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Evaluation of the Montessori-Inspired Lifestyle® as the Foundation of Care in Assisted Living Memory Care
Abstract
The Montessori-Inspired Lifestyle® (MIL) was implemented as the foundation of care in several assisted living memory care (ALMC) neighborhoods to enhance meaningful social roles, engagement, and focus on residents' remaining capabilities. The purpose of this quality improvement project was to evaluate the outcomes regarding resident levels of engagement and prescribed antipsychotic medications before and after MIL implementation. A total of 85 residents were observed for 10-minute periods seven times during 1 day to ascertain the level of engagement during meals and planned and unplanned activities. Positive engagement minutes increased after MIL implementation for activities and meals. Outcomes of this project support the MIL as a foundation of care for ALMC residents and have raised the awareness for addressing diverse cognitive abilities. The need for reoccurring training for the sustainability of this model of care was recognized. [Journal of Gerontological Nursing, 46(5), 40-46.].
... The characteristics of the 15 included studies are presented in Table 1. Five (n = 5, 33.3%) were conducted in Taiwan (Kao et al., 2016;Lin et al., 2010Lin et al., , 2011Wu and Lin, 2013;Wu et al., 2014), four (n = 4, 26.7%) in the United States (Gaspar & Westberg, 2020;Skrajner et al., 2012Skrajner et al., , 2014Wilks et al., 2019); two (n = 2, 13.3%) in China (Chan et al., 2021;Yuen and Kwok, 2019), two (n = 2, 13.3%) in Australia (Mbakile-Mahlanza et al., 2020;Roberts et al., 2015), one (n = 1, 6.7%) in Figure 1. Ã Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). ÃÃ If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools Feeding difficulty (EdFED): M group showed significant reduction of feeding difficulty score post-test (MD = À1.57 ...
... Of the 15 studies, eight programmes (n = 8, 53.3%) employed the individual format of intervention (Giroux et al., 2010;Kao et al., 2016;Lin et al., 2010Lin et al., , 2011Mbakile-Mahlanza et al., 2020;Roberts et al., 2015;Wu and Lin, 2013;Wu et al., 2014). Of the four (n = 4, 26.7%) studies adopting a group format (Chaudhry et al., 2020;Skrajner et al., 2012Skrajner et al., , 2014Yuen and Kwok, 2019), three (n = 3, 20%) were in a mixed format of intervention (Chan et al., 2021;Gaspar and Westberg, 2020;Wilks et al., 2019). The intervention content varied from daily life activities (such as table setting and ironing), leisure activities (such as listening to music and watching movies) to purposeful training activities (memory training activities and eating ability training activities). ...
... • activities were integrated with daily life activities and ranged from 8 months to 18 months (Gaspar and Westberg, 2020;Roberts et al., 2015;Wilks et al., 2019). Only one programme examined the instant effect of the Montessori-based programme using a once only activity (Giroux et al., 2010). ...
Objectives
This systematic review examined the effectiveness of Montessori-based programmes for individuals with dementia living in residential aged care.
Methods
Nine databases were searched between January 2010 to October 2021, including Scopus, CINAHL, MEDLINE, Web of Science, SocINDEX with Full Text, PubMed, PsycINFO, Cochrane library and Cochrane Registry. Publications were included if they used Montessori-based programmes as interventions for individuals with dementia living in residential aged care and were qualitative, quantitative, mixed-method, or pilot studies. The quality of eligible studies was assessed using Joanna Briggs Institute critical appraisal instruments and the Mixed Method Critical Appraisal Tool. The findings were tabulated and narratively synthesised.
Results
Fifteen studies were included in this review. The quality scores of the 15 studies ranged from 62 to 100 out of 100. Four key categories of outcomes were observed: (1) significantly improved engagement; (2) significantly improved mental health outcomes, including affect, depression, agitation, excessive eating and psychotropic medication prescriptions; (3) significantly improved feeding difficulty but mixed results regarding nutritional status; and (4) no significant changes in the activities of daily living and quality of life of individuals with dementia.
Conclusion
Cognitive capacity, personal preferences, individual care needs and the design of Montessori-based activities are pivotal to tailoring personalised Montessori-based activities for individuals with dementia in residential aged care and to maximise intervention outcomes. The synergistic effect of integrating Spaced Retrieval with Montessori-based activities in improving the eating ability and nutritional status of individuals with dementia was also noticed. The study summarised evidence about the effectiveness of Montessori-based programmes for individuals with dementia and informed healthcare professionals about how to implement individualised Montessori-based programmes.
