"Someone's Acknowledged My Mum…in that Moment she Connected": A Qualitative Study of Family Benefits of Elder Clowning for Persons With Dementia in Long-Term Care.

Elder clowning is a multi-component, person-centred intervention delivered to persons living with dementia in long-term care to enhance quality of life through individualised social engagement. Although persons with dementia are the target recipients of the intervention, their families may also derive benefits. However, their perspectives currently remain unexplored. This study aimed to explore whether and in what ways families of persons living with dementia in long-term care benefit from elder clowning interventions, from the perspectives of families and long-term care staff. Semi-structured interviews with family members of persons living with dementia and long-term care staff were conducted in four long-term care homes in Eastern Australia. Interviews were audio-recorded, transcribed, and analysed according to Braun and Clarke's Reflexive Thematic Analysis. Analysis of family member (n = 11) and staff (n = 20) perspectives on elder clowning generated two main themes: (1) transforming the emotional experience of visiting and (2) strengthening family connections through the shared experience. Elder clowning supported families to have improved visiting experiences with their relative in long-term care, which eased visit-related stress before, during, and after visits. Person-centred engagement through elder clowning was perceived to support the reciprocal interaction and happiness of their relative, which supported positive emotions for families. Families learned about their relative's communicative capacity and new dementia-specific communication skills, which they then implemented independently from elder clowning. Shared positive experiences supported socialisation, reminiscence, and memory-making, which may have supported family connections. Elder clowning also provided families with opportunities for social support. While some families were actively involved, others preferred to watch, and some were perceived to decline involvement. Families expressed preferences or suggestions regarding intervention delivery, such as continuity and access. The benefits of elder clowning were found to extend beyond entertainment to support psychosocial wellbeing of families of persons living with dementia in long-term care.