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Living with Dementia: The How is in the WOW – the Montessori Way!

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Written by:  Gail Elliot, Gerontologist & Dementia Specialist, DementiAbility Enterprises Inc.

“Memory is a way of holding onto the things you love, the things you are, the things you never want to lose.”
From the TV show “The Wonder Years”

Memory slips are common at any age.  As the years pass, we often become increasingly concerned about memory loss, with a hidden fear that we may be harbouring early signs of dementia.  These fears are usually unfounded, but when there are legitimate concerns (for you or a loved one) it is important to visit your doctor to determine what might be going on, as dementia is not a normal part of aging.

Dementia is not one single disease. Dementia is a term that describes a wide range of symptoms associated with a decline in memory or other cognitive skills (such as judgment and reasoning).  The impairment is severe enough to reduce a person’s ability to perform activities of daily living. There are a number of different types of dementia, each with its own distinct set of features. The most common types of dementia include Alzheimer’s Disease, Vascular Dementia, Frontotemporal Dementia and Lewy Body Dementia. For more information about these and other types of dementia visit http://www.alzheimer.ca/en.

Dementia is often diagnosed in hindsight, meaning that when you begin to notice changes, the damage has already begun. People with dementia become increasingly disoriented to time, place and person, may have poor judgment (for example, they may think they have lots of money when in fact they need to watch what they spend) and/or may find it increasingly difficult to accomplish daily tasks.  Once you begin to notice such changes in memory and/or behaviour, it is time to learn how to help the person to remain engaged in activities of daily life.  The objective is to help the person maintain his/her independence as long as possible.

How do you begin?

Using the DementiAbility Method, you can begin with a simple three part formula:  The How is in the WOW!  This method connects what you know about the person to what you are going to do, which includes Montessori programming principles.

 

W – Who:  Know the person – focus on present needs while considering past and present interests, skills and abilities.

O – Observations:   What behaviours do you see and why and when do they occur?

W – What are you going to do?  Connect what you know about the person with what you see. This is how you decide what you need to do (thinking about their needs, interests, skills and abilities).

 

10320950_sW – Who is this person?

What do we know about this person? Identify past and present interests, skills and abilities and write these details down to share with the person with dementia as well as those who are involved in providing care. In an effort to help the person with dementia remember important details about past and present, put a memory book together (be sure to put details under each photo). Be sure to include photos of people when they were younger and photos as they look today. Since the person with dementia may not remember he/she has grown old, he/she also tends to forget that their children have also aged.  These photos, along with the written details, serve as important memory supports, as well as talking points for those who visit and/or provide care. This information also connects with the last “W” in the WOW model.

O – Observations. What do you see? What is happening? Why the behaviour?

Some of the changes you may observe are due to changes in the brain (for example, the inability to find their way or constant questioning because they can’t remember the answers).  Other changes may be due to the frustration that arises when they can no longer do things for themselves or because they are bored or lonely.  Try to determine what the person needs when deciding what to do (e.g. – do they need help doing things or people to talk to?)

  • Problems finding places and things: Create signs and labels to support memory loss (for example, an arrow that shows which way to go to find the bathroom or bedroom; labels on drawers and cupboard that identify what is in the drawer or cupboard).
  • Repetitive questioning: If the person is always asking the same question, place the answer to the question on a sheet of paper (laminate it if you can – so it lasts). For example, if the person asks, “When is my daughter coming to visit?” the sheet would provide the answer, “My daughter Gail comes to visit every day at 2:00 pm.”
  • Can’t successfully complete tasks: Sometimes a person can’t remember what to do when he/she gets into the bathroom or what to do first when getting dressed. Break down the tasks, step by step, with words or pictures, and make them available for the person to use. Simple instructions may be all the person needs to maintain dignity and independence.
  • The person is agitated. One of the most common reasons for agitation, aggression or anxiousness is boredom.  You may also see these behaviours when the person is lonely, and in need of spending time with others.  The Montessori Method for DementiaTM focuses on creating activities that support memory loss while placing emphasis on successful outcomes (as the focus is on finding out what they are able to do and creating activities that are aimed at that level of ability).
  •  W – What are you going to do?   When making decisions about what you are going to do, you need to consider the “Who” details and link this information to your “Observations”.  A few ideas follow.
  • Roles and Routines:  Try to find things to do that can be done successfully and regularly (e.g. – set the table, feed the fish, do the dishes, polish things like shoes, golf clubs or silver, fold laundry or, if in a nursing home, greet residents at meals,).  Build in memory supports, such as an agenda, so they can be reminded of the things they can look forward to, as well as what they have done, each day.
  • Create activities that are based on needs, interests, skills and abilities.  Each activity should end in success (this is an important part of the Montessori Method for Dementia).  A game of cards such as “Highest Card Wins” can be played even in the later stages of dementia (where each person takes half the deck and one card is turned over at a time – highest card wins).  If a person could read before the diagnosis of dementia, they might enjoy reading now.  Special books have been written for those with dementia.

Individuals who have been diagnosed with dementia require a range of memory supports and a world where there is something meaningful to do.  Sometimes we simply need to support the memory loss (with memory cueing).  The goal is to find the capacity that remains, consider the person’s interests and adapt what you do each day to meet each person’s unique and individual needs. The objective is to provide meaning and purpose, within the individual’s range of abilities. Rose Kennedy said, “Life isn’t a matter of milestones, but of moments”.  So let’s make every moment count.

To learn more about working with people who have been diagnosed with dementia visit www.dementiability.com.  Dates and locations of workshops are listed as well as numerous resources.

 

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