0.299 0.717 |
2 |
1.000 1.000 |
| 2 | Frequency of visits |
0.927 1.566 |
1 |
0.464 0.464 |
0.660 0.651 |
1 |
0.563 0.563 |
| 3 | Mode of communication |
0.927 1.566 |
1 | 0.464 |
0.660 0.651 |
1 |
0.563 0.563 |
| 4 | Reason for admission in old age home |
0.289 0.503 |
1 | 0.781 |
0.395 1.133 |
1 |
1.000 1.000 |
| 5 | Prior attendance at laughter therapy sessions | NA | NA | NA | NA | NA | NA |
| 6 | Physical activity | NA | NA | NA | NA | NA | NA |
| 7 | Physical illnesses or diseases | NA | NA | NA | NA | NA | NA |
| 8 | Ability to perform daily activities independently |
0.026 0.025 |
1 |
0.648 0.648 |
0.395 0.704 |
1 |
0.708 0.708 |
| 9 | Duration of stay |
0.625 1.219 |
3 |
1.000 1.000 |
2.382 2.454 |
3 |
0.331 0.318 |
| 10 | Frequency of sickness |
0.567 1.344 |
2 |
1.000 0.394 |
1.457 1.476 |
2 |
0.612 0.485 |
p <0.05 level of significance, df: Degree of freedom, NA: Not available.
DISCUSSION
The present randomised controlled study evaluated the effectiveness of laughter therapy in reducing anxiety among older adults residing in selected old age homes in West Bengal. The findings demonstrated a statistically significant reduction in anxiety levels among participants who received laughter therapy compared with those in the control group, indicating that laughter therapy may be an effective non-pharmacological strategy for improving psychological well-being among institutionalised elderly populations.
At baseline, most participants in both the experimental and control groups exhibited mild to moderate levels of anxiety, highlighting that anxiety is a common psychological concern among older adults living in institutional care settings. Previous research has also reported that elderly individuals residing in old age homes often experience emotional challenges related to loneliness, limited social interaction, and separation from family members.[1,2]
Following the intervention, the experimental group demonstrated a significant decrease in anxiety scores, whereas the control group showed no meaningful change. The observed improvement may be explained by the physiological and psychological benefits associated with laughter. Laughter has been shown to reduce stress hormones, promote relaxation, and enhance emotional well-being.[4,5] These findings suggest that structured laughter sessions may help older adults cope more effectively with psychological stress and improve their overall emotional state.
The findings of the present study are consistent with earlier research. Ghodsbin et al.[13] reported that laughter therapy improved general health and psychological well-being among elderly individuals. Similarly, Dhivagar et al.[14] reported that laughter therapy significantly reduced anxiety and stress among elderly residents of old age homes. Supporting these findings, Heidari et al.[15] demonstrated that laughter therapy significantly reduced depression and improved QoL among elderly individuals living in nursing homes. These findings collectively suggest that laughter-based interventions can play an important role in improving psychological well-being among institutionalised elderly populations. Other studies have also reported improvements in stress levels and QoL following laughter therapy interventions.[6,7]
Laughter therapy has been recognised as a simple and accessible complementary intervention that can be easily incorporated into community and institutional care settings.[8,16] In addition, humour-based activities have been suggested as supportive approaches for promoting emotional health among elderly populations.[9]
In the present study, marital status showed a significant association with baseline anxiety levels in the experimental group. Emotional support from spouses or family members may play an important role in maintaining psychological well-being among older adults. Previous studies comparing institutionalised and non-institutionalised elderly populations have also reported higher levels of psychological distress among individuals living in residential care facilities.[10,11]
Overall, the findings of the present study suggest that laughter therapy may serve as a low-cost, safe, and easily implementable intervention for reducing anxiety among older adults residing in institutional settings. Integrating laughter therapy into routine activities in old age homes may contribute to improving the psychological well-being and QoL of elderly residents.
Limitations
This study had several limitations. The sample size was relatively small and limited to selected old age homes in West Bengal, which may restrict the generalisability of the findings. The intervention period was short, and the study used a non-blinded design, which may have introduced response bias.
CONCLUSION
This randomised controlled study demonstrated that laughter therapy significantly reduced anxiety levels among older adults residing in selected old age homes in West Bengal. Participants who received structured laughter therapy sessions showed greater improvement in anxiety scores compared with those who continued routine activities. These findings support the potential role of laughter therapy as a simple, safe, and low-cost complementary intervention for promoting psychological well-being among institutionalised elderly populations. Integrating structured laughter-based activities into routine care programs in old age homes may help improve emotional health and overall QoL among elderly residents.
Acknowledgement
The authors thank all the participants and supporting faculty of Sikkim Manipal College of Nursing, Sikkim Manipal University.
Ethical approval
The research/study was approved by the Institutional Review Board at Sikkim Manipal University, number SMIMS/IEC/2022-30, dated 21st May 2022.
Declaration of patient consent
The authors certify that they have obtained all appropriate participant consent forms. In the form, the participants have given their consent for their clinical information to be reported in the journal. The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
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