Begun in 1996 by Cameron Camp, an experimental psychologist in Ohio, the Montessori treatment approach to dementia mirrors the Montessori Early Childhood education approach.
All the activities are customized to the resident's personal aptitudes and designed for them to succeed; no cookie-cutter approach. "It's working with what they can do, not what they can't do. That's what Montessori is," says Cheryl Thrasher, ALA, executive director at Ashton Gables in Riverchase.
Shoemate adds, "If you give a patient a task to make them feel successful, then they feel good about themselves and have decreased occurrences of negative behavior."
Not only can the Montessori approach lessen the frustration and anger often felt by those with dementia, it can stimulate more appropriate engagement with others. A 2002 study in Clinical Gerontologist reported that the use of Montessori-based activities by nursing home residents with dementia led to "significant increases in active forms of residents' engagement with visitors."
The Ashton Gables staff creates memory boxes to bridge communication with residents, and to connect residents with visitors. The boxes contain items relating to the resident's past that engage the senses and can stir memories.
One woman had been an avid bell collector in younger days. Even when she lost her sight, hearing and touching the bells in the box when her niece visited gave them both something to connect with. "Sometimes the woman would remember having received a bell from the niece long ago. It triggered that memory that we thought was gone," Thrasher says.
One man at the Civic Center had previously only spoken "yes" and "no." "Then we were playing an Al Green song for someone else, and this man started laughing and suddenly said, 'That's Hot Grits Green!'," Shoemate says.
Once that trigger opens up the patient to communication, the staff delves into those memories to create activities. For instance, if a scent elicits a certain memory of a Thanksgiving meal, the patient may create a recipe, make a shopping list, or cook the item depending on their capabilities.
Unlike with children using the Montessori approach, accomplishment alone does not empower the adults. A sense of purpose must be integrated. "It's about being engaged while making a meaningful contribution," Thrasher says.
"If I say we have to work on using a spoon, they get defensive," Shoemate says. Instead she hands them a faulty flashlight with the batteries inserted upside down to get them to practice their fine motor coordination. "Then I say, 'Can you take this apart, figure out what's wrong, and fix it?' Now they're feeling helpful and successful."
With Montessori, difficult tasks are broken down into easier ones that can be performed with relatively quick success. The tasks, introduced with a "can you help me with this" question, become more complicated as the patient's competence grows. For instance, asking a resident to tighten screws on a wobbly table used in the room might progress to having him string line on a fishing rod the staffer has said she needs for a weekend getaway.
Tasks must be created to match the patient's interests to keep their attention. Careers and hobbies often serve as starting points. "If I ask them to tie their shoes, they may bend down, but they're off-track two seconds later," Shoemate says.
"Connecting with the history of who they've been brings that familiarity and the comfort to try and accomplish things," Thrasher says. Retired teachers may grade papers for a nearby Montessori school, gardeners may arrange flowers for the tables, and beauticians can wash and set wigs for a nursing home.
Each Ashton Gables resident has a Life Board that is posted in the hallway. The board is filled with photos and words relating to the resident's youth, jobs, hobbies, kids, likes, dislikes, music preferences...anything that helps the staff to define activities for that resident when needed. "We also want our staff to relate more to the resident as a whole person, rather than as a disease process. To see all they have been, as well as where they are now," Thrasher says.
At Civic Center, Shoemate has found great success with tasks relating to the computer. She once had a patient research lions to help a local preschool class study animals. "Eight months later I stopped at a gas station, and he comes walking out and says, 'I don't remember your name, but I remember about that lion.' And he told me the fact he'd researched," Shoemate says. "There is a huge misconception that those with dementia can no longer learn."
Shoemate adds that, although Montessori can increase skill levels, open memories, and improve communication, it is not a cure for dementia. "It's about quality of life," she says.
