Completing the Circle: The Montessori Method for Alzheimer’s Care

He first stacked the pink tower cubes from the largest to the smallest, very slowly and carefully placing the smallest cube right in the center on top. He leaned back and smiled at this accomplishment. Then the pink tower was carefully dismantled and, to our amazement, reassembled upside down! This time the smallest cube became the supporting base as the painstaking task of building the tower upside down rose before our eyes. Once again, the smile of great satisfaction lit up his face. Our faces must have reflected the absolute astonishment we felt watching Pastor Pat, a man living with both Alzheimer’s and Parkinson’s disease, build and re-build the pink tower with such control and such concentration. However, our astonishment grew even greater as we watched this man rise from his chair and walk unassisted across the room. The aides ran to give him a supporting hand, but he waved them away, walking ramrod straight and with great purpose.

Of course, the trembling and the unsteady gait would return later, but for those few moments, this man had control over his body, he experienced the joy of challenging himself and succeeding in that challenge. Just as children build confidence when they achieve mastery with the Montessori materials, so older people also experience a sense of well being, of purpose when working with the Montessori materials. The materials that we use in working with people living with Alzheimer’s range from table scrubbing to flower arranging, fabric matching to knobbed cylinders, flags of the world to living/not living, painting and drum circles.

These are only a few examples of the exercises and materials that we use in our work. When we adhere to the Montessori principles and build a care program based on the needs and interests of each older person, we find that we are only limited by our own imagination. Each exercise that we create is built on the Montessori principles of using repetitive muscle memory (the procedural memory system) and engaging some or all of the five senses. For example, we have created a fishing tackle box exercise in which we have matching lures (hooks removed), bobbers that can be graded from largest to smallest and matching photos of fish.

This tackle box came in very handy when we met Chet, who was living in a locked Alzheimer’s unit. He was a person who liked to keep himself to himself and rarely joined in activities. We had often tried to engage Chet, but he would always politely decline our invitation. One day we brought in the tackle box and suddenly Chet was there, picking up the lures, examining the fishing reel, looking at the photos of the fish. From that day forward, Chet was always happy to work with us. He never remembered our names, nor did he remember that we met with him almost every week. But, he did remember that tackle box.

In creating exercises that capture people’s interests, we find that objects from nature have a true resonance for people who now live most of their lives indoors. Once we brought in fresh herbs from our garden for a matching exercise. We tied up bunches of sage, thyme, lavender, mint, and rosemary. There was a rather cold and aloof professor living in this memory enhancement center. He was often sarcastic and biting to the staff and other residents. We were surprised when he picked up the sage leaves and began to rub them against his cheek. He softly started to sing, “Are you going to Scarborough Fair? Parsley, sage, rosemary and thyme.”

Tears rolled down his cheeks as he spoke of his mother’s garden and how she had grown her own herbs. We had never seen this professor express any emotion except a haughty arrogance to everyone around him. These simple herbs brought forth heartfelt stories of his childhood and his mother. Without the herbs, we would have never seen this side of the professor. Using the Montessori Method gives us the key to unlock memories that may have been buried for many years.

One of the most difficult aspects of living with Alzheimer’s is the inability to begin a task, or to start a conversation. When a person is living with memory loss, they need sensory cues to act as guideposts for them. Even though the senses may be degraded in an older person, we find that most people still enjoy touching a flower petal, hearing their favorite music, reading a much loved poem, tasting a favorite dish, smelling a freshly mowed lawn. All of these sense memories are powerful and so helpful in priming the pump of memory.

We saw the power of this one day when working with Bob, who loved vintage cars. We created a hub cap polishing exercise for Bob using non toxic metal polish. We thought that polishing the hub caps might give Bob the cues he needed to talk about his vintage car collection. However, Bob didn’t want to talk about his cars, he wanted to talk about the time he served in Vietnam. At first, we didn’t understand why the hub caps led to stories about the war, but then we realized that polishing the hub caps must have triggered Bob’s memories of polishing his brass and his boots in the army. If we had asked Bob to talk about his years in Vietnam without giving him some prompt or cue, he would have likely said nothing; but giving him the hub caps to polish helped Bob open up about his war time memories.

Music is another wonderful tool for reaching people living with Alzheimer’s. One of the most enjoyable times in our work is when we bring out drums for a drum circle. The groups usually begin in a chaos of sound, and then, gradually, they find a common beat and they all begin to hit their drums together. It is a wonderfully bonding experience.

We use the Montessori Method as our foundation for interacting with people living with memory loss because this philosophy believes in finding and building on the strengths of each person. The Montessori Method also teaches us to work with the whole person, the intellectual, physical and spiritual components of the individual. Dr. Montessori believed devoutly (as do we) that every person deserves to be treated with respect and compassion. She encourages us to celebrate each person’s individual gifts and to honor each person’s contribution, whether they are three years old or 83 years old!