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A cluster-randomized crossover trial of Montessori activities delivered by family carers to nursing home residents with behavioral and psychological symptoms of dementia

Published online by Cambridge University Press:  25 November 2019

Lingani Mbakile-Mahlanza ,
Eva S. van der Ploeg ,
Lucy Busija ,
Cameron Camp ,
Helen Walker  and
Daniel W. O’Connor
Lingani Mbakile-Mahlanza*
Affiliation:
Department of Psychology, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
Eva S. van der Ploeg
Affiliation:
Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia
Lucy Busija
Affiliation:
School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
Cameron Camp
Affiliation:
Center for Applied Research in Dementia, Solon, OH, USA
Helen Walker
Affiliation:
Deakin University, Melbourne, Australia
Daniel W. O’Connor
Affiliation:
Department of Psychiatry, Monash University, Clayton, Victoria, Australia
*
Correspondence should be addressed to: Dr. Lingani Mbakile-Mahlanza, Department of Psychology, University of Botswana, Private Bag UB 0022, Gaborone, Botswana. Phone: +267 355 4157. Email: Lingani.Mbakile-Mahlanza@mopipi.ub.bw
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Abstract

Objectives:

One-on-one structured Montessori-based activities conducted with people with dementia can improve agitation and enhance engagement. These activities may however not always be implemented by nursing home staff. Family members may present an untapped resource for enabling these activities. This study aimed to evaluate the impact of the Montessori activities implemented by family members on visitation experiences with people who have dementia.

Design:

Cluster-randomized crossover design.

Setting:

General and psychogeriatric nursing homes in the state of Victoria, Australia.

Participants:

Forty participants (20 residents and 20 carers) were recruited.

Intervention:

During visits, family members interacted with their relative either through engaging in Montessori-based activities or reading a newspaper (the control condition) for four 30-minute sessions over 2 weeks.

Measurements:

Residents’ predominant affect and engagement were rated for each 30-second interval using the Philadelphia Geriatric Center Affect Rating Scale and the Menorah Park Engagement Scale. The Pearlin Mastery Scale was used to rate carers satisfaction with visits. The 15-item Mutuality Scale measured the carers quality of their relationship with the resident. Carers’ mood and overall quality of life were measured using the Center for Epidemiological Studies Depression Scale and Carer-QoL questionnaires, respectively.

Results:

Linear regressions within the generalized estimating equations approach assessed residents’ and carers’ outcomes. Relative to the control condition, the Montessori condition resulted in more positive engagement (b = 13.0, 95%CI 6.3–19.7, p < 0.001) and affect (b = 0.4, 95%CI 0.2–0.6, p < 0.001) for the residents and higher satisfaction with visits for carers (b = 1.7, 95%CI 0.45–3.00, p = 0.008). No correction was applied to p-values for multiple comparisons.

Conclusion:

This study strengthens the evidence base for the use of the Montessori programs in increasing well-being in nursing home residents. The findings also provide evidence that family members are an additional valuable resource in implementing structured activities such as the Montessori program with residents.

Keywords

dementiabehaviorpsychosocial care
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 3: Issue Theme: Improving Healthcare in Long-Term Care and Nursing Homes , March 2020 , pp. 347 - 358
Copyright
© International Psychogeriatric Association 2019