... 40,46 There are also 7 other studies in which the severity of dementia in the samples has not been reported or is not available. 31,36,[41][42][43][44]53 ...
... The effect of Montessori activities on cognitive function (memory, language, visuo-constructional skills, conceptual thinking, calculation and orientation) of the elderly with dementia has been investigated in 5 studies. 31,32,39,44,47 The instrument and questionnaires used in these studies included the Mini-Cog test, General Practitioner Assessment of Cognition (GPCOG) and MoCA for improving their cognitive function. It was reported in all studies that the cognitive function of subjects with dementia improved after implementing the Montessori approach. ...
... Among the reviewed articles, 18 studies have examined the effect of the Montessori intervention on the quality of life of individuals with dementia. In these studies, hope and optimism, 4 engagement, 21,29,31,36,38,[42][43][44]53,54,58 job satisfaction, 34,36,42,44,48 and other factors of quality of life have been evaluated. [33][34][35]38,42,45,50,57 The psychological capital questionnaire was used to investigate hope and optimism. ...
The elderly population of the world is growing fast. The aging phenomenon causes changes in the body’s systems, leading to mental and emotional disorders. Dementia is established as one of the most important challenges associated with the aging process. In this respect, the Montessori-based cognitive rehabilitation program is an increasingly popular choice in dementia care. Therefore, we decided to conduct a review study on the effect of Montessori therapy on different psychological aspects of the elderly with dementia. This narrative review was performed using narrative synthesis. An extensive literature search was performed in databases of ScienceDirect, Google Scholar, PubMed, and ISI Web of Knowledge using OR, AND, and NOT operators and the selected keywords. Only studies published in journals between March 2010 and March 2022 were used for this purpose. The articles chosen in this study were those that have studied the effect of a Montessori-based cognitive rehabilitation program on the elderly with dementia. Studies that involved the Montessori program on other neurological disorders were excluded. Finally, 32 articles were selected from the final evaluation. It can be concluded that the Montessori program effectively reduces anxiety, destructive behavior, and agitation, increases pleasure, hope, optimism, job satisfaction, social skills, and cognitive function, and improves the quality of life and feeding capacity.
... Similarly, the Need Driven Model recognizes engagement as an important variable for improving quality of life (Whall & Kolanowski, 2004). Engagement has also been identified as an important outcome for various other programs implemented in long-term care settings (Gaspar & Westberg, 2020;Westberg et al., 2017). ...
... For example, in research that used the robot dog as an interactive activity, the definition of engagement was focused on interaction with the object. Research that defined engagement as a response to something typically looked at as a response to select aspects of a program, such as Montessori Inspired Lifestyle (Gaspar & Westberg, 2020). Definitions that included characteristics of meaningfulness and satisfaction provided the most holistic perspective of engagement by characterizing the emotions behind the words. ...
Creating meaningful engagement for a person with dementia is recognized as a non-pharmacological approach to enhancing their well-being and decreasing their agitation, anxiety, and depression. However, no standard definition of engagement exists. A scoping review was conducted to examine the current definitions of engagement in persons with dementia and the measurement of engagement. The literature search was conducted using CINAHL/EBSCO and PubMed for the years 2016-2021 using the search terms “dementia AND elderly AND engagement.” A screening process was developed, with articles meeting inclusion criteria independently reviewed by at least two team members. A follow-up of publications of the key authors was conducted alongside a search of the gray literature. Congruent themes of the definitions were identified, and articles were grouped into thematic categories. The two major themes of engagement definitions: were social contact/interaction and response to activity and/or stimuli, and two minor themes, meaningful/satisfying activity and program/activity attendance, were found in the literature. The measurement of engagement reflected the two major themes of definitions reviewed and was primarily captured through observation. Major components of the three observation-based scales were similar, capturing affect, attitude, and attention in various formats and degrees. A comprehensive definition, combining key aspects of the cited definitions developed by the researchers, follows the Emotional and/or behavioral response generated by introducing stimuli through social or activity-based interactions that are meaningful to the individual and create satisfaction. The current observational approach to capture engagement is impractical for clinical use as it is subjective and time-consuming. This scoping review reveals the need for objective technology-based tools that capture the holistic concept of engagement among persons with dementia.
