Putting Research into Action: Developing a Montessori Based Approach for People with Dementia in the Northern Health and Social Care Trust (NI).

Alzheimer’s disease is becoming a social, political and economic issue as a result of growing numbers and the economic, social and emotional costs of care (Onor et al 2007). Worldwide there are estimated 36 million people with dementia and this is set to increase by almost 50 % by 2050 (Alzheimer’s Disease International 2012). In N Ireland the expected increase is 200% the highest expected rise in the UK (Alzheimer’s Society 2007).

Whilst recent impetuous has been set by the G8 summit for a cure for dementia; whilst this remains some years off the need for treatments to enhance and not harm the lives of those living with the disease is urgent.

Anxiety and agitation are deemed to be the main reasons people with dementia are prescribed anti-psychotic medications with the suggestion that up to two thirds of these prescriptions could be avoided if appropriate support was given to people with dementia, their carer’s and staff (Banerjee 2009).

The Montessori approach as a non-pharmacological intervention, is regarded as a successful approach for decreasing agitation and increasing engagement with people with dementia. One reason given for this is if people with dementia are engaged in practising tasks and activities they are familiar with they cannot be simultaneously be engaged in agitated behaviours (Li-Chan Lin 2009).

Professor Cameron Camp the founder of the Montessori Based approach to Activities (MAP™), combines the educational component of Montessori with an environmental approach suggesting people with dementia need to be in environments where they are treated with respect and engaged in meaningful activity (2003).

Without the author having any previous knowledge base for this approach and following a chance attendance at a seminar by Dr Camp, this study was undertaken to combine a literature review with a travel scholarship to experience this methodology first hand in action with a view to implementing it within our inpatient services.

The Scholarship was supported by the Hearthstone Organisation who provided an internship for three weeks across two states in USA. This gave great insights to the process of implementing the theory into practice.

The findings of this study support the need for education for staff working with people with dementia and evidences the benefits when this is provided in a cohesive and skilled manner. This methodology encompasses recognised best practices for working with people with dementia and is grounded in basic human rights principles of respect, dignity, independence and choice.

The simplicity of the Montessori approach can have profound benefits for people with dementia with minimal resources, the principles of moving from simple to complex, slowing down to match their speed, giving cues and hints and making sure the person enjoys the experience are paramount. Whilst the person with dementia is engaged in activities that are meaningful for them, they will be less likely to experience negative symptoms of their disease and therefore a reduction in the use of anti-psychotic medications.

The study is aimed to share not only the rich experience of the visit with the reader but also to signpost the resources available in the literature and via the internet as tools to bring the methodology into practice and enhance the quality of the lived experience of those people with dementia in our care.

Introduction of the ‘I’m Still here’ approach brings positivity to a disease which is more apportioned to a negative overview. The need and ability of people with dementia to learn new skills, be a part of families and communities and to have meaningful occupation is underestimated. Families and carers should be given simple supports and ideas to make their time together more enjoyable as this sometimes is not the case.

Whilst seizing an opportunity for change in inpatient care provision, the study is helping to inform and guide the development of a Montessori approach within dementia care in the Northern Health and Social Care Trust.