As more studies validate the importance of brain fitness programs for keeping seniors’ minds sharp, and as more long-term care operators incorporate them into resident activities, it appears there are still some major obstacles to overcome—namely, the lack of solutions aimed at cognitively impaired seniors.
It’s a shortcoming that seems both logical and perplexing. On one hand, it’s understandable that brain fitness solutions would be geared toward those who are still mentally sharp. The goal is preventing dementia or, at least, delaying its onset. On the other hand, one could reasonably argue that residents already experiencing cognitive decline also could benefit from brain fitness strategies—even if they can’t fully reverse the existing damage.
While experts generally agree that every senior, regardless of where he or she falls on the cognitive impairment spectrum, would benefit from brain fitness solutions, a number of obstacles have inhibited the widespread development of tools for those with dementia.
“Trials and testing with cognitively compromised populations is harder in terms of obtaining Institutional Review Board approvals for studies and trials, obtaining informed consent from participants, training the individuals to use the brain fitness, and getting them to comply with the fitness program,” explains Majd Alwan, Ph.D., director of the Center for Aging Services Technologies, which is affiliated with the AAHSA trade group.
The belief that Alzheimer’s and dementia are irreversible presents another barrier to the development of mental exercises for the cognitively impaired.
Time, control needed
As Alwan points out, efforts to prove that an intervention is effective in slowing down the progression of dementia (let alone reversing it) require years of follow-up and active control. Beyond that, there are challenges in designing brain fitness technologies for the dementia/Alzheimer’s resident that are fun, familiar (such as those that mimic appliances and other recognizable devices), easy to use and engaging.
“It is too early to have more specific evidence-based guidelines on what program to use,” says Alvaro Fernandez, CEO and co-founder of SharpBrains, a provider of senior-focused online brain teasers and interactive games.
In the absence of such data, SharpBrains encourages communities to conduct their own pilot studies to measure pre- and post-cognitive function to determine which practices may be most appropriate in their environments.
Those that do could very well find their efforts well rewarded. In fact, there’s strong evidence that through creative program development and a community-wide commitment to brain fitness, virtually every resident can experience improved cognitive function and quality of life.
“Communities usually start offering programs to their high-functioning [residents] first. These individuals tend to have the ability and motivation to complete the often demanding programs and are not intimidated by computers,” Fernandez notes. “This may be a good place to start, but it is essential to offer appropriate cognitive stimulation, technology-based or not, at each stage of cognitive impairment.”
Breaking down barriers
One respected brain fitness expert has witnessed firsthand how residents of all ages and stages of cognitive function can benefit from regular “mental aerobics.”
“I have seen the impact with my own eyes, so I can say with certainty that it is indeed possible to unlock parts of the brain by exercising it,” says Martha Grove Hipskind, a renowned eldercare consultant who spent 10 years in private practice dealing predominantly in the realm of brain fitness. She now serves as director of senior living for The Cardinal at North Hills, a continuing care retirement community currently under construction in Raleigh, NC. She says it will create a culture of mental stimulation through innovative design and programming.
“What I say to everyone who will listen is that while we may not be able to reverse or stop cognitive impairment and some of those ‘senior moments’ that so many people experience, if you can slow the progression and wake up the brain enough to improve a resident’s day-to-day quality of life, then it’s definitely worth it,” she says.
So which brain fitness strategies are best suited to dementia residents? While there are no hard and fast rules (again, there currently are only limited studies on the subject), experts say rehabilitation and training techniques that trigger the brain and force it to create new neural pathways show some promise.
“From the research point of view, what is clear is the value of engaging in cognitively stimulating activities, which requires a degree of novelty and challenge appropriate for each person, complementing other behavioral interventions, such as physical exercise and stress management,” Fernandez notes.
Hipskind prefers group activities with “rapid-fire” questioning to get the mental gears turning. She is careful to create a safe setting that doesn’t put individual residents on the spot and makes it clear to residents that the goal is less about finding the correct answer and more about exercising the brain and pushing it to seek a response.
“I may, for example, ask them to throw out a three-letter word that begins with a certain letter and then progress to a four-, five-, six-, or seven-letter word of the same letter. Everyone calls out answers and one person’s response will trigger another’s. I’m constantly changing up the categories to keep it fun and keep the brain stimulated,” Hipskind says.