... This should be addressed in future studies, particularly given that cognitive ability has been found to influence a resident's level of mealtime engagement and eating ability. 54 Food consumption is directly related to nutritional status. The evidence suggested that residents receiving spaced retrieval, a Montessori intervention or hand exercises did not increase the amount of food consumed. ...
Objectives:
This systematic review and meta-analysis aimed to examine non-pharmacological interventions for helping people with dementia who experience feeding difficulties in order to improve their nutritional status.
Methods:
The articles were searched using PsycINFO, Medline, PubMed, CINAHL and Cochrane. Two independent investigators critically appraised eligible studies. The PRISMA guidelines and checklist were used. The possibility of risk of bias was assessed using a tool to assess the quality of randomised control trials (RCT) and non-RCT studies. A narrative synthesis was conducted as a method of synthesis. The Cochrane Review Manager (RevMan 5.4) was used for meta-analysis.
Results:
The systematic review and meta-analysis included seven publications. Six interventions were identified and categorised as: eating ability training for people with dementia, staff training and feeding assistance and support. The meta-analysis found evidence of the effect of eating ability training on feeding difficulty, quantified by the Edinburgh Feeding Evaluation in Dementia scale (EdFED) with a weighted mean difference of -1.36 (95% confidence interval: -1.84 to -0.89, p < 0.001) and on self-feeding time. A spaced retrieval intervention showed a positive effect on EdFED. The systematic review discovered that while feeding assistance had a positive effect on feeding difficulty, staff training had no effect. According to the meta-analysis, these interventions had no effect on improving the nutritional status of people with dementia.
Conclusions:
None of the included RCTs met the Cochrane risk-of-bias criteria for randomised trials. This review found that direct training for people with dementia and indirect feeding support from care staff resulted in fewer mealtime difficulties. More RCT studies are needed to determine the efficacy of such interventions.
... This variability remains today. However, the ultimate goal of assisted living remains consistent: to help older individuals age in place by promoting independence and encouraging social and meaningful activities 2,3 . ...
BACKGROUND
This study tested the impact of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC‐AL‐EIT) on: (1) care interactions between residents and direct care staff; and (2) behavior and psychological symptoms associated with dementia among residents.
DESIGN
This was a randomized controlled trial.
SETTING
A total of 59 assisted living facilities in Maryland, Pennsylvania, and Massachusetts participated.
PARTICIPANTS
The sample included 550 mostly White (98%), female (69%) residents with a mean age of 89.30 (standard deviation = 7.63) years.
INTERVENTION
The four‐step FFC‐AL‐EIT intervention was implemented by a function focused care nurse facilitator working with a facility champion over 12 months. The steps included: (1) environment and policy assessments; (2) education; (3) establishing resident function focused care service plans; and (4) mentoring and motivating.
MEASURES
Resident descriptive data (e.g., age, sex, education, and comorbidities), depression, agitation, resistiveness to care, and the quality of care interactions were obtained at baseline and 4 and 12 months. Treatment fidelity data included environment and policy assessments, performance of function focused care by staff, and service plan assessments.
RESULTS
There was a significant positive treatment effect related to depression, agitation, resistiveness to care, and quality of care interactions with either less decline or some improvement in these behaviors and symptoms in the treatment versus control group.
CONCLUSION
The study provides some statistical support, which may not necessarily be clinically significant evidence, for psychosocial outcomes of residents and care interactions between staff and residents in assisted living settings.
Background
Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC.
Methods
This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied.
Results
Findings provide support for the intersection between PCC and Montessori with participants’ descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents’ strengths/abilities, maintaining function, using familiar objects, and guided repetition.
Conclusions
Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC.
