When it comes to brain health, there are two risk factors that you can’t control: genetics and aging. That leaves lots of opportunity to improve your long-term brain function, and possibly your quality of life in the bargain. The secret seems to lie in continuing to challenge yourself, mentally and physically and even socially. As Mary Schulz, director of education for the Alzheimer Society of Canada, explains, “It’s about mixing it up a little, getting out there and being engaged in life, whatever that means for the person.”
When it comes to considering cognitive health, the body has been thought of as separate from the brain for too long, according to Mike Sharratt, executive director of the Schlegel-University of Waterloo (UW) Research Institute for Aging (RIA) and overseer of its research partnership with 10 retirement residences.
It turns out that what’s good for the heart is good for the brain too. A heart-healthy lifestyle that includes a balanced diet and physical activity helps reduce your risk of cognitive loss and improves the brain’s ability to sustain long-term health. “Vascular risks for heart attack and stroke are very much related to risk for vascular dementia,” points out Schulz. The best remedy is to maximize blood flow to the brain, specifically to the frontal lobes where your “working” memory resides; this is the first area of the brain to suffer when the flow of blood and oxygen is insufficient.
Even if it’s been a while since you engaged in physical activity, it’s never too late, emphasizes Sharratt. “Up to 50 per cent of your loss of aerobic capacity is from aging; the rest is from sedentary living. So it is possible to recover a lot of aerobic fitness and muscle strength.” That’s a bonus not only because you can be more active doing things you enjoy, but also because it increases blood flow to the brain.
Sharratt is one of many experts who believe that if you are consciously challenging your brain during physical activity like walking, the increased blood flow enhances the development of new neural connections in the brain. “So playing a game like naming all the four-legged animals you can think of while walking with a friend has the potential to increase cognitive function. It’s a preventive measure for people who are healthy, but for people with mild cognitive impairment, it can slow down the decline in function if it’s done regularly.”
The more you use your brain—whether you’re solving a problem, writing a letter or organizing an event—the better the blood flow to the frontal lobe. If you’re looking to strengthen your brain power, there’s no need to start learning a new language or how to play bridge. A brain-healthy lifestyle involves approaching daily routines in new ways that may be as simple as brushing your teeth with your left hand instead of your right. “Learning new ways to do things helps keep the brain more agile, so that it will be more flexible in finding new pathways if something does challenge it,” notes Schulz.
This is part of the premise behind Brain Gym exercises, movements intended to engage both sides of the brain and stimulate the flow of information along the brain’s networks to enhance learning. At The Grenadier retirement residence in Toronto, Ontario, “we have integrated Brain Gym into an existing mental aerobics program,” says Julie Lang, recreational director. “We play a memory game as usual, but stop halfway through and perform a few Brain Gym exercises, such as bouncing and catching a ball with the non-dominant hand. Then we continue the memory game and note any improvements that followed the Brain Gym activities.”
Staying hydrated is also important to keep the brain’s circuitry functioning efficiently, and a core lesson of Brain Gym. “We used to bring a water pitcher and cups, but now the residents are aware of the importance of drinking water, and they’re bringing their own water bottles. It’s just awesome.” The program has captured the interest of so many residents that several smaller group sessions are in the works, says Lang, adding that one resident even does the exercises on her own as well as with the group.
The retirement residences affiliated with the Schlegel-UW RIA focus on lifelong learning to whatever extent is possible, notes Mike Sharratt. “We provide computers in our homes, which some older folks are not familiar with, so it requires intergenerational help.” Residents aren’t inclined to say no to the grandchildren, he adds, and every time they focus and stretch their minds (even without the added benefit of physical activity to stimulate blood flow), they’re creating new connections in the brain.
The bottom line is that activities need to be meaningful to the people participating in them if they are to promote brain health. Some individuals love playing bingo and going on outings to the mall, while others may have no interest in such activities. “People have a lifetime of interests,” Mary Schulz points out. “Consider what has given you joy through your life, whether it’s music, art, books, movies or travel—and how you might live through those activities, even though you may not be able to do the same things you did.” Families often play a big role in helping to identify activities that retired elders will enjoy.
Contact with friends and family helps us stay mentally and socially engaged. Research shows that people who regularly interact with others maintain their brain function better than those who don’t. Socializing appears to have a protective effect that may help lessen the risk of developing Alzheimer’s disease.
Bingo, a favoured social event in many communities, is also well-received in retirement residences. Susan Brimble, a recreation co-ordinator at Parkland at the Lakes, Dartmouth, Nova Scotia, notes that bingo is by far their most popular activity, drawing residents from all levels of care for games held three times weekly. Their abilities do vary, but “They really love to help each other out.”
Even individuals who are somewhat disabled cognitively or physically should stay socially connected, if only by picking up the phone and calling a friend. Mary Schulz advises making a commitment to stay in contact with at least one friend every week, and actually marking it on the calendar.
One of the innovations some retirement residences offer is a continuum of care to respond to all levels of need. When Marlene Stoyanovitch’s mother, Sadie Daigle, was diagnosed with Alzheimer's disease nine years ago at the age of 81, they looked at several residences. “We had to make sure we could budget for Sunrise Senior Living, but she loved it—it feels very homey, and they refer to it as your house, not the home.” Marlene’s mother moved in on the third floor, and as her need for assistance increased, she simply moved to another wing of the Mississauga, Ontario, residence.
Marlene has also benefited from the staff’s experience and support: “They were really good about preparing me for changes too—we have an annual review of how she’s doing physically, mentally and emotionally. Several years ago, the [nurse] told me there would come a time when I wouldn’t be able to take my mom out anymore. She was preparing me for what was coming, so when it did happen, it wasn’t as overwhelming.”
Rosalie MacNeil works in the reminiscence wing of Sunrise Senior Living with residents who have mid-to-late stage dementia. Activities include things the residents still remember how to do, such as folding linen or setting the table, and that involve changing something in their environment so they feel they’ve had an impact on their world. “Disabilities may be evident, but we train our staff to look at their abilities and how we can help them do things independently. Maybe they can’t get themselves dressed, but they can do up one button. It may take time, but the sense of accomplishment they get from that is tremendous.”
When cognitive abilities decline, it’s important to remember that communication goes beyond words. Again, participation of close family members can be invaluable, says MacNeil. “We ask the family to complete a detailed profile so we know the resident’s background, likes and dislikes. We have them bring in photos of the resident when they were in their 30s to 50s. They may be in an 80-year-old body, but often their memories are of those years when they were working or raising a family.”
The more the staff of the retirement residence knows about a resident’s personal history, the better. MacNeil recalls one woman who always refused to eat her lunch until the staff told that her son, Robert, had made it for her. “Knowing about the family can help us make that connection and build trust with the resident, which in turn often helps eliminate some of the behavioural problems that can arise as dementia advances.”
It can be difficult for family members to adjust as language skills diminish for people with cognitive loss. Keep in mind that their capacity to understand usually exceeds their ability to express themselves verbally. Frustration and feelings of inadequacy can be avoided by making statements about the here and now, rather than asking questions.
When conversation is limited, shared activities can help generate good feelings. Try brushing their hair or massaging their hands with cream. Listening to music, browsing through a magazine, looking out the window or going with them to a program can provide your elder with pleasure and stimulation.
Mike Sharratt says, “Families need to know that every time they can engage their loved one, it has a beneficial effect, even if it doesn’t show.” Remind yourself that you are a comfort to your elder just by being there and letting them know that you are part of their life.