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Letters to the Editor
In conclusion, age influences the response and adverse effects of conventional ITP therapies. Current guidelines published for ITP are probably not fully adapted for elderly patients. Studies must be carried out in the elderly, in order to redefine therapeutic guidelines.
Disclosure statement The authors declare no conflict of interest. Abrar-Ahmad Zulfiqar1 and Emmanuel Andres2 Department of Internal Medicine and Geriatrics, University Hospital of Reims, Reims, and 2Department of Internal Medicine, University Hospital of Strasbourg, Strasbourg, France 1
References 1 George JN, Woolf SH, Raskob GE et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996; 88: 3–40. 2 Linares M, Cervero A, Colombina P et al. Chronic idiopathic thrombocytopenic purpura in the elderly. Acta Haematol 1995; 93: 80–82. 3 Ahn YS, Rocha R, Mylvaganam R, Garcia R, Duncan R, Harrington WJ. Long-term danazol therapy in autoimmune thrombocytopenia: unmaintained remission and agedependent response in women. Ann Intern Med 1989; 111: 723–729.
COMMENTS
Effect of laughing qigong on an elderly population
Dear Editor, Hsieh et al. evaluated the effect of laughter therapy on cognitive function, depression and mood in an institutionalized elderly population.1 The authors concluded that the “Laughing Qigong Program” was effective for improving psychological factors without a change of salivary cortisol level. Although their study design is acceptable, I have some concerns regarding their study. The authors quoted some references on gerontology, and Bennett et al. recently reviewed the association between laughter, humor and medical conditions with a wide range of diseases.2 They selected depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose as factors contributing to physical and mental conditions. Although they intended to confirm the effect of laugher and humor on medical conditions in patients with different types of disease, a systematic review by meta-analysis seems difficult because of the lack of validation studies on quantification of laugher and humor.3 On this point, I appreciate that the study by Hsieh et al. described the process of the “Laughing Qigong Program” precisely to allow reproducibility of the intervention. Second, the authors mentioned that they carried out the first study to discover the effect of laughter on an institutionalized elderly population. I previously reported sleep duration for residents in a nursing home by an accelerometer, and I understand that the level of stress in an institutionalized population is higher in that © 2015 Japan Geriatrics Society
in a community-dwelling population.4 As a further study, a randomized controlled study design is required to confirm the effect of the physiological and physical effects of laughter in an elderly population.5,6 Finally, Mr Cousins previously reported his experience and speculation to improve ankylosing spondylitis by his own approach including laughter.7 Stuber et al. also reported humorous distraction was useful to help children and adolescents tolerate painful procedures.3 In contrast, Martin reviewed the effects of humor and laughter on physical health with special reference to potential causal mechanisms and methodological issues, and they mentioned that the past findings were inconsistent, and most of the studies had methodological problems in confirming the health benefits of laughter and humor.8 There is an opinion that the concept of science, being free from materialism, should also be accepted.9 Although I accept some experiences that laughter and humor are effective to control disease or improve psychological status, the application of a laughter program to an elderly population should be basically handled by a traditional scientific approach with a randomized controlled study design.
Disclosure statement No potential conflicts of interest were disclosed. Tomoyuki Kawada Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan doi: 10.1111/ggi.12476
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T Kawada
References 1 Hsieh CJ, Chang C, Tsai G, Wu HF. Empirical study of the influence of a Laughing Qigong Program on long-term care residents. Geriatr Gerontol Int 2015; 15: 165– 173. 2 Bennett PN, Parsons T, Ben-Moshe R et al. Laughter and humor therapy in dialysis. Semin Dial 2014; 27: 488– 493. 3 Stuber M, Hilber SD, Mintzer LL, Castaneda M, Glover D, Zeltzer L. Laughter, humor and pain perception in children: a pilot study. Evid Based Complement Alternat Med 2009; 6: 271–276. 4 Kawada T. Sleep duration for residents in the nursing home by accelerometer: a preliminary study. J Psychiatr Ment Health Nurs 2013; 20: 662–664.
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5 Hirosaki M, Ohira T, Kajiura M et al. Effects of a laughter and exercise program on physiological and psychological health among community-dwelling elderly in Japan: randomized controlled trial. Geriatr Gerontol Int 2013; 13: 152– 160. 6 Chan CL, Wang CW, Ho RT, Ng SM, Ziea ET, Wong VT. Qigong exercise for the treatment of fibromyalgia: a systematic review of randomized controlled trials. J Altern Complement Med 2012; 18: 641–646. 7 Cousins N. Anatomy of an illness (as perceived by the patient). N Engl J Med 1976; 295: 1458–1463. 8 Martin RA. Humor, laughter, and physical health: methodological issues and research findings. Psychol Bull 2001; 127: 504–519. 9 Sheldrake R. Setting science free from materialism. Explore (NY) 2013; 9: 211–218.