Background: This paper uses Normalization Process Theory (NPT) to examine staff impressions of Montessori-based program training and implementation at Veterans Affairs Community Living Centers (VA CLCs; nursing homes). Methods: We conducted a mixed-methods evaluation of Montessori Approaches to Person-Centered Care (MAP-VA) at eight VA CLCs. Trainings were conducted as either a live virtual course or a pre-recorded asynchronous class. Two NPT constructs, coherence building and cognitive participation, informed qualitative interview questions, surveys, and analyses focused on staff movement from knowledge to action during initial implementation. Data collection included staff-completed standardized post-training exams ( N = 906), post-training evaluations ( N = 761), and optional validated surveys on perceptions of Montessori training ( N = 307). Champions (peer-leaders) from each CLC completed semi-structured qualitative interviews post-training ( N = 22). Findings: The majority of staff (83%–90%) passed all courses. Staff evaluated the training highly (80%+ agreement) on learning relevant new knowledge and confidence applying new skills. On average, staff felt MAP-VA would become a normal part of their work (7.68/10 scale), and reported increased familiarity with Montessori approaches after training ( p = .002). Qualitative interview data from staff trained in Montessori supported three themes concordant with the NPT dimensions of coherence building and cognitive participation. (1) Coherence regarding Montessori: staff demonstrated an understanding of the program and mentioned the benefits of Montessori compared to their previous usual routines. Cognitive participation or engagement with Montessori: (2) staff had positive feelings about Montessori principles/applications and demonstrated a willingness to try the Montessori approach, and (3) staff made sense of the new intervention through early rehearsal of Montessori principles/practices and recognized opportunities for using Montessori in future interactions. Conclusions: Montessori virtual training resulted in high levels of coherence and cognitive participation among multidisciplinary staff, evidenced by high knowledge, self-efficacy, and readiness to act. The asynchronous and synchronous trainings were accessible, relevant, and supported diverse learners.
Background:
Feeding and eating disorders related to cognitive and psycho-behavioral symptoms are strongly associated with health status in persons with dementia (PWD). Non-pharmacological interventions have been the priority selection to address this significant issue. However, the direct targets of non-pharmacological interventions are unclear and there is no consistent evidence of recommendations on the intervention of different dementia stages and the settings of intervention practice.
Objective:
To provide caregivers with a set of self-help non-pharmacological interventions for feeding and eating disorders in PWD.
Methods:
Based on the process of evidence summary, a systematic literature search was performed on dementia websites and seven databases. Two researchers screened the studies independently and appraise the quality. The evidence was graded by Joanna Briggs Institute Grades of Recommendation.
Results:
Twenty-eight articles were included. Twenty-three non-pharmacological intervention recommendations were categorized into six themes containing oral nutritional supplementation, assistance with eating and drinking, person-centered mealtime care, environmental modification, education or training, and multi-component intervention. These interventions corresponded to three direct targets including improving engagement, making up for loss ability, and increasing food intake directly. They were applied to different stages of dementia and most interventions were targeted at PWD in long-term care institutions.
Conclusion:
This article summarized the direct targets and the specific implementation of recommendations at different stages of dementia to provide caregivers with self-help non-pharmacological interventions. The practice of recommendations was more applicable to institutionalized PWD. When applied to PWD at home, caregivers need to identify the specific feeding and eating conditions at different stages and adopted the interventions in conjunction with the wishes of the PWD and professional advice.
Background
People with dementia who are being cared for in long‐term care settings are often not engaged in meaningful activities. We wanted to know whether offering them activities which are tailored to their individual interests and preferences could improve their quality of life and reduce agitation. This review updates our earlier review published in 2018.
Objectives
∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long‐term care facilities.
∙ To describe the components of the interventions.
∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting.
Search methods
We searched the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register, on 15 June 2022. We also performed additional searches in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up‐to‐date and as comprehensive as possible.
Selection criteria
We included randomised controlled trials (RCTs) and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interest in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention.
Data collection and analysis
Two authors independently selected studies for inclusion, extracted data and assessed the risk of bias of included studies. Our primary efficacy outcomes were agitation and participant quality of life. Where possible, we pooled data across studies using a random effects model.
Main results
We identified three new studies, and therefore included 11 studies with 1071 participants in this review update. The mean age of participants was 78 to 88 years and most had moderate or severe dementia. Ten studies were RCTs (three studies randomised clusters to the study groups, six studies randomised individual participants, and one study randomised matched pairs of participants) and one study was a non‐randomised clinical trial. Five studies included a control group receiving usual care, five studies an active control group (activities which were not personally tailored) and one study included both types of control group. The duration of follow‐up ranged from 10 days to nine months.
In nine studies personally tailored activities were delivered directly to the participants. In one study nursing staff, and in another study family members, were trained to deliver the activities. The selection of activities was based on different theoretical models, but the activities delivered did not vary substantially.
