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AKRON, Ohio - Dementia robs the mind, but it can't steal the heart of a clown.
The members of the 2-year-old Beachwood Clown Troupe make that clear.
They reside in the Menorah Park Center for Senior Living, a Cleveland-area long-term care facility, and all have diagnoses of advanced Alzheimer's or another type of dementia.
Last month, eight of them, most in wheelchairs, prepped for visits to other residents of the facility. Staff members and volunteers hovered around tables full of electric pink, blue, and yellow wigs and helped the clowns make simple choices about colors and outfits.
"Give me your foot," activities specialist Katie Lally said to Eve Chuse, as she helped the 91-year-old resident ease into a blue outfit.
Chuse was quick with a quip: "I can't - I need it."
Clowning is one of many alternative therapies at Menorah Park, a Jewish nursing home in Beachwood, Ohio. The way-out-of-the-box therapies are usually the brainchild of Pam Nicholson, a gregarious woman who oversees the nursing home's activities department.
Nicholson holds a graduate degree in divinity and considers dementia patients to be full of potential, even as their mental and physical capabilities deteriorate.
"I know this may be the last day of their lives," Nicholson said. "I know their lives are more fulfilled when they are doing mitzvah."
The doing of mitzvah, or righteous duty, is the foundation of the Jewish faith, said Rabbi David Lipper, of Temple Israel in Akron, Ohio. Even very ill people can perform mitzvah, he said.
And that's what the clowns at Menorah Park do. They entertain some of the most frail and ill residents of the facility.
But in addition to fulfilling religious obligation, the clowning is good medicine for the clowns themselves.
Troupe members tend to act more calmly the rest of the day after they dress up and entertain others, Nicholson said.
The effect is especially obvious during the late afternoon and early evening, a time when many dementia patients "sundown," or become particularly agitated and confused, she said.
Menorah Park staff ask residents to participate in the clowning troupe based on their past interests. Nicholson said those residents who like to clown are likely to be people who enjoyed jokes or comics before they got sick.
Pam Schuellerman, director of the Greater East Ohio Area Alzheimer's Association, said as more is learned about Alzheimer's and other dementias, nursing homes have begun to tailor more activities to the specific interests of residents. Getting dementia patients socially involved with others is now considered extremely important.
The clowning troupe officially began two years ago, although Nicholson previously had experimented with clowning using makeshift materials. The family of a resident with dementia offered to set up a "clown fund," which now pays for the elaborate costumes, makeup and wigs.
"The first days we did the clown troupe was the last good day my mother had," said clown fund co-creator Marcy Cowan of Shaker Heights, Ohio, a businesswoman who said her mother loved a good laugh.
Cowan has continued to volunteer at Menorah Park since her mother, Mildred Bonhard Reitman, died on April Fool's Day two years ago.
After about a half hour of preparation, the clowns were ready for their performance.
"Almost ready to go for the parade?" a staff member asked 93-year-old Claire Green.
"I couldn't be any readier," she replied.
An alarm sounded. "It's a humor breakout!" a staff member joked, as the clowns were wheeled down the hall.
Once at the unit where the performance was to take place, the clown troupe was introduced to residents who are at the end stages of dementia.
Some of those residents were able to smile gently at the sight of the brightly colored seniors. Many others sat quietly, their faces blank. (When people are in the late stages of dementia, Lally explained, usually it is hard for them to show emotions.)
"OK, everybody!" said Lally, who oversees the clowning program. "We came to bring you some smiles!"
The singing began: "When you're happy, and you're smiling, the whole world smiles with you. ... " Some members of the frail audience tried to sing or tap along with the music.
Ten minutes later, the clowns were off to another unit for a repeat performance. Then they went back to their own unit, where they were helped out of their outfits and makeup and readied for lunch.
Most of the clowns probably would not remember the performance. The medicine of joy, however, doesn't rely on memory.
"For them," said social worker Elyssa Pollock, "it's in the moment."
(c) 2005, Akron Beacon Journal (Akron, Ohio). Distributed by Knight Ridder/Tribune News Service.