Montessori intervention for individuals with dementia: feasibility study of a culturally adapted psychosocial intervention in Pakistan (MIRACLE)

Abstract

<jats:sec id="S2056472420000496_sec_a1" sec-type="other"> <jats:title>Background</jats:title> <jats:p>Globally, nearly two-thirds of people with dementia reside in low- and middle-income countries (LMICs), yet research on how to support people with dementia in LMIC settings is sparse, particularly regarding the management of behavioural and psychological symptoms of dementia. Understanding how best to manage these symptoms of dementia with non-specialist approaches in LMICs is critical. One such approach is a non-pharmacological intervention based on the Montessori method.</jats:p> </jats:sec> <jats:sec id="S2056472420000496_sec_a2" sec-type="other"> <jats:title>Aims</jats:title> <jats:p>To evaluate the feasibility and acceptability of a culturally adapted, group-based Montessori intervention for care home residents with dementia and their study partners, who were paid care workers in Pakistan.</jats:p> </jats:sec> <jats:sec id="S2056472420000496_sec_a3" sec-type="methods"> <jats:title>Method</jats:title> <jats:p>This was a two-stage study: a cultural adaptation of the Montessori intervention and a single-arm, open-label, feasibility and acceptability study of 12 participant dyads. Feasibility and tolerability of the intervention and study procedures were determined through the recruitment rate, adherence to the protocol and acceptance of the intervention. Qualitative interviews were undertaken with the study partners. A pre–post exploratory analysis of ratings of behavioural and psychological symptoms of dementia, functional ability and quality of life were also conducted.</jats:p> </jats:sec> <jats:sec id="S2056472420000496_sec_a4" sec-type="results"> <jats:title>Results</jats:title> <jats:p>The recruitment and retention rates of people with dementia were acceptable, and the intervention was well tolerated by participant dyads. Findings show a reduction in agitation levels and improvement in mood and interest for the activities.</jats:p> </jats:sec> <jats:sec id="S2056472420000496_sec_a5" sec-type="conclusions"> <jats:title>Conclusions</jats:title> <jats:p>Feasibility studies of low-cost, easy-to-deliver and culturally adapted interventions are essential in laying the groundwork for subsequent definitive effectiveness and/or implementation trials for dementia in LMICs, where awareness and resources for dementia are limited.</jats:p> </jats:sec>

Effects of Cognitive Rehabilitation on the Psychological Capital of the Elderly with Dementia

“…The results reported by Chaudhry et al (18) are in line with the results of the current study. They showed that treatment based on the Montessori method could be effective in the indicators of positive interaction, positive social behaviors, and cognitive functions that are indirectly related to the psychological capital.…”

Patient and Public Involvement for Dementia Research in Low- and Middle-Income Countries: Developing Capacity and Capability in South Asia

“…Since a focus in underserved areas is often on the most impactful research in the shortest timespan to address areas of greatest need, studies of interventions with an existing evidence-base are often undertaken. An example of this is the global adaptation and implementation trial of Cognitive Stimulation Therapy for dementia (38,64). Adopting an intervention developed elsewhere into a context with a markedly different language, socioeconomic and cultural context requires adaptation prior to evaluation to enhance the appropriateness, uptake and chance for subsequent "scale-up" of the intervention (6,46,(65)(66)(67).…”

“…There is, therefore, a need to strengthen the capacity of PPI in LMIC, particularly for newly emerging areas of research and practice, such as dementia care ( 6 ). Furthermore, PPI in LMIC settings plays a pivotal role in cultural adaptation of interventions where the language, cultural practices, context and health literacy may be limited ( 38 ). Here, we have synthesized our learning and reflection on PPI capacity building in LMIC ( 22 ), developed in the context of a dementia-related feasibility study in seven sites across three South Asian countries: Bangladesh, Pakistan, and India (representing the three most populous countries of the eight countries making up South Asia).…”

The effect of Montessori program in the elderly with dementia: a literature review

“…The total number of participants in the 32 studies of this review is 1220 old people with dementia. 3 studies were performed on 4 subjects, 40,46 9 studies were conducted on 5-18 subjects (average of n = 11.22) 28, 33,34,43,45,48,49,53,57 and 6 studies were done on 20-30 people (average of n = 24). 4,30,35,37,42,55 The number of participants in 2 studies was between 30 and 35 (average of n = 33.5), 39 the number of samples in another 2 studies was 40 36,54 and the sample size in the other 2 studies was 43.…”

“…4,21,29,34,35,39,47 3 studies included samples with moderate to severe dementia 37,48,57 and 2 studies included patients with moderate dementia. 33,54 Also, 4 studies were performed on patients with mild to severe dementia. 28,32,51,52 In one study, it was mentioned that the length of time subjects had been diagnosed with dementia was 25 months 55 and, in another study, it had been reported between 25 and 37 months.…”