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 crossover trial

Eva S Van Der Ploeg,Daniel W O'Connor

doi:10.1186/1471-2318-10-3

Abstract

BackgroundThe agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Behaviours stemming from pain, major depression or psychosis benefit from treatment with analgesics, antidepressants or antipsychotics. In other cases, psychotropic medications have limited efficacy but are used very widely. Therefore, increasingly more attention has been paid to nonpharmacological interventions which are associated with fewer risks. The aim of the current study is to test if personalised one-to-one interaction activities based on Montessori principles will reduce the frequency of behavioural symptoms of dementia significantly more than a relevant control condition.Methods/DesignWe will conduct a controlled trial with randomised cross-over between conditions. Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study. Consented, willing participants will be assigned in random order to Montessori or control blocks for two weeks then switched to the other condition. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. The control intervention consists of conversation or reading from and looking at pictures in a newspaper to control for non-specific benefits of one-to-one interaction. Presence of target behaviour will be noted as well as level of engagement and type of affect displayed. Secondary measures also include the Cohen-Mansfield Agitation Inventory and information on time and funds spend to prepare the activities.DiscussionIf our results show that use of Montessori activities is effective in treating challenging behaviours in individuals with dementia, it will potentially provide a safer and more enjoyable intervention rather than reliance on pharmacology alone.Trial RegistrationAustralian New Zealand Clinical Trials Registry - ACTRN12609000564257

Highlights

IntroductionThe agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat
The agitated behaviours that accompany dementia are stressful to both nursing home residents and their carers and are difficult to treat
If our results show that use of Montessori activities is effective in treating challenging behaviours in individuals with dementia, it will potentially provide a safer and more enjoyable intervention rather than reliance on pharmacology alone

Summary

Introduction

The agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Dementia is associated with cognitive decline as well as behavioural and psychological symptoms (BPSD). The prevalence of agitated behaviours amongst persons with dementia in nursing homes is 48-82% [3]. These challenging behaviours are stressful to carers and. For example, increases in frequency if nursing staff attend to residents when they are noisy but otherwise ignore them [10]. In the unmet needs paradigm, inappropriate behaviours stem from normal human needs - physical, emotional and social - that carers fail to perceive and address [11]. Most psychosocial treatments blend elements of all three paradigms

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