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A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia

Contact Information


Eva S. van der Ploeg

dementia, behavior, nursing homes, psychosocial care


Background: Increasingly more attention has been paid to non-pharmacological interventions as treatment of agitated behaviors that accompany dementia. The aim of the current study is to test if personalized one-to-one interaction activities based on Montessori principles will improve agitation, affect, and engagement more than a relevant control condition. Methods: We conducted a randomized crossover trial in nine residential facilities in metropolitan Melbourne, Australia (n = 44). Personalized one-to-one activities that were delivered using Montessori principles were compared with a non-personalized activity to control for the non-specific benefits of one-to-one interaction. Participants were observed 30 minutes before, during, and after the sessions. The presence or absence of a selected physically non-aggressive behavior was noted in every minute, together with the predominant type of affect and engagement. Results: Behavior counts fell considerably during both the Montessori and control sessions relative to beforehand. During Montessori activities, the amount of time spend actively engaged was double compared to during the control condition and participants displayed more positive affect and interest as well. Participants with no fluency in English (all from non-English speaking backgrounds) showed a significantly larger reduction in agitation during the Montessori than control sessions. Conclusion: Our results show that even non-personalized social contact can assist in settling agitated residents. Tailoring activities to residents' needs and capabilities elicit more positive interactions and are especially suitable for people who have lost fluency in the language spoken predominantly in their residential facility. Future studies could explore implementation by family members and volunteers to avoid demands on facilities' resources.


van der Ploeg, E. S., Eppingstall, B., Camp, C. J., Runci, S. J., Taffe, J., & O’Connor, D. W. (2013). A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia. International Psychogeriatrics, 25(4), 565–575. doi:10.1017/S1041610212002128





Conent Area

Eva S. van der Ploeg

EWB-Related Construct

(3) Positive Affect

Study Design

Species or Study Population

(5) RCT

Sex (%Female)


Age (Mean, SD)

78.1, 9.8

Younger Controls?


Longitudinal Data?


Sample Size



personalized, one-to-one interaction using Montessori-based activities

Ethnicity (%white)

not stated (Australia)

Inclusion Criteria

(1) a chart diagnosis of dementia; (2) a physically agitated behavior that occurred at least several times a day outside nursing interventions; (3) confirmation by nurses, visiting physician, and/or psychiatrist that the behavior was not due to untreated pain, physical illness, major depression, or psychosis; (4) residence in a specialist dementia unit or psychogeriatric nursing home for at least three months; and (5) consent to the study by the next of kin or guardian

Exclusion Criteria

(1) they refused the intervention on two occasions; (2) their psychotropic medications were likely to be changed over the study period (medical and nursing staff were asked not to alter psychotropic medications during the study period if possible); (3) nursing and medical staff reported an acutely life-threatening physical illness; or (4) a behavior presented a potential hazard to the researchers.

EWB Measures

(1) Philadelphia Geriatric Center Affect Rating Scale (PGCARS)

Non-EWB Behavioral

Behavior Observation
Menorah Park Engagement Scale (MPES)
Mini-Mental State Examination (MMSE)
Clinical Dementia Rating (CDR)

Physiological Measures


Brain IMaging Modality

Brain IMaging Paradigm


Brain Region/Circuit


Biological Measures


Other Neural Measures

Data Availability?


Data Avalability Details


Diagnostic Measures

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