Editors' Note: An abridged version of this article appeared in the September 2013 print and digital editions.
The perimeter of the sunny room is lined with three small tables. A staff member from the senior living community and one or two residents sit at each table.
“Are you ready for brain exercise?” one staffer asks her two tablemates, handing each of them worksheets to complete. Following instructions, the residents write their names at the top of their worksheets and begin. A female resident reads out loud the large print on the page while a male resident completes simple math problems. The staff member peppers their efforts with encouragement: “Good job!” “Perfect!”
At another table, a quiet woman slowly picks up large, round chips numbered from one to 10 and places them on a small mat with squares numbered to match the chips. “Nice job!” “You’re flying through this one!” says the staff member with whom the woman is paired. The elderly woman puts the number 10 chip on the number two spot on the mat, but when all squares on the mat are occupied by chips, the staff member clicks a timer and excitedly tells the resident, “You completed this exercise in 1:50 yesterday, and today you did it in 1:05. You beat your record!” Next she asks the resident to count from one to 10. Instead, the woman pushes the chips off the mat and starts the previous exercise again. The staff member tells her, “You’re doing great!
Back at the first table, the woman has completed her reading assignment—stopping occasionally when something in the short narrative prompted a memory and a question to the staff member—and the man has completed his math worksheet. The staff member asks them to write their finish times, obtained from a large clock on the table, on their worksheets. Then they trade reading and writing exercises. When the staff member grades their efforts, she writes a large 100 in red on the pages and congratulates them.
This is SAIDO (pronounced sī-dō) Learning, a nonpharmaceutical program developed in Japan to improve symptoms in those with Alzheimer’s disease or dementia. The goal is not only to improve the quality of life for older adults but also to reduce both their required levels of care and the overall cost of that care.
In SAIDO, caregivers are referred to as supporters, participating residents are called learners and certain principles guide the half-hour, five-day-a-week sessions:
- Exercises are tailored to the ability of each learner.
- Learners receive continual encouragement.
- Learners always receive a perfect score on their performance.
The technique has been practiced in Japan for more than 11 years, but it only recently came to the United States, where it currently can be found only at the three communities of the Eliza Jennings Senior Care Network in Northeast Ohio. The program's potential to reduce care needs and care costs could take on increased importance in the United States as the incidence of Alzheimer's disease and other forms of dementia increases with the aging population.
Currently, 5 million people aged at least 65 years have Alzheimer's disease, the affliction that represents 60 percent to 80 percent of dementia cases, according to the Alzheimer's Association. That number is expected to increase to 7.1 million by 2025 and to 13.8 million by 2050 unless a medical breakthrough prevents, slows or stops the disease, the organization predicts.
Three-fourths of those in whom dementia is diagnosed eventually are admitted to nursing homes. Eliza Jennings finds that almost 70 percent of those in its communities and programs have some type of dementia.
Direct costs associated with caring for those with Alzheimer's disease, including Medicare and Medicaid expenses, are expected to total $203 billion in 2013 and could top $1.2 trillion (in current dollars) by 2050, according to the Alzheimer's Association. The average per-person Medicare costs for those with Alzheimer's disease and other dementias are three times higher than average costs for those without these conditions, the organization notes, and the average per-person Medicaid spending for seniors with Alzheimer's disease and other dementias is 19 times higher than the average per-person Medicaid spending for all other seniors.
A NEW TOOL IN DEMENTIA CARE
In 2010, Deborah Hiller, president and CEO of the Eliza Jennings Senior Care Network, joined four other senior care organization representatives at a presentation about a new learning program for residents with dementia. Hiller had never heard of the SAIDO Learning program, developed in 2001 by Dr. Ryuta Kawashima, a neuroscientist, in conjunction with the Kumon Institute of Education in Osaka, Japan.