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. 

For more information about this subject please visit

Montessori for Dementia, Disability and Ageing

or download our list of possible activities

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.

Activities for Aged and Dementia Care Settings
Suggested Activities	Purpose	Presentation	Example Materials
Practical Life Activities	Mimic everyday tasks and support independence, dignity, and routine.	Present all the items in a basket, box or tray lined with contrasting colours or have a work mat in a contrasting colour for the visually impaired.
Lacing beads	Excellent for fine motor skills, developing the pincer grip and practising precision, the beads increase in difficulty.	Choose level of complexity suitable to the ability of the user. Some activities have a fixed wooden "needle" for easier threading.	Montessori Wooden Threading Shapes
Lacing cards	Excellent for fine motor skills and developing the pincer grip, this activity will also encourage shape recognition and language.	Choose level of complexity suitable to the ability of the user.	Montessori Wooden Lacing Shapes
Folding cloths	Folding is an important life skill which will be a familiar activity from home.  It requires precision and fine motor skills.	Show how the corners are carefully aligned and then run two fingers along the stiched line to smooth the fold.  Extend this activity by having napkins or clothes to fold.	Montessori Cloth Folding Box
Folding napkins	Fine motor skills, sense of purpose, routine, and preparation for a meal.	This is a real life activity which can be available before all meals, napkins can be simply folded into squares, but some people may have the dexterity and skills for more flamboyant folds.
Matching and folding socks	Pairing socks is an important life skill which will be a familiar activity from home.  It requires precision and fine motor skills and sorting,	A range of socks in contrasting colours, textures, patterns and sizes can be presented in a basket for pairing, have a second basket for the paired socks.
Pouring exercises (water or dry ingredients)	Pouring is an important element of autonomous self care, it requires motor control and some strength.	Choose jugs appropriate to the needs of the user.  To prevent liquid spills, beads or grains can be poured instead for different sensory experiences. The complexity of the task can be differentiated.	Practical Life Pouring Set
Transferring activities (spoon, tongs, etc.)	Maintaining independent feeding and serving skills	Using sprung tongs strengthens the grip, using a ladle requires wrist twisting, so varying the implements for transferring varies the skills needed.  A range of  items can be transferred.	Practical Life Transferring Set
Flower arranging	Provides cognitive and sensory simulation, improves motor skills and gives a sense of independence and accomplishment	A selection of flowers and foliage, a choice of vases, a watering can, some scissors if appropriate (or a helper can cut to desired length).
Polishing silver	Familiar, purposeful, and success-oriented tasks that can provide a sense of meaning and accomplishment.	Provide a small amount of non-toxic polish (or simply toothpaste/cooking oil as an alternative), cloth and silver or other metal cutlery. Apply the "polish," wipe the item and buff it with a soft cloth.
Polishing shoes	Familiar, purposeful, and success-oriented tasks that can provide a sense of meaning and accomplishment.	Lay out a simple shoe polishing kit with a brush, cloths, and polish. This task is familiar to many and allows them to feel productive.	Montessori 2 Shoe Polishing Brushes
Wiping the table	A meaningful life-skill that provides a sense of purpose and physical exercise to engage individuals and provide sensory stimulation.	"Would you mind helping me get this last bit of the table clean?". The goal is engagement and the feeling of contributing, not a perfectly sterile surface. Avoid correcting or criticizing their efforts.	Table Crumb Brush Set
Setting the table	Familiar, purposeful, and success-oriented tasks that can provide a sense of meaning and accomplishment.	Have the correct amounts of the items available on on tray, placemats with the outlines of plates, cutlery and cups can help avoid errors.
Sorting cutlery	A valuable and engaging activity for people with dementia, drawing on preserved abilities and providing a sense of purpose and routine.	Place a basket of unsorted cutlery on one side, place an empty cutlery tray (or multiple labelled containers) on the other side.  Demonstrate the task by sorting one of each item into the correct spot.
