Montessori For Dementia and Aging: An Approach Worth Learning About

Jennifer Brush, MA, CCC/SLP
Director, Brush Development
Association Montessori International, Certified Educator in Montessori for Dementia and Aging

Montessori for Dementia and Aging is a person-centered approach for the diverse communities where elders may reside.¹ Based on the work of Dr. Maria Montessori, this approach extends the tenets of person-centered care by focusing on the abilities, needs, interests, and strengths of elders with dementia in a supportive environment.² In 2014, Association Montessori International (AMI) created a Montessori Advisory Group for Montessori for Dementia and Aging to develop guidelines for the application of a Montessori approach for older people and persons living with dementia. This philosophical approach helps individuals change the way they interrelate with elders and elders with dementia by improving the quality of those interactions.³

In Montessori for Dementia and Aging, a person maintains their roles and their identity throughout the full course of their life. This philosophy of care focuses on engaging the older adult in an environment that is adapted to support memory loss and sensory impairment and facilitate independence. As a result, elders are empowered to care for themselves and others, make contributions to their community, and engage in meaningful activities.⁴ Montessori goals for individuals with dementia include: to enable individuals to be as independent as possible; to make important contributions and have a meaningful place in the home and community; and to possess high self-esteem.¹

Implementation of Montessori for Elders

Components of a Montessori classroom may be integrated into the eldercare setting to create an environment that supports independence. This “prepared” environment as envisioned by Dr. Montessori provides opportunities for freedom of movement, is structured and orderly, has easy access to nature, is beautiful, and provides specialized materials that meet individuals’ cognitive needs.¹

The Environment. The prepared environment supports individuals by placing needed memory, visual, auditory, tactile and olfactory cues in the environment. This orderly or visually organized environment provides useful cues and allows for attention to activities that are personally relevant to the elder. ^{5, 6} High contrast signage is used to compensate for memory deficits and invite the individuals to engage in and care for the environment. There are opportunities for elders to clean, wash, dust, tidy, serve, fold, weed, rake, plant, and so forth, as done in the past. All materials need to complete leisure activities and household chores or physically and visually accessible in the environment at all times.

Care for oneself. Within the Montessori philosophy, elders may continue to care for themselves by bathing and dressing themselves with as much independence as possible in order to maintain self-respect and dignity.

Care for others. Implementation of the Montessori philosophy also supports individuals having an opportunity to help others who may not be able to complete a task on their own due to cognitive, physical, or sensory impairment. For example, one may read to another who has vision impairment. When living or spending the day with others, one develops meaningful relationships that contribute to wellbeing.⁷

Evidence for Montessori based interventions for elders with dementia. In addition to being appealing to elders and their families, Montessori based interventions additionally boast a strong scientific evidence base. ^{2, 8} For example, a significant reduction in antipsychotic and sedative medication was noted after the implementation of Montessori activities; this reduction in medication was noted to maintain at an 18-month follow-up as well.⁸ The implementation of a Montessori environment resulted in more quality communicative interactions as well as improved overall well-being.² Similarly, elders who engaged in Montessori training displayed fewer feeding difficulties and an increased ability to feed oneself independently.⁹

Recently Brush and Colleagues evaluated the impact of the implementation of the AMI Montessori for Dementia and Aging program in a memory care Assisted Living community¹⁰. A pre-post quasi experimental descriptive study was conducted with 29 elders in an assisted living community. The Montessori program was implemented over the course of one year; adoption of program features was documented pre- and post-implementation. Outcomes for elders included number of neuropsychiatric symptoms due to dementia (Cohen-Mansfield Agitation Inventory), falls, medications and hospitalizations; attitude, attention and engagement (Observational Measure of Engagement), affect (Observed Emotion Rating Scale); and the Dementia Quality of Life Scale. The Benjamin Rose Nurse Assistant Job Satisfaction Scale was used to measure employee job satisfaction before and after implementation of the program.

After one year, the community had adopted 68% of program features compared to 28% at study start¹⁰. Elders displayed significantly more positive emotions, affect, and feelings of self-esteem and belonging after the intervention; positive trends were documented for increased engagement¹⁰. Overall, employee job satisfaction was higher after the implementation of the program¹⁰.

Prior to the implementation of the program, none of the elders had a role in caring for the community. Staff matched most of the elders with a community role to support purposeful and meaningful living. Some of the roles included wiping down tables and chairs after meals, garden caretaker, delivering cards, setting tables, passing out waters, serving appetizers, folding bulletins, visiting other residents, writing the menu for lunch and supper, playing the piano for sing a longs and bible study, delivering mail, volunteering in the mini mart volunteer, creating art with a fellow resident.

These and other study results verify the value of a person-centered, Montessori-based approach to the care of elders with dementia. It’s been shown that implementation of specific leadership, staff, and environmental features leads to changes in the quality of life and affect of individuals with dementia and in the job satisfaction of the staff employed to care for them. Montessori has the potential to significantly change the culture of care and quality of life outcomes of persons with dementia.

1. Brush JA, Norris K. Getting started with Montessori volume 1: practical life activities for elders. Chardon, OH: Brush Development; 2017.
2. Barry L. Creating a world with meaning and purpose. Australian Journal of Dementia Care 2017; 6: 17-19
3. Elliot GM. Montessori methods for dementia: focusing on the person and the prepared environment. Tasmania: The Franklin Press 2015.
4. Bourgeois MS, Brush J, Elliot G, Kelly A. Join the revolution: how Montessori for aging and dementia can change long-term care culture. Semin Speech Lang 2015; 36: 209-214
5. Sheppard CL, McArthur C, Hitzig S. A systematic review of Montessori-based activities for persons with dementia. J Am Med Dir Assoc 2016; 17: 117-122.
6. Milte R, Shulver W, Killington M, Bradley C, Ratcliffe J, Crotty M. Quality in residential care from the perspective of people living with dementia: the importance of personhood. Arch Gerontol Geriatr 2016; 63: 9-17
7. Mahendra N, Scullion A, Hamerschlag, C. Cognitive-linguistic interventions for persons with dementia: a practitioner’s guide to 3 evidence-based approached. Top Geriatr Rehabil 2011; 27: 278-288.
8. Roberts G, Morley C, Walters W, Malta S, Doyle C. Caring for people with dementia in residential aged care: successes with a composite model featuring Montessori-based activities. Geriatr Nurs 2015; 36: 106-110
9. Sheppard CL, McArthur C, Hitzig S. A systematic review of Montessori-based activities for persons with dementia. J Am Med Dir Assoc 2016; 17: 117-122.
10. Brush, J., Douglas, N., & Bourgeois, M. (in press). Implementation of the Montessori program in assisted living: positive outcomes and challenges. The Journal of Nursing Home Research Sciences 2018; 4: 64-70.