Effects of a culturally adapted group based Montessori based activities on engagement and affect in Chinese older people with dementia: a randomized controlled trial

Abstract

Background The Montessori Method underpinned by the principle of person-centered care has been widely adopted to design activities for people with dementia. However, the methodological quality of the existing evidence is fair. The objectives of this study are to examine the feasibility and effects of a culturally adapted group-based Montessori Method for Dementia program in Chinese community on engagement and affect in community-dwelling people with dementia. Methods This was a two-arm randomized controlled trial. People who were aged 60 years or over and with mild to moderate dementia were recruited and randomly assigned to the intervention group to receive Montessori-based activities or the comparison group to receive conventional group activities over eight weeks. The attendance rates were recorded for evaluating the feasibility. The Menorah Park Engagement Scale and the Apparent Affect Rating Scale were used to assess the engagement and affect during the activities based on observations. Generalized Estimating Equation model was used to examine the intervention effect on the outcomes across the sessions. Results A total of 108 people with dementia were recruited. The average attendance rate of the intervention group (81.5%) was higher than that of the comparison group (76.3%). There was a significant time-by-group intervention effect on constructive engagement in the first 10 minutes of the sessions (Wald χ2 = 15.21–19.93, ps = 0.006–0.033), as well as on pleasure (Wald χ2 = 25.37–25.73, ps ≤ 0.001) and interest (Wald χ2 = 19.14–21.11, ps = 0.004–0.008) in the first and the middle 10 minutes of the sessions, adjusted for cognitive functioning. Conclusions This study provide evidence that Montessori-based group activities adapted to the local cultural context could effectively engage community-dwelling Chinese older people with mild to moderate dementia in social interactions and meaningful activities and significantly increase their positive affect. Trial registration ClinicalTrials.gov, NCT04352387. Registered 20 April 2020. Retrospectively registered.

The impact of montessori-based programmes on individuals with dementia living in residential aged care: A systematic review

“…Five (n = 5, 33.3%) were conducted in Taiwan (Kao et al, 2016; Lin et al, 2010, 2011; Wu and Lin, 2013; Wu et al, 2014), four (n = 4, 26.7%) in the United States (Gaspar & Westberg, 2020; Skrajner et al, 2012, 2014; Wilks et al, 2019); two (n = 2, 13.3%) in China (Chan et al, 2021; Yuen and Kwok, 2019), two (n = 2, 13.3%) in Australia (Mbakile-Mahlanza et al, 2020; Roberts et al, 2015), one (n = 1, 6.7%) in Canada (Giroux et al, 2010); and one (n = 1, 6.7%) in Pakistan (Chaudhry et al, 2020). About the care settings, nine (n = 9, 60%) studies were conducted in nursing homes (Chaudhry et al, 2020; Giroux et al, 2010; Mbakile-Mahlanza et al, 2020; Skrajner et al, 2012, 2014; Wilks et al, 2019; Wu and Lin, 2013; Wu et al, 2014; Yuen and Kwok, 2019), three (n = 3, 20%) in dementia care units (Kao et al, 2016; Lin et al, 2010, 2011), two (n = 2, 13.3%) in memory care units (Gaspar and Westberg, 2020; Roberts et al, 2015); and one (n = 1, 6.7%) in a mixture of the community centre, day care and nursing home (Chan et al, 2021). Regarding study design, five (n = 5, 33.3%) studies adopted a RCT design (Chan et al, 2021; Kao et al, 2016; Lin et al, 2010; Mbakile-Mahlanza et al, 2020; Yuen and Kwok, 2019), eight (n = 8, 53.3%) were quasi-experimental design (Gaspar and Westberg, 2020; Giroux et al, 2010; Lin et al, 2011; Skrajner et al, 2012, 2014; Wilks et al, 2019; Wu and Lin, 2013; Wu et al, 2014) and two (n = 2, 13.3%) were mixed-methods (Chaudhry et al, 2020; Robert...…”