We judged the risk of selection bias to be high in five studies, the risk of performance bias to be high in five studies and the risk of detection bias to be high in four studies.
We found low‐certainty evidence that personally tailored activities may slightly reduce agitation (standardised mean difference −0.26, 95% CI −0.53 to 0.01; I² = 50%; 7 studies, 485 participants). We also found low‐certainty evidence from one study that was not included in the meta‐analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). Two studies investigated quality of life by proxy‐rating. We found low‐certainty evidence that personally tailored activities may result in little to no difference in quality of life in comparison with usual care or an active control group (MD ‐0.83, 95% CI ‐3.97 to 2.30; I² = 51%; 2 studies, 177 participants). Self‐rated quality of life was only available for a small number of participants from one study, and there was little or no difference between personally tailored activities and usual care on this outcome (MD 0.26, 95% CI −3.04 to 3.56; 42 participants; low‐certainty evidence). Two studies assessed adverse effects, but no adverse effects were observed.
We are very uncertain about the effects of personally tailored activities on mood and positive affect. For negative affect we found moderate‐certainty evidence that there is probably little to no effect of personally tailored activities compared to usual care or activities which are not personalised (standardised mean difference ‐0.02, 95% CI −0.19 to 0.14; 6 studies, 632 participants). We were not able to undertake meta‐analyses for engagement and sleep‐related outcomes, and we are very uncertain whether personally tailored activities have any effect on these outcomes.
Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects they found persisted only during the period of delivery of the activities.
Authors' conclusions
Offering personally tailored activities to people with dementia in long‐term care may slightly reduce agitation. Personally tailored activities may result in little to no difference in quality of life rated by proxies, but we acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities probably have little or no effect on negative affect, and we are uncertain whether they have any effect on positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one theoretical model rather than another. We included three new studies in this updated review, but two studies were pilot trials and included only a small number of participants. Certainty of evidence was predominately very low or low due to several methodological limitations of and inconsistencies between the included studies. Evidence is still limited, and we remain unable to describe optimal activity programmes. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
Purpose:
This study examined the impact of a Montessori mealtime intervention for people living with dementia to support the mealtime experience of residents and mealtime care practices of staff in a memory support unit. The mealtime intervention was part of a broader culture change project.
Method:
An observational research design was used to evaluate changes in the mealtime experience and care practices across three time points (baseline, post-implementation, maintenance), spanning 30 months. Five video recordings of the lunch time service (range: 19-32 min) were analysed. The coding protocol comprised pre-determined indicators related to accepted dimensions of person-centred care. Resident and staff behaviours were quantified across four categories: providing choice and preferences, promoting the social side of eating, supporting independence and showing respect towards residents. Staff behaviours that reflected personal enhancing actions and personal detractors were also coded during each mealtime service.
Results:
A significant increase in staff providing residents with the opportunity for choice and a subsequent significant increase in residents demonstrating choice behaviours was evident. Staff and residents both significantly increased their interactional behaviours, with greater social interaction between staff and residents. Staff further demonstrated greater support for mealtime independence that reached and maintained significance during the final two sampling points. Significant gains observed post implementation were largely maintained and, on specific measures, further increased over time. A significant increase in staff use of personal enhancing actions during mealtime care was also evident. Variability in individual staff and resident behaviour highlighted the complexity of mealtime care and culture change processes.
Implications:
The study provides novel evidence to support the use of a Montessori mealtime intervention to achieve more person-centred mealtime care, and which resulted in a more respectful, enabling and social dining experience. Clinical implications and direction for future research are presented to build on these findings.
Objectives:
Montessori-based activities are becoming a popular approach for the care of older adults living with dementia. The aim of this study was to systematically assess the quality of the research examining the benefits of Montessori-based activities for persons with dementia.
Methods:
Six peer-reviewed databases were systematically searched for all relevant articles published until April 2015. Included articles were peer-reviewed studies published in English that employed Montessori-based activities with persons with dementia. Methodological quality was assessed by 2 independent raters using the Physiotherapy Evidence Database Scale or the Downs and Black evaluation tool. Levels of evidence were assigned to the study design using a modified Sackett scale.