House plant care	Provides mental stimulation and a sense of purpose through low-maintenance plants that offer sensory rewards.	Choose hardy plants and simplify tasks to build routine and self-confidence. Snake plants are very hardy and produce oxygen at night, while fragrant  lavender can improve focus and memory recall.	Plant care
Washing cloths	Provides a purpose through a real-life chore. Uses muscle memory and focus on remaining abilities rather than weaknesses.	Have all items together in one place. The activity should be broken down into simple, sequential steps. Demonstrate one step at a time slowly and clearly before inviting the person to participate.	Montessori Cloth Washing Bowl
Cutting fruit and vegetables	Ues motor skills and stimulates the senses. This task can be adapted to ensure success and a sense of success and purpose.	The activity can be broken down into individual steps. The person might wash or peel the fruit (e.g., a banana) or use a safe nylon or plastic knife for softer fruits like bananas, kiwi, or pre-sliced melon.	Crinkle cutter
Using tools	Skills that may resonate with former abilities that strengthen the hand	Presenting simple clear tasks with all the components presented together and any steps broken down into single stages.	Montessori Screwdriver Set
Gardening	A range of benefits including reducing stress, easing anxiety, giving a sense of purpose, walking, planting or weeding and fresh air.	Have clearly defined tasks for those who need the structure, but allow freedom for those who can still weed or water for example.
Pegging up washing	Strengthens the pincer grip, gives a sense of purpose.	Can be a normal wash hung out on a line or a set of small clothes pegged onto a clothes airer depending on the mobility of the person.
Unlocking padlocks, matching keys to locks	Strengthens the pincer grip, requires fine motor skills and sorting.	Present 3 different padlocks with 3 different keys.	Sorting tray
Sorting & Matching Sets	Promote fine motor skills and cognitive stimulation (classification and dexterity).
Wooden trays with compartments	Using procedural memory and fostering a sense of purpose. Help improve overall well-being and reduce challenging behaviors.	Activities are individualized to a person's interests and abilities. Demonstrate how the items may be sorted.	Wooden Sorting Trays
Familiar objects (nuts and bolts, buttons, first aid kit)	Using fine motor skills which help with other necessary daily tasks, also enhances cognitive skills	Activities are individualized to a person's interests and abilities, familiar objects (nuts and bolts, buttons, first aid kit)
Coloured beads or counters	Using fine motor skills which help with other necessary daily tasks like dressing eg the counters are a similar size to buttons.	Present the activity by placing counters into different compartments by exaggerating the decision process of colour matching.	Wooden Round 4 Compartment Sorting Tray with Counters
Shape blocks	Sorting by more than one attribute: size, colour and shape	Discuss the different attributes of the shapes and the openings in the base.	Sorting and matching shapes
Picture cards of familiar objects, places, people, animals	Matching activities are easier than classifying activities, simple picture cards can be used or matching pictures to objects or word cards.	Picture cards of familiar objects, places, people, animals	Downloadable resources
Puzzles & Manipulatives	Promote fine motor skills and conversation/problem-solving.	Discuss the images, allow them to be prompts for reminiscences.
