There has been talk these days in San Diego about the relationship between the recent solar eclipse, the earth’s magnetic field flip-flop, and forgetfulness.  While many of us would like to point to atmospheric conditions as a reason that we have misplaced keys, lost that all-important paper, or forgotten a birthday, we are perhaps experiencing information overload.  But for many others, memory decline is a frightening reality. Here at the 65th Annual Scientific Meeting of the Gerontological Society of America -- attended by approximately 4,000 -- topics on aging, issues of memory loss, optimal cognitive functioning, and dignity in aging and care facilities are among the broad range of topics.

Our brain is a muscle

Working in a breakout session, my topic is on “Nursing Home Care and Cognitive Enrichment.” The value of such a session helps with perspective and with generation of ideas. Toni P. Miles, M.D., Ph.D., pointed out: “Our brains are composed of muscle fiber.  And we all know that muscles improve with use.  It is vital to your brain’s health that it engage in strength and conditioning that come through cognitive stimulation."

The words of Dr. Miles, Director of the Institute on Gerontology at the University of Georgia’s College of Public Health, are particularly poignant given a British Medical Journal report this past January that memory loss associated with Alzheimer’s may be detectable as early as age 45.

Cognition enhancers

Exercise is known to enhance cognition. But an added benefit includes computerized cognitive games. The American Journal of Preventive Medicine in February reported clinical trial results on what is being called “exergaming” in which stationary cycling incorporates video scenery and competitors. The cognitive benefit of this combination is said to exceed that of cycling alone. 

However, a concern expressed by many of us is just how little exercise residents receive in nursing care facilities.

Care facility basics -- cognitive enrichment

Many presenters and members at the GSA were also concerned about cognitive enrichment and recreational activities in which music was highlighted. However, too few facilities have policies in place to evalute programs. 

Ten questions to ask to determine if a facitility gets a top grade in:

  • Providing culturally appropriate songs whether at a sing-along or from invited musicians
  • Understanding the vital importance of music as participatory with a repetoire of songs tailored to the community 
  • Ensuring that residents have words to songs, preferably large type lyrics projected on a screen or even song sheets 
  • Creating activities for men such as checkers or chess rather than just arts and crafts 
  • Determining a set of recommended books – primarily with photographs that can help stimulate imagination -- rather than story hours 
  • Following recommended guidelines for Reminiscence Therapy (eg.Reminiscence therapy for dementia from NIH) instead of reading gift catalogues or recipes 
  • Encouraging a range of games, creative painting exercises, and jigsaw puzzles
  • Engaging residents in activities that are participatory, eg. planting flowers or herbs in individual pots rather than watching another person dig up a garden 
  • Holding activities outdoors whenever possible 
  • Working with residents on gratitude boosters to help alleviate negativity and anxiety

James M. Ellison, M.D., M.P.H., is associate professor of psychiatry at Harvard Medical School and Clinical Director or the Geriatric Psychiatry Program at McLean Hospital in Belmont, Mass. In talking with him earlier, he said: "Families need to know that their loved ones are being cared for by a kind staff in an atmosphere that stimulates them emotionally, socially, and cognitively. It's important to remember that even with a diagnosis of dementia people can find joy in the appropriate surroundings.”

Hope for the future

Matt Perry of the California Health Report is a MetLife Journalism Fellow who teaches film studies and screen writing. An advocate for individual expression through creativity, he is very concerned about the use of restraints in nursing homes.  He introduced me to the concept of multi-sensory rooms as a future model, perhaps, for nursing care environments.

Such rooms are "an artificially created venue that brings together multi-sensory equipment in one place to stimulate the senses….It changes arousal levels and relieves stress, anxiety and pain. MSEs have been shown to help with autism, brain injury, challenging behaviors, dementia, developmental disabilities, mental illness, palliative care, pre and post surgery, PTSD, special education and of course wellness." AAMSE - American Association of Multi Sensory Environments

Vital research

As for the future, Holly-Brown Borg, Ph.D., is a member of the biological sciences section of the GSA, a group devoted to understanding the processes of aging, “the causes and effects from the molecular to the whole organism level.”  She said, “This enhanced understanding will provide avenues to target age-related disease including Alzheimer’s, arthritis, cancer, and diabetes.” Dr. Brown-Borg is the Chester Fritz Distinguished Professor, University of North Dakota.

The fountain of youth has eluded us.  As such, we must depend upon translational research and advocates today to encourage programs and policies that will promote healthy aging in our future.

Written as 2012 MetLife Foundation Journalist in Aging Fellow, a program collaboration of New America Media and the Gerontological Society of America.

Copyright 2013 Rita Watson/ All Rights Reserved  

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