The "Seven Solutions," as outlined by André Picard in The Globe's coverage of Canada's dementia crisis, are indeed central to addressing this crisis, and take us a step closer to formulating a national plan to support those caught in the web of dementia, that is the afflicted, their families and those who provide care.
Until a cure is found, there's a need for proven, innovative, non-pharmacological interventions - interventions that focus first on identifying the normal person behind the dementia and then finding ways to circumvent their deficits in order to improve their lives.
Surprisingly, one such intervention is the Montessori method. Yes, the same Montessori method pioneered by Maria Montessori, the famed Italian physician and childhood educator. Montessori believed that by adapting the environment to suit the needs of children (small tables and chairs; tools designed for small hands and level of dexterity), you could accomplish great things. You could relieve boredom, encourage independence and achieve higher levels of engagement.
It was Cameron Camp, an American psychologist and researcher, who discovered that Montessori's philosophy and principles could be adapted and applied to the world of dementia.
The Gilbrea Centre for Studies in Aging, in the Faculty of Social Sciences at McMaster University, has discovered something even more basic: Boredom is a trigger for people with dementia. The centre has set about developing programs and tools for those who see the brilliance of the Montessori method as it relates to people with dementia. More than 1,000 people have been trained and are now putting these methods into practice.
Look around any classroom, lecture hall or meeting room. After an hour, people start to fidget, doodle or scribble. In children, boredom manifests itself in behavioural problems and outbursts. As we mature, we learn to control our boredom in more socially acceptable ways. Now, imagine living in a nursing home for a year or more with nothing to do. In people with dementia, boredom triggers behaviours that are considered to be difficult or challenging.
While memory loss is the hallmark feature of dementia, it is the declarative memory loss that is devastated, the memory that is responsible for such things as facts, events, world knowledge, language and biographic history. Evidence shows that this form of memory loss can benefit from techniques like environmental cueing. Thus, a person who cannot retrieve details from their memory might find the information they need in their environment (such as printed words on cue cards). For example, a person who constantly asks to go to the washroom may do so because she can't remember she has just been. A laminated card indicating what time she went to the washroom and when someone will return to take her again will alleviate her anxiety and agitation.
Behaviours such as wandering, repetitive questioning, trying to get to a different place and constant unwarranted requests for attention or help are often cited as one of the most difficult aspects of dementia care. Montessori claimed that when children were engaged at their own level of ability, behavioural challenges disappeared. This same principle works for those with dementia. If Betty is constantly banging on the exit doors in an attempt to leave the floor or building, we need to ask the question, "Why she is doing that?" One explanation may be that Betty has forgotten that she has aged: She thinks she still has young children at home and her anxiety is related to her need to get home to her children. Activities, visual cues, and roles and routines based on Betty's interests and abilities could be created to provide her with a sense of purpose and something to do, thereby reducing her agitation.
Montessori principles have been adopted in nursing-home environments to accommodate the many and diverse needs of the residents. Grandview Lodge in Dunnville, Ont., for example, has built a garage for men to gather in for social connectivity, and to find things to keep them busy and stimulate their minds. The range and scope of the activities, as well as the environmental changes that can be created using the Montessori method and principles, are limited only by one's imagination.
As Montessori herself noted years ago: "A social change of this type cannot come from the ideas or energies of individual reformers but from a slow and steady emergence of a new world in the midst of the old."
Gail Elliot is assistant director of the Gilbrea Centre for Studies in Aging at McMaster University.