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Could the Montessori method help people with dementia?

Normally associated with children – in particular, a future king of England – it may come as a surprise that Montessori education methods can be highly effective for supporting people with dementia.

This alternative approach to schooling was founded by Italian educator Maria Montessori in the early 20th century. Adapting these methods for people with dementia sprang from conversations between an Ohio Montessori schoolteacher and her psychologist husband in the 1990s. This approach has since been adopted in the US, Canada and Australia, where the results have been positive.

In 2011, adopting the Montessori method enabled one facility in Australia to eliminate the use of antipsychotic drugs, previously used by 75% of residents, and to reduce the use of sedatives from 67% of residents to just 2%.

In 2006, a report prepared for the District of Columbia Office on Aging found people with dementia responded better to Montessori-based activities, with increased levels of engagement and ability to handle difficult tasks, than to non-Montessori-based activities.

Anne Kelly, an Australian Montessori in aged care expert, also points to positive results that will resonate with care home managers. “The Montessori approach leads to cost savings, you get less sick leave among staff and less time spent dealing with family complaints,” she says. Homes become happier, more vibrant places and the benefits are felt by residents and staff. Also helping residents do more for themselves for longer means less need for expensive one-on-one care.

Now the method has reached the UK. This January, the Maria Montessori Institute UK hosted workshops led by Kelly. She spoke of how limiting the life of dementia patients can be.

“We rob them of their dignity by many of the practices in place” through medication, by using bibs and plastic crockery, by dressing people in their pyjamas in the afternoon, and by locking them in their rooms as well as confining them to the routines of the care home rather than their own, she says.

Individuality lies at the heart of Montessori for aged care, which recognises that there are different types of memory: declarative memory – the facts we learn, such as dates; and procedural memory – the things we learn that are embedded and are less easily forgotten, such as catching a ball.

Thus, a way of helping a person with dementia keep some physical strength could be to do ball-based exercises, rather than something more complicated that they may struggle with. And, by breaking down activities that require procedural memory, such as dressing, into small tasks and repeating them, it is possible to teach people to do certain things for themselves again.

Montessori urges practitioners to remember that each person has a unique history when trying to use these different types of memory.

To help compensate for deficits in declarative memory, Kelly suggests using appropriate signs. Homes could put up signs informing residents they can help themselves to fruit, or leave out art and craft materials and signs encouraging residents to use them.

Signs could be used to help residents with tasks such as pointing to a button on the phone that will call a relative, or to a setting on the washing machine. Some tasks, like dressing, could be broken down into doable activities to make them more manageable.

This all sounds rather simplistic but, says NHS occupational therapist Sally Dando, attention to the simple things has been lost.

“I’ve been a nurse for 40 years and there’s something about Montessori that brings together some of the things we know in a slightly different way – I’ve never been to a care home that used signage,” says Lynne Phair, an independent nurse adviser who works with regulator the Care Quality Commission.

Phair and Dando are spearheading the introduction of Montessori techniques into UK care homes. Following Kelly’s workshops, they plan to become accredited Montessori for aged care educators and, in a “measured and methodical” way, train others and provide support so hundreds of care homes could be utilising the Montessori method within a decade.

The accreditation requires at least five years’ experience of working in aged care. Given that a majority of those at the London workshop were Montessori teachers, it may be that more homes follow the collaboration model adopted by the Meadows Montessori school in Ipswich and a local dementia care provider.

Kelly and Phair anticipate the biggest challenge will be keeping the workforce onboard with changing established practice. “The Montessori philosophy is about enabling people, whereas traditionally if a nurse thinks you need something, they’ll do it for you,” says Phair. “This is turning our world on its head.”

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