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References

Alzheimer’s Disease International (2019). World Alzheimer Report 2019: Attitudes to Dementia. London: Alzheimer’s Disease International.Google Scholar
Archbold, P. G., Stewart, B. J., Greenlick, M. R. and Harvath, T. (1990). Mutuality and preparedness as predictors of caregiver role strain. Research in Nursing & Health, 13, 375–384.CrossRefGoogle ScholarPubMed
Brodaty, H. and Arasaratnam, C. (2013). Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 169, 946–953.10.1176/appi.ajp.2012.11101529CrossRefGoogle Scholar
Brodaty, H.et al. (2001). Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504–512.CrossRefGoogle ScholarPubMed
Brouwer, W. B. F., Van Exel, N. J. A., Van Gorp, B. and Redekop, W. K. (2006). The CarerQol instrument: a new instrument to measure care-related quality of life of informal caregivers for use in economic evaluations. Quality of Life Research, 15, 1005–1021.CrossRefGoogle ScholarPubMed
Camp, C. J. (1999). Montessori-Based Activities for Persons with Dementia, Volume 1. Beachwood, OH: Menorah Park Center for Senior Living.Google Scholar
Camp, C. J.et al. (2006). Montessori-Based Activities for Persons with Dementia, Volume 2. Beachwood, OH: Menorah Park Center for Senior Living.Google Scholar
Carter, J. H.et al. (1998). Living with a person who has Parkinson’s disease: the Spouse’s perspective by stage of disease. Movement Disorders, 13, 20–28.10.1002/mds.870130108CrossRefGoogle ScholarPubMed
Chien, W. T. and Chan, S. W. C. (2013). The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: a randomised controlled trial with 24-month follow-up. International Journal of Nursing Studies, 50, 1326–1340.CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
Cohen-Mansfield, J. (1986). Agitated behaviors in the elderly: II. Preliminary results in the cognitively deteriorated. Journal of the American Geriatrics Society, 34, 722–727.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. (2001). Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. The American Journal of Geriatric Psychiatry, 9, 361–381.CrossRefGoogle ScholarPubMed
Douglas, S., James, I. and Ballard, C. (2004). Non-pharmacological interventions in dementia. Advances in Psychiatric Treatment, 10, 171–177.CrossRefGoogle Scholar
Garland, K., Beer, E., Eppingstall, B. and O’Connor, D. W. (2007). A comparison of two treatments of agitated behavior in nursing home residents with dementia: simulated family presence and preferred music. The American Journal of Geriatric Psychiatry, 15, 514–521.CrossRefGoogle ScholarPubMed
Gerdner, L. A. (2000). Effects of individualized versus classical “relaxation” music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders. International Psychogeriatrics, 12, 49–65.CrossRefGoogle ScholarPubMed
Gitlin, L. N.et al. (2009). The Tailored Activity Program to reduce behavioral symptoms in individuals with dementia: feasibility, acceptability, and replication potential. The Gerontologist, 49, 428–439.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Judge, K. S., Camp, C. J. and Orsulic-Jeras, S. (2000). Use of Montessori-based activities for clients with dementia in adult day care: effects on engagement. American Journal of Alzheimer’s Disease, 15, 42–46.CrossRefGoogle Scholar
Kales, H. C., Gitlin, L. N. and Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. BMJ, 350, h369.CrossRefGoogle ScholarPubMed
Koder, D. (2016). The use of cognitive behaviour therapy in the management of BPSD in dementia (Innovative Practice). Dementia, 1–7.Google Scholar
Lawton, M. P., Van Haitsma, K. and Klapper, J. (1996). Observed affect in nursing home residents with Alzheimer’s disease. The Journals of Gerontology: Series B, 51B, P3–P14.CrossRefGoogle Scholar
Logsdon, R. G.et al. (2010). Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial. The Journals of Gerontology: Series B, 65B, 691–697.CrossRefGoogle Scholar
Lyketsos, C. G.et al. (2011). Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 5(7), 532–539.CrossRefGoogle Scholar
O’Connor, D. W., Ames, D., Gardner, B. and King, M. (2009). Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics, 21, 225–240.10.1017/S1041610208007588CrossRefGoogle ScholarPubMed
Oken, B.et al. (2010). Pilot controlled trial of mindfulness meditation and education for dementia caregivers. The Journal of Alternative and Complementary Medicine, 16, 1031–1038.CrossRefGoogle ScholarPubMed
Orsulic-Jeras, S., Judge, K. and Camp, C. (2000). Montessori-based activities for long-term care residents with advanced dementia: effects on engagement and affect. The Gerontologist, 40, 107.Google ScholarPubMed
Pearlin, L. and Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21.CrossRefGoogle ScholarPubMed
Pioli, M. F. (2010). Global and caregiving mastery as moderators in the caregiving stress process. Aging & Mental Health, 14, 603–612.CrossRefGoogle ScholarPubMed
Radloff, L. and Teri, L. (1986). Use of the center for epidemiological studies-depression scale with older adults. Clinical Gerontologist, 5, 119–136.CrossRefGoogle Scholar
Rausch, A., Caljouw, M. A. and Van Der Ploeg, E. S. (2017). Keeping the person with dementia and the informal caregiver together: a systematic review of psychosocial interventions. International psychogeriatrics, 29, 583–593.10.1017/S1041610216002106CrossRefGoogle ScholarPubMed
Roberts, G., Morley, C., Walters, W., Malta, S. and Doyle, C. (2015). Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities. Geriatric Nursing, 36, 106–110.CrossRefGoogle ScholarPubMed
Sansoni, J. E., Marosszeky, N. and Sansoni, E. (2008). Recent findings: the dementia outcomes measurement suite (DOMS) project. National Health Outcomes Conference. Wollongong, Australia: Australian Health Outcomes Collaboration.Google Scholar
Skrajner, M. and Camp, C. (2007). Resident-Assisted Montessori Programming (RAMP™): use of a small group reading activity run by persons with dementia in Adult Day Health Care and long-term care settings. American Journal of Alzheimer’s Disease & Other Dementiasr, 22, 27–36.10.1177/1533317506297895CrossRefGoogle Scholar
Sörensen, S., Duberstein, P., Gill, D. and Pinquart, M. (2006). Dementia care: mental health effects, intervention strategies, and clinical implications. The Lancet Neurology, 5, 961–973.CrossRefGoogle ScholarPubMed
Van Der Ploeg, E. S., Camp, C. J., Eppingstall, B., Runci, S. J. and O’Connor, D. W. (2012a). The study protocol of a cluster-randomised controlled trial of family-mediated personalised activities for nursing home residents with dementia. BMC geriatrics, 12, 2.CrossRefGoogle Scholar
Van Der Ploeg, E. S., Eppingstall, B., Camp, C. J., Runci, S. J., Taffe, J. and O’Connor, D. W. (2013). A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia. International psychogeriatrics, 25, 565–575.10.1017/S1041610212002128CrossRefGoogle Scholar
Van Der Ploeg, E. S., Mbakile, T., Genovesi, S. and O’Connor, D. W. (2012b). The potential of volunteers to implement non-pharmacological interventions to reduce agitation associated with dementia in nursing home residents. International psychogeriatrics, 24, 1790–1797.CrossRefGoogle ScholarPubMed
Van Der Ploeg, E. S., Walker, H. and O’Connor, D. W. (2014). The feasibility of volunteers facilitating personalized activities for nursing home residents with dementia and agitation. Geriatric Nursing, 35, 142–146.CrossRefGoogle ScholarPubMed
Whitlatch, C. J. and Orsulic-Jeras, S. (2018). Meeting the informational, educational, and psychosocial support needs of persons living with dementia and their family caregivers. The Gerontologist, 58, S58–S73.Google ScholarPubMed
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