Issue link: https://maltatoday.uberflip.com/i/1517916
19 Unity SUNDAY 24 MARCH 2024 Active ageing for older persons living with dementia: The Montessori Approach Rosette Farrugia-Bonello Department of Gerontology and Dementia Studies WHILE ageing is a natural aspect of human growth, age is the main unmodifiable risk factor for dementia. The prob- ability of a person being di- agnosed with dementia rises with rising life expectancy and population ageing. Dementia is an umbrella term for various neurodegenerative syndromes that impact primarily memory, cognition and daily function- ing. It is a complex condition that can have significant im- pacts on both the individuals living with dementia and their primary caregivers, who most often are their families. Ap- proximately 50 million indi- viduals worldwide are estimat- ed to be living with dementia, and an estimated 10 million new instances of dementia are reported each year. According to projections, the global pop- ulation living with dementia is expected to nearly double every 20 years, reaching 75.6 million in 2030 and 135.5 mil- lion in 2050. Malta is hardly an exception to this trend, given its ageing population. It is pro- jected that the total number of persons living with dementia in Malta will more than dou- ble from 6,552 to 14,117 in the 2018-2050 period. Persons living with dementia experience challenging behav- iours, characterise through physical or verbal expressions of unmet needs. Studies have suggested that a lack of mean- ingful social interactions and activities may serve as triggers. Consequently, there is mount- ing evidence that non-phar- macological therapies and psychosocial activities may be effective in treating cognitive impairment as well as behav- ioural and psychological symp- toms of dementia. Psychoso- cial approaches to supporting those living with dementia include the use of Meaningful activities, which focus on the individual's interests and abili- ties, have been found to reduce responsive challenging behav- iours, increase social engage- ment, and hence, improving the overall quality of life. Montessori-based activities are undoubtedly one strategy that is believed to encourage social interaction and engage- ment for persons living with dementia through the imple- mentation of person-centred care. The Montessori-based activities are based on the 'Montessori Method,' which was created in the early 1900s by physician and educator Ma- ria Montessori for the educa- tion of young children. Camer- on Camp created the method's use in dementia care through- out the 1990s after observ- ing that activities designed by Montessori are a good fit for persons living with dementia. As the Montessori approach is an educational philosophy and approach that emphasis- es self-directed learning and hands-on activities, it is based on the belief that individuals learn best when they are ac- tively engaged in the learning process and have the freedom to explore and discover at their own pace. In the context of demen- tia care, the Montessori ap- proach offers a holistic and person-centred care by focus- ing on the remaining abilities, needs, interests and strengths of older persons living with dementia. It provides indi- vidualised activities and rou- tines that are culturally rele- vant, meaningful, purposeful, and promote engagement, independence, and cognitive functioning, within a sup- portive physical environment. Montessori-based activities are based on task breakdown; guided repetition; cues for self-correcting behaviours; modifiable tasks by moving progressively from simple to complex; as well as from con- crete to abstract. This type of approach works with the procedural memory, the one responsible for skill and task performance, which is typically intact in cognitive impairment. Activities within this approach require care- ful planning. They should be matched to the interest, abili- ty, and skill level of the persons living with dementia, which means that the activity facili- tator should have an accurate knowledge of the life-history and background of the persons that will be taking part in the activities. Activities, which ideally should be applied from everyday environment, can ei- ther be facilitated one-to-one, or in groups. On one hand, one-to-one activities may include sorting pictures and/or familiar items into categories; activities that make use of fine motor skills such as folding or activities which require repetitive mo- tion. On the other hand, group- based activities may include reminiscence about a common interested topic; or facilitated group discussion based on a short story amongst others. A key feature of this method is by inviting individuals to partici- pate and to provide them with different activity choices. Evidence shows that engage- ment in Montessori-based activities result in improved cognition, increase in social interaction and reduction in agitation and aggressive be- haviour. Understanding the unique challenges and needs of older persons living with dementia is crucial in provid- ing effective person-centred care. By employing the Mon- tessori Approach, caregivers and healthcare professionals can implement strategies that cater to the specific require- ments of older persons living with dementia, by promoting their wellbeing and enhancing their overall quality of life. lic funds for a guaranteed number of years, for a se- cure investment with mini- mal risks and a sound return on investment. Government will seek public recognition, boasting of the progress be- ing registered in the servic- es for older persons. Yet, to what extent can older per- sons be listed as beneficiar- ies? Are those persons, in whose interest these servic- es are being created, actual beneficiaries, or are they the ones losing out for others to benefit? There's an old joke that goes around the religious circles about this individual who went to seek the Rab- bi's advice, and the conver- sation goes as follows: "Rab- bi, I have a strong desire to live forever. What can I do?" "Get married" replies the Rabbi. "And will I live forev- er?" "No, but the desire will disappear." I wonder wheth- er the Rabbi would now reply: "Get a publicly fund- ed retirement home place- ment." As one older person living in a residential home put it: "This is not the life I worked so hard for and not the life I want to be living. It is not a proper life. I get the feeling that I'm a burden and that it will be much bet- ter for everyone the quicker it is all over." On a national policy level, how does one reconcile a strong strategy for the dein- stitutionalisation of disabled persons while on the other hand financing and implic- itly promoting the mass in- stitutionalisation of older persons? And how does the massive public funding go- ing into the institutionali- sation of older persons con- tribute to a national strategy for active ageing? When older persons move out of their home, their neighbourhood and their community, they experience a terrible prolonged shock of loss, the loss of a way of life, their circles of support, and all they would have hoped for in the evening of their life journey. And they find themselves becoming yet another num- ber in the balance sheet of the profitable business of ageing, financed by public funds – their retirement dreams engulfed by the cor- porate schemes that not on- ly replace one's own home but also the hope of digni- fied twilight years. Imagine being compelled to leave your own home for whatever reason, being admitted to a residential facility