Stretching the mind
“I have seen 85-year-olds spitting out words that people even half their age would be challenged to do,” Hipskin adds.
She’s also seen good outcomes with multi-sensory techniques, such as those that involve different colors and music-based methods that incorporate hand-drumming techniques.
“I can see the excitement in them when they know their brains are clicking. It really starts to set the ball in motion,” she says.
With cuing and direction from staff, dementia residents also can benefit from computer-based brain fitness solutions. Communities that shift from a narrowly focused definition of success to one that considers a resident’s overall enjoyment of the experience will likely see noteworthy benefits, vendor experts assured.
“When programs are purely improvement-driven, I think there are some missed opportunities. Using programs that can improve quality of life in [residents] with dementia by engaging them and creating unique, personalized experiences that they can enjoy and share with family members and loved ones is also beneficial,” notes Jack York, co-founder and president of It’s Never 2 Late, a Centennial, CO-based provider of customized computer systems that can be tailored to seniors of any age and cognitive ability.
Personalized brain exercise programs that incorporate photos and era-specific music and movie clips, among other features, can be powerful mind and memory triggers, according to Dan Michel, CEO of Dakim Inc., a Santa Monica, CA-based provider of interactive and intuitive brain fitness programs.
“Music, in particular, can be a very powerful tool and can go very deep,” he says.
Giving voice
Michel recalled one resident, a woman with dementia who hadn’t spoken for more than a year. After she had completed a Dakim BrainFitness computer exercise with piano music, she turned to a staff member and announced that she wished she had learned to play piano as a young girl.
“She had only been using the system for about a month. It’s these types of breakthroughs that show us every senior can benefit from brain stimulating exercises —and that participation in cognitive development should be a lifelong [endeavor] where there is no finish line,” Michel says.
Senior care company CareOne, which manages long-term care communities throughout New Jersey, is currently piloting the Dakim and It’s Never 2 Late systems, and has seen favorable results from both.
“[Resident] satisfaction and response has been overwhelmingly positive,” said CareOne director of special projects Elizabeth Straus. “With both systems, we have seen clinical therapeutic benefits, including improved cognition and improved motor status for our stroke and dementia residents.”
Some CareOne communities also incorporate the Nintendo Wii into their brain fitness programming. Aside from being fun, Straus said simulated activities, such as bowling, golfing and driving, have helped improve residents’ hand-eye coordination, as well as their overall balance and gait movement.
“The more services and therapeutic recreation activities we offer our [residents], the more we believe this contributes to their overall satisfaction, and most importantly, their healing.”
Brain fitness shouldn’t be limited to just one-hour sessions. There’s evidence that specific rehabilitation and training strategies are effective for seniors suffering from dementia and Alzheimer’s, according to Alwan. He stressed, however, that such strategies might serve only to improve the person’s ability to perform those specific tasks, and might neither improve overall cognitive functioning nor slow the progression of dementia.
Pushing the boundaries
Regardless of the limitations, Hipskind encourages senior housing operators to get creative with their brain fitness efforts and carry them into as many different aspects of care and daily living as possible. If residents are in the kitchen preparing food, for example, she suggests asking them to name foods of a specific color or those that contain a certain letter. Staff should also encourage residents to keep learning and trying new activities—even if it’s challenging them to brush their teeth or eat with their non-dominant hand.
“Many of us are creatures of habit, but keeping everything the same lets our brains off the hook for creating new neural pathways,” Hipskind says. “The brain loves new and different things, so encourage staff and residents’ family members to [facilitate that] in as many different ways as they can.”
She stressed that the ideal approach is creating an overall culture within a community that ingrains brain fitness and mental stimulation into all aspects—from program development to facility design.
“Not only will residents benefit, I’m confident that facilities will find that their staff will benefit, too. Cognitive impairment doesn’t happen overnight, so it’s never too early to start exercising the brain,” she says. “At the same time, I believe it’s never too late. You have nothing to lose and, potentially, everything to gain.”
From the May 01, 2009 Issue of McKnight's Long-Term Care News