Board Puzzles (limited number of pieces)	Promote fine motor skills and conversation/problem-solving.	Puzzles with familiar objects, places, people, animals.  Use a contrasting colour workmat or tray liner.	Puzzles selection
Jumbo puzzles (fewer, large pieces)	Promote fine motor skills and conversation/problem-solving.	Large pieces with photographic images	Jigsaw puzzles selection
Peg boards with oversized pegs	Ideal for developing fine motor skills, threading, counting, sorting, sequencing and creating and following patterns.	Give a clear task, eg to put all the pegs of one colour on one row then find all the pegs of the same shape and put in the same column.	Jumbo Peg Board
Activity boards (latches, nuts and bolts)	Promote the dexterity to use common dressing fastenings to maintain independence.	The doors are large enough for a blank playing card or similarly sized piece of paper to be put inside. This can have a picture, greeting message or instruction, giving a purpose to opening the doors.	Montessori Set of 6 Latch Boards
Dressing frames (laces, zippers, buttons)	Promote the dexterity to open common fastenings to maintain independence.	Isolate the skill and practise repeatedly.	6 Simple Fastenings Frames – Absorbent Minds Montessori
Metal or Plastic Insets for Design (stencils)	A non-verbal outlet for concentration, fine motor control, and creativity.	Use the stencils for tracing and shading. The finished product (a geometric design) can be a source of pride and self-correction.	Plastic Insets For Design
Wooden Nuts and Bolts Frame	Promote dexterity particularly wrist twisting.	Put the wooden cylinders on the correct bolts.  Use this as an opportiunity to discuss the vocabulary of size, thin, thick, large small etc.	Wooden Nuts and Bolts Frame
Pinboard with Elastic Bands	A non-verbal outlet for concentration, fine motor control, and pattern making.	Use the large wooden board if dexterity is limited, or the plastic board for more fine motor challenge.  Have cards to copy the designs or allow creativity.	Geo pinboard
Binomial Cube	Unlock former mathematical understanding, or just enjoy as a colour puzzle.	Match the coloured faces to build the cube, or thin of it as an algebraic puzzle.  Extend with the Trinomial Cube	Binomial Cube
Memo Pairs Games	Target short-term memory and concentration through visual matching.	Limit the number of pairs to reduce complexity
Food matching pairs	Target short-term memory and concentration through visual matching.	Food matching pairs	Montessori Plants and Fruits Memo Game
Animal skin matching puzzles	Target short-term memory and concentration through visual matching.	Animal skin matching puzzles	Animal Memo
Geometric shape puzzles	Visual matching exercise	Match the shape to its place on the board	Shape puzzles
Sensory Tools	Engage multiple senses for soothing experiences and sensory grading/pairing.
Textured boards	Tactile sensory input, matching, and vocabulary (soft, rough, smooth).	Match the textures with or without a blindfold	Touch textures
Scented jars (lavender, cinnamon, coffee)	Sensory stimulation, memory retrieval, and discussion prompts.	Sniff the different smalling jars and discuss the scents, match the pairs.	Smelling bottles
Soft fabrics	Tactile sensory input, matching, and vocabulary (soft, rough, smooth).	Match the textures with or without a blindfold	Touch fabrics
Heuristic baskets of sensory objects	Use vocabulary to describe the object you can feel	Enjoy feeling the objects and finding words to describe them.	Heuristic treasure basket
Sound cylinders	A matching game that enhances auditory discrimination.	The focus is on matching the sounds, not naming the contents.	Sound boxes
Musical bells	A matching game that enhances auditory discrimination.	Pair the bells to match the notes. Simple tunes could be copied.	Musical Bells
Colour matching	A simple task for visual discrimination and matching	Initially use the ones which feature the most distinct colours (primary colours), or simply match colour swatches of fabric or yarn.	Colour matching
Sensorial objects with graduated size	Strengthens the pincer grasp, visual perception of size, and sequencing.	Use the original wooden materials for their tactile quality (especially the weight and smoothness of the wood), but simplify the task to matching or putting the pieces back, rather than grading them.	Sorting by size
Spatial awareness	Explore the spatial relationship between 2-D images and 3-D shapes and designs.	Use wooden blocks to match the images on the assignment cards.	Spatial position
Sequencing activities	Ordering events
Daily tasks	Focus on the stages of the process of completing a task. Sequencing errors can be a common issue in dementia sufferers.	Create a visual instruction aid for a daily task.  Order the process steps.
Ordering events in stories	Develop logical thinking and story telling skills.	Put the cards in order. Describe the event that happens.	Tell the story
Ordering items by characteristics	Use concepts such as “more than” and “less than”.	Put the cards in order, perhaps find real objects that match in some way.	Maths games
Seriation by size	Use concepts such as “larger” and “smaller”.	Put the cylinders in size order, the blocks give a control of error.	Knobbed and knobless cylinders
Reminiscence Materials	Trigger positive memories and encourage conversation and identity recall.
