The Montessori approach to aged care and dementia

The Montessori approach to aged care and dementia

Elderly people can often be infantilised by care, the Montessori approach to aged care is to treat them with respect and understanding, looking at each person as an individual: discovering their particular strengths and needs, finding ways to give meaning and purpose.  The AMI's four key principles of Montessori for Dementia, Disability and Ageing support a person's self-esteem and independence, and their ability to make choices and meaningful contributions to their community. It is life changing for older people especially those living with dementia or other disabilities, as well as their families, care partners and communities.

History

Dr Maria Montessori began her educational journey teaching children in a mental institution, convinced that with appropriate techniques she could make a real difference. A number of the children made such significant progress that when she entered them in mainstream examinations they outperformed other children educated in ordinary schools. Montessori then realised that something must be wrong with the mainstream teaching for this to have happened and she set about researching how children could be better taught.

In 1907 Montessori was appointed as the director of a nursery for 50 three- to six-year olds in a slum area of Rome, set up by the housing authority to keep the children off the streets. Montessori used the same techniques she had used at the mental institution, allowing the children to work independently and to choose the activities that interested them. She was led by the children and carefully observed how they learnt and what materials they chose to use. She developed the theories of the Montessori Method based on careful observation of what children revealed about their developmental needs.  These same techniques are also valuable in the care of adults.

Montessori Theory:

The Montessori approach is based on careful observation of an individual to see what interests them and what they need to learn and for the elderly this might also include what they need to retain.  In a classroom the role of the Montessori guide is to observe and understand, this is also true of the carer at home or in a care setting.

Human beings have a number of behavioural tendencies that help them adapt to its place and time. These human traits, for example, to explore, order, manipulate, imagine, repeat, work and communicate have been crucial to human evolution.  We need to provide opportunities for these to be nurtured.

Montessori Practice:

Self-Esteem

Independence

Choice

Meaningful Engagement

A prepared environment

Montessori education seeks to provide the person with an environment ideally suited to their needs and the freedom to act safely in accordance with their natural behavioural tendencies. The Montessori environment in long-term care is carefully prepared to compensate for declarative memory impairment and support independence. Cues such as low height shelves filled with accessible materials, signage and templates are used to support independence.  People should be encouraged to find and do meaningful tasks independently.  Activities should be available for those who want to undertake them: folding the napkins ready for a meal, pairing socks, pouring their own drinks, making their own snack ...

Montessori materials

Many activities available in this setting are the ‘practical life’ activities. These are everyday activities, familiar from daily life, such as pouring, folding, polishing, arranging or sorting. These simple daily tasks retain a person's ability to concentrate and to coordinate movements.

The other areas of the Montessori curriculum also might have their place.  The 'sensorial materials' are ideal for adults needing to manipulate through the senses rather than the intellect. There are materials for the refinement of each sense, with each activity isolating one particular quality, for example colour, size, loudness, taste or weight. For example, the material known as the pink tower is made up of ten pink cubes of varying sizes. The tower is constructed with the largest cube on the bottom and the smallest on top. This material isolates the concept of size. The cubes are all the same colour and texture; the only difference is their size. Other materials isolate different concepts: colour tablets for colour, touch fabrics for texture etc.

Also aspects of communication can be helped by the language materials, classification and sequencing activities for example can help cognitive function. 

The cultural materials are sensory-based giving opportunities to think about the world and the plants and animals in it.

Materials that aid independence

The materials themselves invite activity, they are presented beautifully.  All the materials in a Montessori environment are designed for maximum independence: everything is laid out in an orderly way on easily accessible open shelves and the design of the materials make it easy for the user to identify, and gradually correct by themselves, any error.

Freedom

Just as important as the physical environment and its contents, is the functioning of the environment. People must also have the freedom to complete the activities and to manifest their tendencies to repeat, to explore, or manipulate. Someone’s interaction with the environment is most productive when it is self-chosen and founded on individual interest. Freedom of choice is important as is the choice to sit and do nothing – quietly watching friends.  Choice gives practice of decision making. But the environment also contains within it limits, both natural and social, that give boundaries. The only limit to individual freedom being the needs of the group as a whole.

Montessori environments promote positive characteristics including initiative, self-discipline, concentration, independence, a love of purposeful activity, and compassion. When people are allowed freedom in an environment suited to their needs, they blossom. 

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Montessori for Dementia, Disability and Ageing

For some ideas of materials that might interest older people please see our curated (by no means exhaustive) list of examples here but many activities will be simple household tasks, neatly presented and accessible.  Many items in our Sensory & Motor Skills section will make good initial activities but language games, number activities and general puzzles will always be popular too.