No-one wants to end up in a prison-like nursing home, but some of us will. And, although it’s not always polite to raise the issue, we’re all getting older: especially those folk in the Baby Boomer generation.
Being stuck, sedated, in an impersonal institution with no control or dignity is my idea of a nightmare. And, it’s even more terrifying for those of who will one day be diagnosed with a type of dementia, e.g. Alzheimer’s Disease, vascular dementia, Parkinson’s Disease, Dementia with Lewy bodies, Fronto-Temporal Lobar Degeneration (FTLD), Huntington’s Disease, alcohol-related dementia (Korsakoff’s Syndrome) or Creutzfeldt-Jakob Disease.
In the late 1990s, “person-centred care” became a buzz-word in caring for people with dementia. This movement is about creating services and places that give older people choice, dignity, self-determination and purposeful living.
Surprisingly, the evidence for person-centred care in aged-care, generally, is mixed (e.g. Zimmerman et al., 2013). But, in the last decades, evidence has started to mount about how to use a person-centred approach to improve the quality of life for people with dementia in long-term care. And, as reported in a review led by American speech pathologist Professor Michelle Bourgeois, some of it has come from an unexpected source: Maria Montessori.
Montessori principles in aged care
Montessori’s philosophy was to enable people to be as independent as possible, to have a meaningful place in the community, to possess high self-esteem, and to have a chance to make meaningful contributions to their community. In aged care, these principles are applied by changing the nursing home to give adults lots of opportunities to be engaged. The overall aim is to connect what is known about each adult in the past to their present abilities and to change the activities and the environment to suit their needs, interests and abilities.
That all sounds great in theory. But what are some practical examples?
1. Changing the environment
- training staff and carers in Montessori techniques;
- posting bulletin boards near the dining room with name badges for each resident;
- colourful, homelike interior spaces for specific uses like music, reading, physical activities, social interaction and domestic activities;
- clear signage, e.g. arrows and text to indicate different places using principles similar to writing for people with aphasia;
- clear instructions/requests to cue people to engage in activities: e.g. “Please fold the serviettes”;
- personalised information on each resident’s door (e.g. pictures of family members, residents);
- attractive activity materials stacked in an orderly fashion;
- large-print, high-contrast name tags displaying residents’ first names;
- easy to read name badges for all staff and visitors;
- interactive wall spaces;
- useful outdoor areas with things like chicken coops, raised garden beds and barbeques; and
- memory books for each resident containing photos and mementos of life events, interests, and pictures of close friends and family members.
Examples of useful activities and routines
- 24/7 accessibility to activities;
- polishing silverware;
- setting the table;
- rolling bandages;
- sorting silverware;
- sorting balls and floral arrangements;
- washing and drying clothes;
- updating wall displays and calendars;
- offering drinks to peers and passing them out;
- giving hand massages to peers;
- watering garden beds;
- delivering mail to other residents;
- preparing vegetables (e.g. peeling carrots and parsnips);
- participating in a band to entertain the other residents;
- shoe-polishing;
- sweeping the floor; and
- making beds.
But what do these things actually look like in practice?
Benefits
In one Australian study of 16 clients with dementia, adoption of Montessori principles saw a 100% elimination of antipsychotic medication use and a reduction in the use of sedatives from 67% to 2% (Roberts et al., 2015). The study also showed significant reductions in challenging behaviours, with families questioned about it reporting “overwhelmingly positive” responses.
At Grandview Lodge, in Ontario, Canada, medication use decreased from an average of over 11 medications per person, to 4; and decreases were seen in the number of falls and infection rates (Elliot, 2011).
Clinical bottom line
There is some low-level evidence to show that adopting the Montessori methods described can improve the quality of life for people with dementia in long-term care. But more evidence is required, and the methods used need to be described in enough detail to be copied and implemented accurately in line with the studies. The Association Montessori Internationale is overseeing a training certification program to set standards for training and certification of staff and sites. But more work needs to be done to define and test outcomes that matter to clients and their families and to demonstrate the superiority of the approach to traditional methods of care.
Principal source: Bourgeois, M.S., Brush, J., Elliot, G., & Kelly, A. (2015). Join the Revolution: How Montessori for Aging and Dementia can Change Long-Term Care Culture. Seminars in Speech and Language, 36(3), 209-214.
Further reading and watching:
- Dementia care and the Montessori way at Grandview Lodge
- DementiAbility Methods: The Montessori Way (Canada)
- Montessori for Dementia Australia
- Australian ABLE model
- For more about dementia, go to Alzheimer’s Australia Fight Dementia.
Hi there, I’m David Kinnane.
Principal Speech Pathologist, Banter Speech & Language
Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.
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