Montessori-Based Interventions for Dementia
(MAP-VA Trial)
Trial Summary
What is the purpose of this trial?
Background: Addressing behavioral and neuropsychiatric symptoms of Veterans with dementia and serious mental illness (SMI) such as schizophrenia can be challenging for staff in VA long-term care settings, called Community Living Centers or CLCs. These behaviors of distress (agitation, aggression, and mood disturbance) are not just associated with staff stress and burnout; they also hasten residents' functional decline, decrease quality of life, and increase mortality. Staff training in non-pharmacological interventions can be effective. Yet systems barriers, task-based care models, and time constraints often result in staff employing "quicker," less effective strategies. Montessori Approaches to Person-Centered Care for VA (MAP-VA)- a staff training, intervention, and delivery toolkit- developed in collaboration with VA operational partners, Veterans, and frontline CLC staff is positioned to respond to this challenge. The investigators' prior work shows probable impacts on CLC quality indicators at the individual and unit level (e.g., psychotropic medications, depressive symptoms, weight loss, falls, pain). The goal of this study is to evaluate the MAP-VA program and necessary supports for a successful implementation at 8 VA CLCs. Significance/ Innovation: VHA's Modernization Plan focuses on empowering front-line staff to lead quality improvement efforts like the ones taught through MAP-VA. MAP-VA is distinct from existing interventions in its: 1) application to Veterans with a range of diagnoses and cognitive abilities; 2) emphasis on pairing practical skill-building for staff with overcoming system-level barriers that inhibit person-centered care; and 3) engagement of all staff rather than a reliance on provider-level champions. Yet, MAP-VA is a complex intervention that requires participation of multiple stakeholder groups, making implementation facilitation necessary. To date, no studies have evaluated MAP implementation success in operational settings (community or VA) and sustainability is rarely examined. Aims: This 4-year study will examine both the effectiveness of the MAP-VA program on resident outcomes, person-centered care practices, and organizational culture as well as an evaluation of the implementation barriers to adopting MAP-VA in a sustainable way over a 12 month period. Staff and residents at 8 CLCs will participate in the study.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It seems to focus on non-drug interventions, so you might not have to stop, but it's best to check with the trial coordinators.
What data supports the effectiveness of the treatment Montessori Approaches to Person-Centered Care (MAP-VA) for dementia?
Research shows that Montessori-based activities, which are part of person-centered care, can improve engagement and emotional well-being in people with dementia. Studies have found that these activities are enjoyable and positively received by both participants and caregivers, although their effectiveness may vary depending on the stage of dementia.12345
Is Montessori-Based Intervention safe for people with dementia?
Montessori-Based Interventions for dementia are generally considered safe, as they focus on engaging activities and improving quality of life without involving medication. However, the effectiveness of these interventions is still rated as weak, and more high-quality research is needed to fully understand their impact.15678
How is the Montessori Approaches to Person-Centered Care (MAP-VA) treatment different from other dementia treatments?
The Montessori Approaches to Person-Centered Care (MAP-VA) treatment is unique because it focuses on person-centered care, emphasizing the abilities, needs, and interests of individuals with dementia. It uses activities and routines that are meaningful to the person, aiming to improve their quality of life by creating a supportive environment tailored to their strengths.12369
Research Team
Michelle Marie Hilgeman, PhD
Principal Investigator
Tuscaloosa VA Medical Center, Tuscaloosa, AL
Eligibility Criteria
This trial is for Veterans with dementia or serious mental illness in VA long-term care, showing symptoms like agitation or aggression. They must have a cognitive impairment score indicating issues and may be on medications like antipsychotics or sedatives. It's not for those in hospice or respite care.Inclusion Criteria
Exclusion Criteria
Timeline
Pre-Intervention Baseline Collection
All sites will start with a baseline collection phase without exposure to the intervention
MAP-VA Intervention
Montessori approaches to person-centered care (MAP-VA) introduces practical strategies for staff to engage residents
Follow-up
Participants are monitored for effectiveness and sustainability of the MAP-VA program after intervention
Treatment Details
Interventions
- Montessori Approaches to Person-Centered Care (MAP-VA)
Find a Clinic Near You
Who Is Running the Clinical Trial?
VA Office of Research and Development
Lead Sponsor
Edith Nourse Rogers Memorial Veterans Hospital
Collaborator
VA Salt Lake City Health Care System
Collaborator
The VA Western New York Healthcare System
Collaborator
Center for Applied Research in Dementia
Collaborator
University of Alabama at Birmingham
Collaborator
Providence VA Medical Center
Collaborator