“…Five (n = 5, 33.3%) were conducted in Taiwan ( Kao et al, 2016 ; Lin et al, 2010 , 2011 ; Wu and Lin, 2013 ; Wu et al, 2014 ), four (n = 4, 26.7%) in the United States ( Gaspar & Westberg, 2020 ; Skrajner et al, 2012 , 2014 ; Wilks et al, 2019 ); two (n = 2, 13.3%) in China ( Chan et al, 2021 ; Yuen and Kwok, 2019 ), two (n = 2, 13.3%) in Australia ( Mbakile-Mahlanza et al, 2020 ; Roberts et al, 2015 ), one (n = 1, 6.7%) in Canada ( Giroux et al, 2010 ); and one (n = 1, 6.7%) in Pakistan ( Chaudhry et al, 2020 ). About the care settings, nine (n = 9, 60%) studies were conducted in nursing homes ( Chaudhry et al, 2020 ; Giroux et al, 2010 ; Mbakile-Mahlanza et al, 2020 ; Skrajner et al, 2012 , 2014 ; Wilks et al, 2019 ; Wu and Lin, 2013 ; Wu et al, 2014 ; Yuen and Kwok, 2019 ), three (n = 3, 20%) in dementia care units ( Kao et al, 2016 ; Lin et al, 2010 , 2011 ), two (n = 2, 13.3%) in memory care units ( Gaspar and Westberg, 2020 ; Roberts et al, 2015 ); and one (n = 1, 6.7%) in a mixture of the community centre, day care and nursing home ( Chan et al, 2021 ). Regarding study design, five (n = 5, 33.3%) studies adopted a RCT design ( Chan et al, 2021 ; Kao et al, 2016 ; Lin et al, 2010 ; Mbakile-Mahlanza et al, 2020 ; Yuen and Kwok, 2019 ), eight (n = 8, 53.3%) were quasi-experimental design ( Gaspar and Westberg, 2020 ; Giroux et al, 2010 ; L...…”

“…The characteristics of the 15 included studies are presented in Table 1. Five (n = 5, 33.3%) were conducted in Taiwan (Kao et al, 2016;Lin et al, 2010Lin et al, , 2011Wu and Lin, 2013;Wu et al, 2014), four (n = 4, 26.7%) in the United States (Gaspar & Westberg, 2020;Skrajner et al, 2012Skrajner et al, , 2014Wilks et al, 2019); two (n = 2, 13.3%) in China (Chan et al, 2021;Yuen and Kwok, 2019), two (n = 2, 13.3%) in Australia (Mbakile-Mahlanza et al, 2020;Roberts et al, 2015), one (n = 1, 6.7%) in…”

“…These mental health outcomes, include but are not limited to psychological wellbeing, cognition, affect (mood), depression, anxiety, agitation, behavioural and psychological symptoms of dementia, hyperphagic behaviour, prescription rates of antipsychotic and sedative medications (Gaspar and Westberg, 2020;Roberts et al, 2015). Prior studies showed significantly positive outcomes (p < 0.05) on affect (mood) (Chan et al, 2021;Giroux et al, 2010;Mbakile-Mahlanza et al, 2020), agitation (Chaudhry et al, 2020;Roberts et al, 2015;Yuen and Kwok, 2019), hyperphagic behaviour (Kao et al, 2016) and psychotropic and sedation medication rates (Gaspar and Westberg, 2020;Roberts et al, 2015). Whereas there was a significant reduction in psychological well-being score post-intervention (p < 0.01) (Wilks et al, 2019) and a varying impact on depression post-intervention, with one Montessori-based programme reported a strong significant positive outcome (p = 0.001) (Wu and Lin, 2013) and another reporting no significant changes (Chaudhry et al, 2020).…”

Montessori Method applied to dementia, a person-centered global approach Part 2. Review of literature, effects and perspectives

“…durant les activités et d'une réduction des affects négatifs (anxiété, désintérêt, colère, tristesse). De manière intéressante, des résultats similaires ont été retrouvés dans des études récentes évaluant les effets d'activités Montessori, mais adaptées à des contextes culturels très différents, comme au Pakistan [19] ou en Chine [20]. Notons que si ces effets se maintenaient au fil du temps, ils ne se généralisaient pas ou peu en dehors des périodes d'activité.…”