© 2015 Japan Geriatrics Society
Letters to the Editor
In conclusion, age influences the response and adverse effects of conventional ITP therapies. Current guidelines published for ITP are probably not fully adapted for elderly patients. Studies must be carried out in the elderly, in order to redefine therapeutic guidelines.
Disclosure statement The authors declare no conflict of interest. Abrar-Ahmad Zulfiqar1 and Emmanuel Andres2 Department of Internal Medicine and Geriatrics, University Hospital of Reims, Reims, and 2Department of Internal Medicine, University Hospital of Strasbourg, Strasbourg, France 1
References 1 George JN, Woolf SH, Raskob GE et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996; 88: 3–40. 2 Linares M, Cervero A, Colombina P et al. Chronic idiopathic thrombocytopenic purpura in the elderly. Acta Haematol 1995; 93: 80–82. 3 Ahn YS, Rocha R, Mylvaganam R, Garcia R, Duncan R, Harrington WJ. Long-term danazol therapy in autoimmune thrombocytopenia: unmaintained remission and agedependent response in women. Ann Intern Med 1989; 111: 723–729.
COMMENTS
Effect of laughing qigong on an elderly population
Dear Editor, Hsieh et al. evaluated the effect of laughter therapy on cognitive function, depression and mood in an institutionalized elderly population.1 The authors concluded that the “Laughing Qigong Program” was effective for improving psychological factors without a change of salivary cortisol level. Although their study design is acceptable, I have some concerns regarding their study. The authors quoted some references on gerontology, and Bennett et al. recently reviewed the association between laughter, humor and medical conditions with a wide range of diseases.2 They selected depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose as factors contributing to physical and mental conditions. Although they intended to confirm the effect of laugher and humor on medical conditions in patients with different types of disease, a systematic review by meta-analysis seems difficult because of the lack of validation studies on quantification of laugher and humor.3 On this point, I appreciate that the study by Hsieh et al. described the process of the “Laughing Qigong Program” precisely to allow reproducibility of the intervention. Second, the authors mentioned that they carried out the first study to discover the effect of laughter on an institutionalized elderly population. I previously reported sleep duration for residents in a nursing home by an accelerometer, and I understand that the level of stress in an institutionalized population is higher in that © 2015 Japan Geriatrics Society
in a community-dwelling population.4 As a further study, a randomized controlled study design is required to confirm the effect of the physiological and physical effects of laughter in an elderly population.5,6 Finally, Mr Cousins previously reported his experience and speculation to improve ankylosing spondylitis by his own approach including laughter.7 Stuber et al. also reported humorous distraction was useful to help children and adolescents tolerate painful procedures.3 In contrast, Martin reviewed the effects of humor and laughter on physical health with special reference to potential causal mechanisms and methodological issues, and they mentioned that the past findings were inconsistent, and most of the studies had methodological problems in confirming the health benefits of laughter and humor.8 There is an opinion that the concept of science, being free from materialism, should also be accepted.9 Although I accept some experiences that laughter and humor are effective to control disease or improve psychological status, the application of a laughter program to an elderly population should be basically handled by a traditional scientific approach with a randomized controlled study design.
Disclosure statement No potential conflicts of interest were disclosed. Tomoyuki Kawada Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan doi: 10.1111/ggi.12476
| 929
T Kawada
References 1 Hsieh CJ, Chang C, Tsai G, Wu HF. Empirical study of the influence of a Laughing Qigong Program on long-term care residents. Geriatr Gerontol Int 2015; 15: 165– 173. 2 Bennett PN, Parsons T, Ben-Moshe R et al. Laughter and humor therapy in dialysis. Semin Dial 2014; 27: 488– 493. 3 Stuber M, Hilber SD, Mintzer LL, Castaneda M, Glover D, Zeltzer L. Laughter, humor and pain perception in children: a pilot study. Evid Based Complement Alternat Med 2009; 6: 271–276. 4 Kawada T. Sleep duration for residents in the nursing home by accelerometer: a preliminary study. J Psychiatr Ment Health Nurs 2013; 20: 662–664.
930 |
5 Hirosaki M, Ohira T, Kajiura M et al. Effects of a laughter and exercise program on physiological and psychological health among community-dwelling elderly in Japan: randomized controlled trial. Geriatr Gerontol Int 2013; 13: 152– 160. 6 Chan CL, Wang CW, Ho RT, Ng SM, Ziea ET, Wong VT. Qigong exercise for the treatment of fibromyalgia: a systematic review of randomized controlled trials. J Altern Complement Med 2012; 18: 641–646. 7 Cousins N. Anatomy of an illness (as perceived by the patient). N Engl J Med 1976; 295: 1458–1463. 8 Martin RA. Humor, laughter, and physical health: methodological issues and research findings. Psychol Bull 2001; 127: 504–519. 9 Sheldrake R. Setting science free from materialism. Explore (NY) 2013; 9: 211–218.
© 2015 Japan Geriatrics Society