Results:
One hundred fifty articles were identified, and 14 were selected for inclusion. Level-2 evidence examining the impact of Montessori-based activities on eating behaviors suggested that difficulties with eating could be reduced with Montessori training. There was limited level-4 evidence for the benefits of Montessori-based activities on cognition, wherein benefits appeared to be specific to lower-level cognitive abilities including memory and attention. Finally, there is level-1 (n = 1), level-2 (n = 3), and level-4 (n = 6) evidence for the benefits of Montessori-based activities on engagement and affect, whereby constructive engagement and positive affect were heightened.
Discussion:
Overall, there is a strong level of evidence for the benefits of Montessori-based activities on eating behaviors and weak evidence for the benefits on cognition. Evidence for the benefits of Montessori-based activities on engagement and affect are mixed. Future research is needed to examine the long-term benefits of Montessori-based activities.
The objectives of the current research were (1) to test and evaluate the investigator-designed Behavior, Engagement, and Affect Measure (BEAM) touchpad direct observational data collection tool, and (2) to implement this tool to investigate residents' patterns of behavioral agitation, engagement, affect, behaviors associated with positive mood, general time-activity use, and social interactions within long-term care.
Raters collected cross-sectional observational data and conducted semistructured interviews with participants of the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) Study. Researchers tested the BEAM's reliability and validity and evaluated the instrument's discriminate validity for sampling resident behaviors.
Data were collected in 36 long-term care homes. The sample included low-care hostels, high-care nursing homes, and residential facilities offering aging-in-place.
Participants were 406 residents aged 52 to 105 years, with and without dementia.
Researchers collected direct observational data using the BEAM and operationalized behavioral domains based largely on concepts from Kitwood's model of person-centered care. Care staff reported on resident behavior using standardized measures of agitation, depression, quality of life, and social engagement.
The BEAM showed moderate-to-substantial interrater reliability and slight-to-moderate correlations with staff-report data gathered through standardized questionnaire measures. Observations showed that residents spent the greatest amount of time stationary and expressing little emotion, although actively engaged with their environment. Residents were observed to be coping adequately and experiencing a positive social and/or positive care interaction in approximately half of observations; however, close to a third of ratings identified "ill-being." Residents showed more positive behavior, appeared happier and less anxious, and exhibited higher "well-being" during structured activity than during free time or meals.
The BEAM is a reliable and valid observational tool for measuring behavior in long-term care. Long-term care residents expressed little emotion and experienced limited positive social interaction in their daily routine. Increased provision of structured activities may increase resident experiences of positive behavior, affect, and well-being.
Lack of engagement has detrimental effects on the quality of life of residents, especially those with dementia. Yet the level of engagement of individuals in memory care units that had implemented the Pearls of Life® program (US program) had not been determined. Seventy-four residents of 13 skilled nursing and assisted living facilities were observed for 10 minutes during five planned activities to describe engagement levels and determine factors influencing engagement. Participants were engaged only about 50% of the time. Total engagement time was significantly associated with the number of engagement strategies used. There were several differences in the use of select strategies for the setting. The evaluation served as the basis for program refinement.
Purpose of the Study
A scoping review was conducted to develop an understanding of Montessori-based programing (MBP) approaches used in dementia care and to identify optimal ways to implement these programs across various settings.
Design and Methods
Six peer-reviewed databases were searched for relevant abstracts by 2 independent reviewers. Included articles and book chapters were those available in English and published by the end of January 2016. Twenty-three articles and 2 book chapters met the inclusion criteria.
Results
Four approaches to implementing MBP were identified: (a) staff assisted (n = 14); (b) intergenerational (n = 5); (c) resident assisted (n = 4); and (d) volunteer or family assisted (n = 2). There is a high degree of variability with how MBP was delivered and no clearly established “best practices” or standardized protocol emerged across approaches except for resident-assisted MBP.
Implications
The findings from this scoping review provide an initial road map on suggestions for implementing MBP across dementia care settings. Irrespective of implementation approach, there are several pragmatic and logistical issues that need to be taken into account for optimal implementation.
