New research will look at whether one-on-one activities utilizing a Montessori philosophy will provide an efficacious non-pharmacological treatment for problem behaviors associated with dementia. Researchers from Australia published their study protocol and provided an interesting framework for dementia care practitioners to support psychosocial interventions in their care environments.
Older adults living with dementia sometimes express their needs and wishes with aggressive verbal and physical behavior, and these behaviors create stress for nursing home residents and staff, are difficult to manage, and disrupt the nursing care process. The traditional approach has been to either treat care recipients pharmacologically or respond to problems as they arise. Some of the interventions have been shown to precipitate agitation in nursing home residents and have negative side-effects, including confusion, balance problems, and falls. Because of the known limitations of and the obvious ethical problems with pharmacological treatments, new behavioral interventions are being tested as a replacement or complement to medical treatment.
Three new frameworks have emerged to help explain problem behaviors. The proposed research is meant to test whether a practical application of these three paradigms can provide an efficacious treatment intervention. Each points to what these researchers believe will be a more successful set of interventions, which have the potential to reduce stress on the care floor and improve dementia care outcomes. They help reinterpret problem behaviors in a more person-centered way and allow the caregiver to incorporate the personal perspectives of the dementia care recipient into the intervention.
- Behavioral learning theory, when applied to persons living with dementia, suggests that problem behaviors are reinforced by taking for granted certain aspects of the caregiving relationship. For instance, a resident who routinely calls out will increase this behavior when the nursing staff attends to them only when they are noisy, but ignores him or her most of the time otherwise.
- The unmet needs paradigm suggests that problem behaviors in dementia are a care recipient’s way of expressing the needs that the caregivers are failing to address. Under this type of paradigm, behaviors serve as communication signals to the caregiver, and learning to interpret them is the key to providing quality care.
- The stress threshold model conceptualizes problem behaviors as manifesting from a reduced capacity to cope with stressful situations. This should be seen as part of the functional loss associated with dementia, and signs and symptoms of stress should be moderated accordingly.
In an effort to translate these paradigms into a practical intervention, researchers have attempted to apply the Montessori educational concept to dementia care. Montessori involves breakdown tasks, guided repetition, and moving the learner from simple to complex problem solving. Tasks should be designed to promote engagement and socialization and can be guided through one-on-one interactions. For dementia care, the activities are designed to enhance procedural memory, which is easier for care recipients to manage than verbal forms of memory.
The implications of this study, should the intervention prove successful, are numerous. It will lend further support to the growing body of evidence supporting the use of person-centered care, promote the use of a more psychosocial approach for behavioral interventions, and provide a rigorously tested model intervention for dementia care practitioners to implement. At the very least, the Montessori concept is an interesting one for those pursuing new ways of delivering person-centered care.
Source: van der Ploeg, E, O’Connor, D. 2010. Evaluation of personalized, one-to-one interaction using Montessori-type activities as a treatment of challenging behaviors in people with dementia: the study protocol of a crossover trial. BMC Geriatrics 10:3-6.
Subscribe to Real Time Aging In Action Updates
{ 1 trackback }
{ 0 comments… add one now }