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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

Published online by Cambridge University Press:  14 December 2012

Eva S. van der Ploeg ,
Barbara Eppingstall ,
Cameron J. Camp ,
Susannah J. Runci ,
John Taffe  and
Daniel W. O'Connor
Eva S. van der Ploeg*
Affiliation:
Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia
Barbara Eppingstall
Affiliation:
Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia
Cameron J. Camp
Affiliation:
Center for Applied Research in Dementia, Solon, Ohio, USA
Susannah J. Runci
Affiliation:
Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia
John Taffe
Affiliation:
School of Psychology and Psychiatry, Monash University, Melbourne, Australia
Daniel W. O'Connor
Affiliation:
Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia
*
Correspondence should be addressed to: Eva S. van der Ploeg, Aged Mental Health Research Unit, Kingston Centre, School of Psychology and Psychiatry, Monash University, Warrigal Road, Cheltenham VIC 3192, Melbourne, Australia. Phone: 0061 3 9265 1700, Fax: 0061 3 9265 1711. Email: [email protected].
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Abstract

Background: Increasingly more attention has been paid to non-pharmacological interventions as treatment of agitated behaviors that accompany dementia. The aim of the current study is to test if personalized one-to-one interaction activities based on Montessori principles will improve agitation, affect, and engagement more than a relevant control condition.

Methods: We conducted a randomized crossover trial in nine residential facilities in metropolitan Melbourne, Australia (n = 44). Personalized one-to-one activities that were delivered using Montessori principles were compared with a non-personalized activity to control for the non-specific benefits of one-to-one interaction. Participants were observed 30 minutes before, during, and after the sessions. The presence or absence of a selected physically non-aggressive behavior was noted in every minute, together with the predominant type of affect and engagement.

Results: Behavior counts fell considerably during both the Montessori and control sessions relative to beforehand. During Montessori activities, the amount of time spend actively engaged was double compared to during the control condition and participants displayed more positive affect and interest as well. Participants with no fluency in English (all from non-English speaking backgrounds) showed a significantly larger reduction in agitation during the Montessori than control sessions.

Conclusion: Our results show that even non-personalized social contact can assist in settling agitated residents. Tailoring activities to residents’ needs and capabilities elicit more positive interactions and are especially suitable for people who have lost fluency in the language spoken predominantly in their residential facility. Future studies could explore implementation by family members and volunteers to avoid demands on facilities’ resources.

Trial Registration: Australian New Zealand Clinical Trials Registry – ACTRN12609000564257.

Keywords

dementiabehaviornursing homespsychosocial care
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 4 , April 2013 , pp. 565 - 575
Copyright
Copyright © International Psychogeriatric Association 2012

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References

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
Cohen-Mansfield, J. (1986). Agitated behaviours in the elderly II: preliminary results in the cognitively deteriorated. Journal of the American Geriatric Society, 34, 722–727.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. (2001). Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. American Journal of Geriatric Psychiatry, 9, 361–381.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Libin, A. and Marx, M. S. (2007). Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. Journal of Gerontology, 62A, 908–916.Google Scholar
Cohen-Mansfield, J., Marx, M. S., Dakheel-Ali, M., Regier, N. G., Thein, K. and Freedman, L. (2010). Can agitated behavior of nursing home residents with dementia be prevented with the use of standardized stimuli. Journal of the American Geriatric Society, 58, 1459–1464.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.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 behaviour: simulated family presence and preferred music. 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. Gerontologist, 49, 428–439.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L. and Danziger, W. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
International Psychogeriatric Association (IPA) (2010a). Module 1: An Introduction to BPSD. Complete Guide to Behavioral and Psychological Symptoms of Dementia. Chicago: International Psychogeriatric Association.Google Scholar
International Psychogeriatric Association (IPA) (2010b). Module 6: Pharmacological Management. Complete Guide to Behavioral and Psychological Symptoms of Dementia. Chicago: International Psychogeriatric Association.Google Scholar
Lawton, M. P., van Haitsma, K. and Klapper, J. (1996). Observed affect in nursing home residents with Alzheimer's disease. Journal of Gerontology: Psychological Sciences, 51, 3–14.CrossRefGoogle ScholarPubMed
Lin, L. C., Yang, M. H., Kao, C. C., Wu, S.-C., Tang, S.-H. and Lin, J.-G. (2009). Using acupressure and Montessori-based activities to decrease agitation for residents in dementia: a cross-over trial. Journal of the American Geriatric Society, 57, 1022–1029.CrossRefGoogle ScholarPubMed
Motenko, A. K. (1989). The frustrations, gratifications, and well-being of dementia caregivers. Gerontologist, 29, 166–172.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Orsulic-Jeras, S., Judge, K. S. and Camp, C. J. (2000) Montessori-based activities for long-term care residents with advanced dementia: effects on engagement and affect. Gerontologist, 40, 107–111.Google ScholarPubMed
Rankin, E. D., Haut, M. W. and Keefover, R. W. (2001). Current marital functioning as a mediating factor in depression among spouse caregivers in dementia. Clinical Gerontologist; 23, 27–44.CrossRefGoogle Scholar
Runci, S. J., Eppingstall, B. J. and O'Connor, D. W. (2012). A comparison of verbal communication and psychiatric medication use by Greek and Italian residents with dementia in Australian ethno-specific and mainstream aged care facilities. International Psychogeriatrics, 24, 733–741.CrossRefGoogle ScholarPubMed
Runci, S. J., Redman, J. R. and O'Connor, D. W. (2005). Language use of older Italian-background persons with dementia in mainstream and ethno-specific residential care. International Psychogeriatrics, 17, 699–708.CrossRefGoogle ScholarPubMed
Schneider, L. S., Dagerman, K. and Insel, P. S. (2006). Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. American Journal of Geriatric Psychiatry, 14, 191–210.CrossRefGoogle ScholarPubMed
Skrajner, M. J. and Camp, C. J. (2007). Resident-Assisted Montessori Programming (RAMPTM): Use of a small group reading activity run by persons with dementia in adult health care and long-term care settings. American Journal of Alzheimers Disease and Other Dementias, 22, 27–36.CrossRefGoogle Scholar
Squire, L. R. (2004). Memory systems of the brain: a brief history and current perspective. Neurobiology & Learning Memory, 82, 171–177.CrossRefGoogle Scholar
Stephens, M. A. P., Kinney, J. M. and Ogrocki, P. K. (1991) Stressors and well-being among caregivers to older adults with dementia: the in-home versus nursing home experience. Gerontologist, 31, 217–223.CrossRefGoogle ScholarPubMed
Van der Ploeg, E. S. and O'Connor, D. W. (2010). Evaluation of personalised, one-to-one interaction using Montessori-type activities as a treatment of challenging behaviours in people with dementia: the study protocol of a cross-over trial. BMC Geriatrics, 10, 3.CrossRefGoogle Scholar
Van der Ploeg, E. S., Mbakile, T., Genovesi, S. and O'Connor, D. W. (2012). 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
Zuidema, S., Koopmans, R. and Verhey, F. (2007). Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. Journal of Geriatric Psychiatry and Neurology, 20, 41–49.CrossRefGoogle ScholarPubMed