Nomenclature picture cards (familiar items)	Promotes vocabulary, recognition, and language skills; serves as a reminiscence tool.	Choose images that are relevant to the person.	Downloadable resources
Memory boards: personal circumstances / daily schedule	Promotes vocabulary, recognition, and language skills; relieves anxiety and confusion.	Whether it be a daily schedule or a picture board of the people they will encounter in their day for example, this can avoid confusion and help relieve anxiety.
Life story boxes & Family photos	Promotes vocabulary, recognition, and language skills; serves as a reminiscence tool.	Gives a prompt to happy memories and discussion.
Activities based on life experiences	Promotes vocabulary, recognition, and language skills; serves as a reminiscence tool.	Find activities that relate to their careers or experiences, eg cart for delivering newspapers, fining papers, gardening, food serving
Art and Craft Kits	Foster creativity and self-expression.
Painting	Foster creativity and self-expression.	Have a picture or still life arrangement ready for painting or drawing	Painting
Collage	Foster creativity and self-expression.	Provide a set of materials ready cut, or with scissors where approriate,	Pasting box
Modelling sets	Foster creativity and self-expression.	This could be a free creative task or some example models could be shown to make initial interaction easier.	Modelling clay
Adult colouring books	Fine motor skills.	Allows less artistic to create a beautiful picture.
Knitting or crochet	Pincer grip and creativity.	This could be a free creative task or some example creations could be taught to make initial interaction easier.
Presentation	Ensure activities are stored and presented attractively and simply (key to the Montessori method).
Baskets			Baskets
Trays			Trays
Work mats			Working rugs
Trays with compartments			Sorting trays
General Tips for Success
Prepare the environment:  Make the activities accessible with a clearly defined location.
Keep it Simple: Break the activity into small, manageable steps. Focus on one stage of the task at a time.
Focus on Purpose: Frame the activity as helping with a real task (e.g., "Could you help me make this cutlery shine for dinner?"). This provides a sense of value and meaning.
Do it With Them, Not For Them: Encourage participation and avoid taking over, which can diminish confidence.
Avoid Correction: The goal is engagement and positive feeling, not perfection. It's okay if it's not done the "right" way.
Be Mindful of Ability: Adapt the activity based on their current abilities. If they can't manage small items, use larger ones. If their concentration wanes, switch activities or take a break.
Engage the Senses: The different textures,  smells, patterns and colours can all provide valuable sensory stimulation.
Ensure visual contrast: Tonally different colours will help those with visual impairment. (Look at an activity in black and white to understand this.) A contrasting work mat or work tray can help.
Assess the risks: Different people will pose different risks with small or sharp items, items they might hurt themselves with or swallow for example.  They may need supervision or alternatives.
Montessori-based tasks in dementia care provide significant benefits by improving engagement, reducing agitation and anxiety, and enhancing self-esteem and independence. These activities are person-centered, focusing on an individual's remaining skills and interests rather than their limitations.
Key Benefits
Promotes Independence and Dignity: Tasks are designed to be achievable and self-correcting, allowing individuals to successfully complete them without constant supervision. This fosters a sense of self-reliance and preserves their dignity.
Enhances Engagement and Mood: Engaging in meaningful and purposeful activities directly combats boredom and apathy. Studies show increased constructive engagement and more positive affect (pleasure, interest) compared to standard activities.
Reduces Challenging Behaviors: A highly noted benefit is the reduction in "responsive" behaviors such as wandering, agitation, anxiety, depression, and repetitive questioning. This can also lead to a decreased need for psychotropic medications.
Stimulates Cognitive and Motor Skills: Activities often involve hands-on, multi-sensory experiences like sorting objects, folding laundry, or using tools, which help maintain fine motor skills, hand-eye coordination, memory recall, and concentration.
Fosters Social Interaction and Community: Group activities encourage communication and social roles, such as leading a group task or preparing a meal together, which helps alleviate isolation and builds a sense of belonging and contribution to the community.
Improves Quality of Life: By providing opportunities for success, choice, and a meaningful daily routine, the overall quality of life for people with dementia is significantly improved.