Montessori: Changing the Face of Dementia Care

Montessori in Aged Care is a fairly new concept that is picking up momentum in Australia. It revolves around the idea of maintaining independence rather than creating excess disability. Excess disability simply means to increase the dependence of the individual when they can independently complete the activity or task. For example, if an elderly woman can brush her hair, often a staff worker will do it for them with the impression that they are helping, when in actuality they are taking away the resident’s independence. Imagine living in a nursing home away from the comfort of your own home and not being allowed to do the things you enjoy.

Photo Credit: Edwin M Escobar

Montessori in Dementia Care enables individuals to maintain that independence, make choices and boost their self-esteem. It also empowers people to make important contributions and have a meaningful place in their community. The impact of dementia affects the resident in various ways including perception, attention, planning, insight, language, emotions, apathy, behavior, physical function and memory.

Therefore, the Montessori Method offers more choices and opportunities that promote self-determination and individuality to provide the best quality care for all. Here are strategies to provide relevant activities for people with dementia:

  • Take advantage of the known and remembered and use it to create meaningful activities for residents.
  • Offer more social interaction opportunities with people of all ages.
  • Provide more physical activity to keep residents, even those in wheelchair, active such as indoor bowling or ball games.
  • Provide mental stimulation for residents such as crosswords, word games, etc.
  • Utilize music therapy to play familiar music and trigger well-preserved memories and improve quality of life.
  • Delegate roles for different residents, if possible. Responsibility gives residents a sense of purpose.
  • Prepare resources ready to be used to minimize noise and distractions.
  • Know the residents individually: This involves personal history, employment, hobbies, interests and culture.
  • Always have a plan B, C, D, E, F, G because things never go as planned.

In conclusion, I think this new concept of dementia care focuses on the strengths and abilities of people with dementia rather than their condition. Montessori programs provide individuals the opportunity to engage the five senses, such as touch, sight, smell, taste and sound, and stimulate their minds. As success is easily achieved, people are encouraged to focus on tasks at hand. This creates a sense of security and high self-esteem, which contributes to the attainment of a life full of purpose and meaning.

Hazel Dompreh is currently a Diversional/Recreational Therapist at a nursing home in New South Wales, Australia.

 

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Dementia Among the Aging in Australia

For Australians aged 65 and older, dementia has been identified as the third leading cause of disability and its prevalence is expected to rise as the population ages. Among this age group, roughly nine percent are living with dementia and among those aged 85 and older, the percentage increases to nearly 30 percent. As a disorder, the risk for dementia increases as an individual ages and it is expected that cases may increase to as many as 900,000 among older adults in Australia by the year 2050.

Photo Credit: Pixabay
                                                                                 Photo Credit: Pixabay

Dementia is not considered a single specific disease, but rather describes a series of symptoms associated with more than 100 different diseases.The symptom most commonly associated with dementia is impaired brain function, which often manifests as problems with language, memory, perception, personality, and/or cognitive skills. Typically, the decline in brain function that is the hallmark of dementia is significant enough to create challenges in daily living.

In Australia in 2010, dementia was the third leading cause of death overall and among adults aged 65 and over, it was the leading cause of morbidity. From a structural perspective, there are many barriers to the provision of quality care for older adults living with dementia in Australia. It has been estimated that by the year 2029, there could be a shortage of more than 150,000 caregivers for those living with this disorder – a bleak prospect when considering the projected rise in those diagnosed. Additionally, it is estimated that the costs of care to the healthcare system associated with dementia will arise and reach nearly one percent of Australia’s GDP in the next 20 years.

Among Australia’s indigenous groups, the risk for dementia is higher than the general population. Research has suggested that the prevalence of dementia among “remote and rural indigenous people” could be nearly four to five times higher than the general population. For individuals aged 45 and older among indigenous groups, dementia prevalence was 12.4 percent compared to 2.6 percent compared to 2.6% in the broader Australian population. Research has also shown that among indigenous groups, dementia tends to be higher among males while the rate is generally higher among females in the overall population.

The Australian government has recognized the importance of addressing dementia risk among the aging population. In 2012, the Australian Health Ministers included dementia as the ninth National Health Priority Area and it is the newest health issue to be added. By including dementia as a priority area, it is recognized as a significant issue of concern for the Australian population and allows for more concerted, focused efforts to combat its effects. Continued efforts and prioritization will be necessary to ensure older adults in Australia, particularly those living with dementia, may continue to age while experiencing improved quality of life.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.

