The Montessori method is an approach to educating children based on the research and observations of Italian physician and educator Maria Montessori in the early 1900s. The method arose from Montessori’s observation that children, when given the freedom to play in an environment equipped with appropriate materials, could direct their own learning activities.
The Montessori method had been used for decades to teach children, when, in the 1980s, researchers at the Myers Research Institute in Ohio, led by Cameron J. Camp, PhD, discovered that some of the same techniques could be used with people with dementia. Today, caregivers across the globe employ the Montessori method to work with people with dementia.
The Gilbrea Centre for Studies in Aging at McMaster University in Hamilton, Ontario, Canada, offers training and develops resources for professionals working in the field of aging. Active Aging Today asked Gail Elliot, Centre assistant director, to describe the Montessori method and the Centre’s work.
Since the 1980s, the Montessori method has been adapted to address dementia. Would you describe these ideas? What are the most significant lessons that can be applied to this population?
Dr. Montessori’s philosophy and mission was to enable individuals to be as independent as possible, to have a meaningful place in their community, to possess high self-esteem, and to have the chance to make meaningful contributions to their community.
This philosophy guided the development of the principles that Dr. Montessori subsequently created. The principles provide a framework for programming. They focus on such things as creating an environment that supports the needs of the child, where they learn at their own level of ability, and placing emphasis on successful outcomes. These same principles have been adapted for dementia.
One of the major differences between kids and people with dementia is that people with dementia are experiencing memory decline, which is opposite to the child who is building memory. Patterned sequencing in the reverse order that a child learns is central to determining level of ability in dementia (meaning that memories are lost in the opposite direction – most recent memories lost first). Moreover, it is important to understand the type of memory that is spared in dementia (procedural memory) and then recognize that the memory that is most impaired (declarative memory) must be supported. This knowledge of memory is central to understanding how activities, roles, and routines can be developed in a supportive environment.
Dr. Montessori said that everything you need for an activity is built into that activity (e.g., the coloured building blocks or rings that are stacked according to size were created by Dr. Montessori). For those with dementia, this principle that states that “everything that will be needed is included in the activity” is a critical piece of the success that is experienced with this type of programming. When the principles are taken into account, all the items needed for the activity are provided (including word or picture cueing to support the memory loss in dementia). In other words, when the person isn’t capable of “remembering” important information, the cues are available in his/her environment.
For example, if you want to create a game in which the individual sorts items (such as folding and sorting green and red towels), you would put one red towel in front of the person and one green towel beside it. This provides the cue to help the person remember where each folded towel will be placed. The colours of the towels to be sorted provide sensory stimulation and cognitive stimulation, as he/she has to think about where each towel is to be placed. Also, an activity such as this supports activities of daily living, as physical function is involved and the activity helps to maintain arm and hand use and coordination.
Another principle that is involved in this example is that of demonstrating rather than describing. Montessori said that the child learns by observing then trying to do it on their own, and this same principle applies to those with dementia. Each activity is demonstrated to ensure the individual understands what he/she is expected to do.
The most important message is that people with dementia are still people—there is a person behind the dementia. Many people believed Dr. Montessori would never be able to help the “insane,” “difficult” children to whom she was assigned. Similarly, nihilistic attitudes suggest we cannot help those with dementia. People have been proven wrong on both counts. People with dementia need an environment that places the information they need into the environment (such as directional signs, information about when loved ones will visit, templates that provide directions to help them complete an activity and reminders about things they need to do). When you take this supportive environment into consideration, and create a world where they have roles, routines, and activities that are created at their level of ability and suited to their needs and interests, you find a normal person who wants to be engaged in life. Always remember that a person with dementia is a person with a past, a present, and a future. The challenge is to create a purposeful, meaningful world where the person with dementia can enjoy each day with dignity and hope for a better tomorrow.
The Gilbrea Centre for Studies in Aging has stated that boredom is a trigger for people with dementia, and therefore, it should be a goal to reduce boredom in the lives of people with dementia. What are some ways that caregivers or caregiving organizations can do that?
Montessori methods for dementia focus on creating an environment that is suited to the needs of each individual. When we support the memory loss and give people something to do, at their level of ability, they are engaged in life. Dr. Montessori said that disruptive behaviours and being engaged are mutually exclusive.
Daily roles and routines are part of our lives from the time we are born. When someone enters into the world of dementia this begins to disappear, with the exception of mealtime and bedtime routines. Think about how many things we must accomplish daily (planning meals, shopping for meals, cooking, doing laundry, and making plans for tomorrow). All of this disappears when someone is diagnosed with dementia, not because it needs to disappear, but because we think they can no longer do many of the simple tasks that were once part of their daily routines. We can put these things back into their world, but we need to support the memory loss by providing cueing (e.g., labels on drawers that lists items inside, placemats with the template indicating where items should be placed so they can set the table, laundry baskets with items that need to be folded, etc.)
You can also create roles, based on a person’s interests and abilities. For example, someone who loves people could be the breakfast greeter, another person could be the lunch greeter, and someone else could be the dinner greeter. Someone who enjoys religious practices could visit those who want to listen to religious verse, and that, in turn, provides a regular visitor to those people. This “visitor” role would be supported by providing large-print materials that can be easily seen and read. The “volunteer visitor” would learn what to do (staff would teach them), then they would be taken to those who are on their “visitation list.” The more they do this, the better they will get at it. The roles, routines, and activities are limited only by one’s imagination. A first step is to ask, “What activities fill my day? How can I put these things back into the lives of people with dementia?”