Montessori philosophy and methods can be used not only at the beginning of the life cycle but throughout life to the end. Over recent years there has been an exciting emergence of Montessori principles being applied in dementia, disability and aged care settings around the globe.
Alzheimer’s Disease International estimate that by 2050 there will be 131 million people across the world who will be living with dementia and a further 929 million living with other disability. Even now the numbers of people affected by dementia or other disability is alarming and the costs associated with these are also enormous. It is well recognized that any disability not only takes a tremendous toll on those people living with it, but also on care providers, families, health and social services. And for those living with dementia, at this time there is no cure in sight.
As the number of people living with dementia and or other disability continues to rise, it becomes increasingly important to find meaningful and enjoyable activities, at a person’s own level of ability, which are designed to enhance quality of life. Appropriate evidence-based interventions are needed to help all people regardless of diagnosis to end continue their life with dignity, respect, engagement and a sense of worth, until the end.
As early as 2006, it was recognised that the Montessori philosophy and principles could be modified for dementia and adopted as a philosophy for dementia care. This epiphany was responsible for the work that was to become a framework for the creation of Montessori environments in aged care. In recent years it was identified that the same philosophy applies to every person, regardless of age who is living with any sort of disability. We all need a reason to get out of bed every day, to feel valued, respected and to be able to contribute to our community wherever that may be.
Dr Montessori’s emphasis on the person, including the dignity and respect that was central to all aspects of her work, applies to us all. Her vision was to develop the minds of young children with the purpose of building independence, self-esteem and a promising future. Older adults and people living with dementia or other disability also need these things.
Montessori methods for dementia, disability and ageing focus on supporting both the person and the environment in which they live. The techniques are intended to engage people in life and living, by providing an environment that supports their losses and circumvents their deficits whilst providing meaning and purpose to their day.
Fitting into the framework of rehabilitation services, Montessori methods focus on a learning strategy and excellent overall dementia, disability and aged care. While activities adapted within the context of rehabilitation are not expected to return the person to his/her pre-morbid state, they can be used to maintain and enhance cognitive, psychosocial and physical function.
For a person living with dementia, remembering information for any length of time is difficult, therefore the information needs to be put into the environment. Memory deficits can be circumvented in this way with the person now able to access the information when needed rather than trying to remember what is often too difficult to recall from the banks of information in their memory.
One of the main strategies used by Montessori was that of creating a physical environment that would stimulate the senses or engage the imagination, encourage exploration and provide opportunities for engagement in purposeful activity. A supported environment was critical for the success and independence of her children. The same applies for people living with dementia or other disability.
With a feeling that they are no longer useful or able to contribute to their community, a sense of despair and worthlessness can begin to take hold. These feelings can be avoided if people are encouraged to do things for themselves whenever possible and by providing opportunities for them to make contributions to their world. We can do this by assigning meaningful roles and routines that are based on a person’s interests, strengths and needs.
Dr Montessori placed a great deal of emphasis on preparing the environment, thereby creating a world where children would be challenged at their own pace and at their own level of ability. This conviction of preparing the environment and challenging people at their own level of ability also underpins all aspects of a Montessori for dementia, disability and ageing approach to care.
The characteristics of dementia or disability means all people will have unique needs and abilities. As Montessorians we prepare the environment to respond to these needs. An example would be activities for the recovery of movement (feeding oneself), as an aid to functional independence.
In our work the role of the prepared adult is similar to the classroom. The prepared care professional supports and enables the linking of the person to the Montessori dementia, disability or aged care prepared environment.
Applying Montessori principles is possible wherever an older adult is living. Family members can also play a role in the promotion of both activities that encourage independence and bring pleasure to roles that increase self-esteem and sense of worth. It is possible for all people to continue to have a role in their community. It may be a changed or modified role but a role, nevertheless.
Building relationships with people who are living with dementia or disability, their care partners and the professional staff who care for and support them is essential to influence change in a system that often robs people of their independence, dignity and self-esteem.
Within our own Montessori family it has taken some time to build pathways and acceptance that Montessori is indeed learning for life and that the principles of independence, choice, high self-esteem and engagement are applicable to everyone, regardless of age. Dr Maria Montessori talked about the slow emergence of a brave new world and this emergence of Montessori across all ages, countries and cultures is indeed evidence of the emergence of a brave new world even for our own Montessori family.
Anne Kelly, Head of Montessori for Dementia, Disability and Ageing