Australia: Integrating Mental Health Services at the Primary Care Level

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In many developed countries, the aging populations are on the rise and Australia is no exception. Currently, 13% of Australia’s population is over 65 years and this is projected to grow 19-21% by 2031 and 26% by 2051. The experience of aging can range from a positive, fulfilling one to an anxiety filled, negative experience. In Australia, mental health disorders are highly prevalent among the elderly.

Existing mental health services are provided at the primary care level, with the general practitioner. In 1992, Australia changed its mental health services policy from an institutional to a community-oriented set up. When it comes to health, one’s General Practitioner (GP) is usually the first point of contact for an elderly patient. By integrating mental health services at the primary care level, the Australian government places mental health as a mainstream agenda in the health system.

An example of a model is the case of St. Vincent’s District in the inner city of Sydney. This district had a heterogeneous elderly population, comprising of Holocaust survivors, people who are homeless, or in hostels among others. Less than 1% of the population surveyed went directly to a hospital for mental health services, and a significantly larger proportion went to their GP. Since the elderly have the freedom to choose their GP, they place a high level of trust with these health professionals. The model encouraged collaboration across primary care, community services and specialist services such as geriatric medicine and geriatric psychiatry. An impact evaluation of this program suggested that general practitioners and other primary health care workers became more skilled in assessing and managing elderly mental health, requiring less support. Additionally, there has been better outcomes with regards to maintaining continuity of care.

This model was applauded for not only improving access to mental health services, but also in the collaboration it achieved. However, stigma against mental health issues is a concern. Elderly patients are often victims of the existing stigma around mental health and this is a significant barrier to engaging in dialogue on mental health issues with one’s General Practitioner. Another critique of this program is that care and treatment can be ‘fragmented, piece meal and sometimes non-existent,’ and that there is no nationally consistent protocol.

It is estimated that 10-15% of the elderly population have experienced depression. If one looks specifically at the elderly population in residential care homes, this population has more than twice the rate of the depression, at 35%. Additionally, about 10% have experienced problems with anxiety. Suicide rates among the elderly are also a cause for concern as men over 85 years have the highest likelihood of dying by suicide than any other age group. This age group’s suicide rate  is three times higher than the national rate, at 37.6 deaths per 100,000 people. Some of the key reasons for depression include loss of a partner and deterioration of health.

These figures look grim. Perhaps there is a need for the re-evaluation of this model, looking at health systems factors as well as sociocultural factors affecting access and use of mental health services.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

Old and Homeless in Australia: It Can Happen to Anyone

In Australia, on any given night, 1 in 200 people are homeless.” One fifth of all people who are older than 55 years of age are homeless; many more live in unsecured housing.

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What is homelessness and what may cause someone to become homeless? A person is considered homeless when he or she does not have a conventional home and lives on the streets or in a park. Someone may be at risk of homelessness when living in unsecured housing. There are certain reasons that can cause homelessness which may include lack of social bonding and support from family or friends. What if you are in a crisis and cannot receive help from the closest people in your life—your family and friends? What would you do? You may think it can never happen to you but that may not be the case. Homelessness can happen to anybody. Young, old, women, and men.

Today, Australia and most other developed nations face more issues with divorces, family breakdown, and higher rent for affordable housing. Due to the growing aging population, homelessness will become a rising issue because of the lack of money to build affordable housing or lack of space for seniors in existing homeless shelters.

ABC Australia reports that Australian older women outnumber the men in homeless shelters. In fact, 9% of single women over the age of 45 are in crisis accommodation and that number will continue to rise. The woman being interviewed by ABC makes it clear that it can happen to anybody. She notes that “there is a fine line between having a roof over your head and having nothing.” Imagine if you, from one day to another, lost everything and couldn’t turn to anyone.

The report “Homelessness and older Australians: Scoping the Issues” reports that there are systems in place in Australia that give the homeless population access to certain services. However, the homeless believe that their complex needs are not addressed. In addition, they have difficulties to access those services and obtain the needed information because the service system in itself is too complex. There needs to be an increased collaboration and integration of existing service departments.

Australia must think of sustainable ideas and strategies to increase and invest in the affordable housing stock. The government, non-governmental organizations and service providers also need to step up and create strategies to reduce the bureaucracy and make easier access to the services the homeless population needs easier.

Martina Lesperance
is a Health Educator and Screening Technician in El Paso, Texas.