The brain works like a muscle—use it or lose it. That saying is gaining increasing credibility in the field of aging studies. For decades, of course, the standard take on geriatric cognition was that the elderly person had long since maxed out on brain cells and had been losing these in steady decline for decades. Cognitive decline, whether Alzheimer's-related or not, was the aging individual's inexorable fate. Recent years have seen a dramatic turnaround in such conceptualizing, at least in scientific circles. Evidence has accumulated from carefully controlled studies that many factors—physical, mental, social, spiritual, and dietary—can impact positively on brain function throughout life, regardless of age. Recently, the 14-year-old senior care chain Emeritus Assisted Living, with more than 200 communities in 38 states, decided to put brain health programming into action, in partnership with one of its leading scientific proponents, Paul Nussbaum, PhD, adjunct associate professor of Neurological Surgery at the University of Pittsburgh School of Medicine. The brain health program is rolling out as a pilot project in three Emeritus facilities and real-world results are being monitored. Recently, several key staffers involved in the pilot, along with Dr. Nussbaum, discussed how this approach stands to impact their company and long-term care in general, in a roundtable moderated by Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.
Adora Brouillard, Director of Education and Training
Chris Guay, Northeast Divisional Director of Operations
Andrea Hunter, Executive Director, Anderson Place, Anderson, South Carolina
John Madden, Executive Director, Stanford Center, Altamonte Springs, Florida
Dee McGinnis, National Director of Wellness
Paul Nussbaum, PhD, Associate Professor of Neurological Surgery, University of Pittsburgh School of Medicine
Kelly Scott, Director of Training and Special Care Program, East Operations
Peck: How did the brain health program get started at Emeritus?
Chris Guay: Senior Vice-President Gary Becker saw Dr. Nussbaum speak about three years ago and was highly impressed. We are always seeking to improve our resident care, and Mr. Becker saw a way we might do better with residents who have dementia, and even help those without dementia maintain their wellness. Dr. Nussbaum was interested in partnering with us and before long a number of us in management were involved in taking this to another level.
We know that this is not a pill or a computer program—it is a lifestyle change to maintain brain wellness. The five critical components of brain health involve physical exercise, mental stimulation, social connection, spirituality, and appropriate nutrition. We’ve piloted this program in three facilities, using principally a three-pronged approach: educating our residents and families about the benefits of brain health; getting employees involved in maintaining their own brain health and becoming “ambassadors” for this; and opening this education to the surrounding community so as to be seen as a “brain health” resource center. We are trying to create a culture in Emeritus facilities that will benefit everyone who comes in contact with our organization.
Peck: How did you specifically implement this in the individual facilities?
Kelly Scott: Dr. Nussbaum met with every department head and manager involved to educate and guide them. Among the things we're doing is helping encourage consumption of brain-healthy foods and snacks by identifying them with specially designed brain-health logos on the menus that we post for residents every day. We're also encouraging employee involvement by having them wear pedometers and attempt to walk at least 10,000 steps (about five miles) a day; we have people competing on this now, and one maintenance director impressed everyone recently by doing 50,000 steps in one day! We're also offering stimulating activities, such as board games, word games, trivia, storytelling, and dance (which is highly popular), as well as regular church services.
Dr. Paul Nussbaum: It's important to note that all of this is research-based. Research shows, for example, the health benefit of daily prayer, attending church services, doing breathing exercises, slowing down, and saying “no” to stress. There is established benefit in having at least one sit-down meal a day, preferably with relative “strangers” in a novel and complex environment, the best situation for brain health. It's been shown that stimulating, though not overstimulating, the hippocampus of the brain leads to new cellular connections in that area of the brain and protection against Alzheimer's disease. For example, playing board games, traveling, reading and writing daily, or learning a second language can have this protective effect. We’ve seen that physical activity, such as dance or walking three hours a week, actually causes beneficial structural change in the brain. Socialization—joining clubs and organizations, developing one's hidden talents—avoids the isolation that poses risk of Alzheimer's. With nutrition, we know that the brain is 60% fat, and so it makes sense that fatty fish consumption is brain healthy, as are intake of antioxidants and vitamins A, B, C, and E. Dietitians know that a healthy plate should look like a rainbow, with fruits and vegetables of many colors, and that snacks like bowls of walnuts or red grapes can be helpful, as can a glass of red wine or red grape juice each day.
Peck: What are some of the operational challenges of incorporating some of these ideas in managing a facility?