The Unmet Needs Model states that problem behaviors of people with dementia result from unmet needs stemming from a decreased ability to communicate those needs and to provide for oneself. The purpose of this study is to describe the unmet needs of persons with dementia exhibiting behavior problems. Eighty-nine residents with dementia from six Maryland nursing homes were assessed by research assistants and nursing assistants for their unmet needs using multiple assessment tools. Three unmet needs per resident were identified on average, with informants rating boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity as the most prevalent needs. Discomfort was associated with higher levels of verbally agitated behaviors (e.g., complaining). Based on results and independent ratings of pain, the authors estimate notable under-detection of discomfort and pain by both types of informants. The study demonstrates methodologies for uncovering unmet needs among persons with dementia and highlights the importance of developing programs that address those unmet needs, especially social and activity needs of nursing home residents. The detection of pain, and possibly that of discomfort, may require a different methodology.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
The purpose of this article is to present practitioners with current empirical evidence on 3 nonpharmacological, cognitive-linguistic interventions for persons with dementia. We begin with a brief review of cognitive-communicative functioning in Alzheimer disease, followed by presenting rationale for conducting comprehensive assessments and systematic interventions for persons with dementia. We then review recently published evidence and new empirical data on the treatment outcomes of 3 contemporary intervention approaches—spaced retrieval training, use of memory books and wallets, and Montessori-based interventions. These interventions were selected on the basis of high quality, replicable evidence of positive treatment outcomes, interdisciplinary appeal, and potential for optimizing functioning and quality of life of persons with dementia and their caregivers.
The focus of this article is on the evolution of the use of Montessori educational methods as the basis for creating interventions for persons with dementia. The account of this evolution is autobiographical, as the development of Montessori Programming for Dementia (MPD) initially was through the efforts of myself and my research associates. My initial exposure to Maria Montessori's work came as a result of my involvement with my own children's education. This exposure influenced ongoing research on development of cognitive interventions for persons with dementia. A brief description of Montessori's work with children and the educational methods she developed is followed by a description of how this approach can be translated into development of activities for persons with dementia. Assessment tools to document effects of MPD were created, focusing on observational tools to measure engagement and affect during individual and group activities programming for persons with dementia. Examples of the use of MPD by researchers, staff members, and family members are given, as well as examples of how persons with dementia can provide MPD to other persons with dementia or to children. Finally, examples of MPD's dissemination internationally and future directions for research are presented.
Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy.
The Comprehensive Process Model of Engagement was examined, in which environmental, personal, and stimulus characteristics impact the level of engagement.
: Participants were 193 residents of 7 Maryland nursing with a diagnosis of dementia. Stimulus engagement was assessed via the Observational Measure of Engagement, measuring duration, attention, and attitude to the stimulus. Twenty-five stimuli were presented, which were categorized as live human social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli.
All stimuli elicited significantly greater engagement in comparison to the control stimulus. In the multivariate model, music significantly increased engagement duration, whereas all other stimuli significantly increased duration, attention, and attitude. Significant environmental variables in the multivariate model that increased engagement were: use of the long introduction with modeling (relative to minimal introduction), any level of sound (especially moderate sound), and the presence of between 2 and 24 people in the room. Significant personal attributes included Mini-Mental State Examination scores, activities of daily living performance and clarity of speech, which were positively associated with higher engagement scores.
Results are consistent with the Comprehensive Process Model of Engagement. Personal attributes, environmental factors, and stimulus characteristics all contribute to the level and nature of engagement, with a secondary finding being that exposure to any stimulus elicits engagement in persons with dementia.
The aim of this article is to delineate the underlying premises of the concept of engagement in persons with dementia and present a new theoretical framework of engagement.
The sample included 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia.
The authors describe a model of factors that affect engagement of persons with dementia. Moreover, the authors present the psychometric qualities of an assessment designed to capture the dimensions of engagement (Observational Measurement of Engagement). Finally, the authors detail plans for future research and data analyses that are currently underway.
This article lays the foundation for a new theoretical framework concerning the mechanisms of interactions between persons with cognitive impairment and environmental stimuli. Additionally, the study examines what factors are associated with interest and negative and positive feelings in engagement.
Cognitive decline associated with old age and consistent with the diagnosis of primary degenerative dementia is a unique clinical syndrome with characteristic phenomena and progression. The authors describe a Global Deterioration Scale for the assessment of primary degenerative dementia and delineation of its stages. The authors have used the Global Deterioration Scale successfully for more than 5 years and have validated it against behavioral, neuroanatomic, and neurophysiologic measures in patients with primary degenerative dementia.
Montessori-based dementia programming in long-term care: A case study of disseminating and intervention for persons with dementia
- C J Camp
- Camp C. J.