The Use of Montessori Methods in Support of People Living with Dementia
In the twilight years of my grandmother’s life, she stayed engaged with our family through the lives of her grandchildren and great children. She was always willing to babysit, she hosted birthday parties and Christmases, she attended sports games and co-signed leases. Having seven kids of her own, children continued to be the great joy of her life until the end. She stayed engaged with her local community through volunteering at an elementary school, at her church and her local polling place. I believe that staying engaged with family and community, and the feelings of usefulness that provided is what kept her so seemingly young and energetic up until the end of her life.
These days, my two young sons attend a Montessori Preschool. I came across Maria Montessori’s work early in my first son’s life. I did my best to apply Montessori principle in my care of him and always wanted to put him into a Montessori school but did not think I could afford it. That is until I had my second son during the COVID-19 pandemic. While searching for daycare possibilities for my cabin-fevered 3-year-old, we found a small community school in the town up the hill from us. Over the last two years, I’ve witnessed the benefits of Montessori for the very young. I can see how similar principles could apply to the elderly who are facing physical and mental challenges to independence and needing to find new ways to approach familiar tasks. Thus, when I saw You Say Goodbye and We Say Hello: The Montessori Method for Positive Dementia Care by Tom & Karen Brenner on the booksale shelf at the library I picked it up and quickly consumed the message.
The authors are a couple, one of which is a gerontologist with experience researching dementia and the other is a Montessori teacher. Through their experience in senior communities and with family caregivers, they have developed a program using Montessori principles to support those living with dementia with the goals of helping folks maintain the highest quality life possible and to stay connected with those they love. I found the lessons in this book to be of importance for the support of elders in and out of memory care and for all of us as a society — if we are lucky, each of us will grow old.
Alzheimer’s is the most common type of dementia and according to the CDC, there are 5.8 million people currently living with disease in the US, and it is predicted that will increase to 14 million by 2060 (CDC, 2019). I hope my writing about how Montessori principles can apply to the care of the elderly with dementia can give folks more access to these concepts and encourage increased interest in their use.
The Montessori Method is an experience-based learning system whether it is applied to children or adults. The individual is given small accomplishments to master working up to a whole task. In one example with preschool children, they learn to make orange juice. First by learning to wash their hands, then they learn how to walk while holding a tray with two hands, and eventually how to press half an orange into juice and pour the juice into a cup to enjoy. By breaking down the task into small steps it becomes more manageable for the child as they learn to complete a complex action.
A similar method can be used with an adult who may have forgotten how to start a task, breaking it down to manageable pieces that they can practice, building procedural memory and with the support of caregivers, the adult with dementia can be given the opportunity to relearn some lost skills and through small achievements, gain a sense of accomplishment. Being able to do things on your own even with the support of a caregiver, has a positive effect on one’s self-esteem. While it is important not to confuse and frustrate elderly people living with dementia it is important for people to do work appropriate to their abilities, “In general, self-esteem in the elderly seems to be related to one’s perceptions of productivity, personal control, role status, and performance,” (Hunter, Linn, & Harris, 1982).
In a time in their lives when much of their daily life is out of their control, the person living with dementia can benefit from therapy that enhances their ability to take care of themselves or just have a moment of joy in creating, connecting and perhaps even reminiscing at the level that is appropriate to them.
In addition to breaking down tasks into manageable pieces, Montessori focuses on organization of materials — “the prepared environment”, as well as beauty and quality of materials. A respect for oneself and one’s environment is developed through the care of self, materials and the learning space. Contact with nature is encouraged for its grounding, peaceful effect and to enable instinctive learning.
In their book, Tom & Karen Brenner say one of the most effective means for encouraging recall and engagement for people living with dementia is to place a meaningful object in their hand. An example they gave was of a patient at a memory care facility who terrorized the unit, she would insult other patients and caregivers and go into people rooms and take things. Through speaking with her family the couple found that she had a great interest in flowers, and had been known as the “flower lady” in her hometown. The decided to place flowers and the materials needed to work with them into her hands.
They gave her the job of flower arranging for the dining hall — providing safety scissors, vases, a water pitcher, a few washcloths for cleaning spills and a variety of flowers. While her behavior didn’t become perfect overnight, the couple noticed that her attitude changed dramatically overtime. Though she still occasionally took things from someone’s room, she was no longer the scourge of the community. She may not have been aware that she had arranged the flowers, but she was able to complete the task with support; flower arranging gave her joy in the moment and she was very happy looking at the arrangements throughout the day in the dining room.
Caregiving professionals can learn about a person’s interests and histories by speaking with family and friends and through intake paperwork. Those with mobility issues can be given sit down work- a fishing tackle box with sets of large flies with hooks removed to match or different fabric varying in texture and color to organize. It is important that none of the materials be small enough to be swallowed and that materials are completely safe to handle. These tactile experiences can bring pleasure to the person living with dementia and may even trigger memories in unexpected ways.
The authors explained the difference between declarative memory and procedural memory. Declarative memory is what allows us to remember events and facts, declarative memory is how we remember what just happened to us. In a person with dementia declarative memory is impaired while procedural memory — things learned through repetitive muscle memory may remain intact. By using procedural memory, people with dementia can be given the opportunity to get better at something and to relearn a skill they may have lost.
Some examples of people who retain the procedural memory needed to complete an activity are the artist who can still paint beautiful scenes when guided to the easel and a brush put in their hand, or the musician who can lead the community in group sings at the piano. If you asked these people to paint a picture or play a song, they would likely tell you they cannot but when the object is placed in their hand things of beauty are created.
The authors spoke about the interests of the current generation living with dementia including poetry and group singing. These can be great sources of community connection for those living in a center. If printed large enough many elders retain their ability to read and with practice can improve. Many people living with dementia can still sing even if their ability to speak is fading — remembering the words to old tunes and singing along with others.
Children can be another great source of joy and healthy engagement for those living with dementia. The authors wrote about one care center which housed both memory care and a facility day care center for 3–5 year olds. Once a week, children visited the memory unit, and the group was given Montessori projects to work on together.
The authors witnessed how sometimes the elderly would help the children and sometimes the children would help the elderly. The children and elderly both were kind and patient, and it was clear that both groups enjoyed getting to be teachers to the other. In one case, a woman who hadn’t spoken in months, who was thought to have lost her ability to speak, was able to speak during activities with the children. In the time following the visit with the children her ability to speak would continue breifly but slowly fade away until they visited again.
While I can only imagine what it is like to face a diagnosis of dementia myself or to watch your loved one face this illness, having the support of care professionals that respect the individual and aim to preserve their independence and quality of life can only benefit those facing these challenges. The knowledge shared in You Say Goodbye and We Say Hello: The Montessori Method for Positive Dementia Care (Tom & Karen Brenner, 2012), gives me hope for the care of this vulnerable population. I hope we as a society will continue this important work of developing methods to best care for elderly people living with dementia so that we may give them and potentially our own elderly selves the best lives possible.
