Award Winning Memory Care Program:The Science Behind Whole Brain FitnessBeverly Sanborn | VP Program Development

Belmont Village Senior Living

Strategic External Assessment: The Customer Demands a Hybrid Model

HYBRID WELLNESS MODEL

Residents more medically compromised; staff need more clinical and dementia skills to manage them

Residents/families want a social model with hospitality, choice, purposeful life, & Whole Brain Fitness

NEEDS WANTS

Whole Brain Fitness is a Key Component of a Comprehensive Wellness Program

Whole Brain Fitness

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WHOLE BRAIN FITNESS IN ASSISTED LIVING

Assisted Living

Live in open environment, but need supervision

Whole Brain Fitness programs to maintain highest functioning & keep residents in least restrictive environment

Independent Living

Mild Cognitive Impairment common, but live in open environment

Whole Brain Fitness programs to maintain cognitive functioning

Late Stage Dementia

Restricted environment:Adapted programming and Specialized training for staff

Whole Brain Fitness programs to preserve remaining abilities and achieve highest functioning possible

WHOLE BRAIN FITNESS: It Begins With NEUROLOGY

We are born with hundreds of billions of neurons in our brain

Close-up of Neurons in the Brain

WHAT IS WHOLE BRAIN FITNESS?

It is a comprehensive program that builds cognitive reserve in the brain

COGNITIVE RESERVE: What Is It?

It is the capacity of the brain to find another set of neurons to handle thinking when either disease or injury has damaged parts of the brain.

This cannot be changed

This YOU can change

TWO ASPECTS OF COGNITIVE RESERVE

Amount of available brain “hardware”

(the number of neurons and synapses)

Degree of efficiency and flexibility in the brain to

process information

WHOLE BRAIN FITNESS: A COMPREHENSIVE PROGRAM

Aerobic & StrengthExercise

Mental Workout

Lifelong Learning

Healthy lifestyle:Reduced Stress

Heart-Healthy Diet

Sense of Purpose

and Feeling Useful

Strong SocialNetwork

Constant emphasis on frontal lobe exercises

You need daily exercise of your frontal lobe, which gives you:•REASONING•JUDGMENT•PROBLEM-SOLVING

Requirements for a JUST RIGHT CHALLENGE

It must be something NEW to

the brain

It must be a

MENTAL STRETCH

Building Cognitive Reserve Requires a Therapeutic Program

LEISURE GOALS:1. To provide recreation and leisure

2. To enhance social and spiritual

3. No measured goal or outcome

THERAPEUTIC GOALS:1. To maintain/improve psychosocial,

physical, spiritual, creative, cognitive

2. To provide learning opportunities that are a Just Right Challenge

3. To enhance sense of purpose

4. To measure goals/outcomes: quantify enjoyment, socialization, mental and physical function

LEISURE

THERAPEUTIC

PARADIGM SHIFT IN ASSISTED LIVING: Leisure vs. Therapeutic

Therapeutic activities are based on science

3 B’s of the Leisure Life

Typical Activities

• Bingo

• Ball Toss

• Bible

3 C’s of the Purposeful Life

Typical Activities

• Creativity

• Challenge

• Cognitive Reserve

LEISURE VS. THERAPEUTIC

For each activity, determine whether it is leisure or therapeutic:

1. Wine & Cheese + Entertainment

2. Reminiscing Discussion

3. Watching Reality TV

4. Reading current events

5. Listening to a lecture

Snapshot of Circle of Friends

o Cognitive scores in mild to moderate dementia range

o Research-based Therapeutic Whole Brain Fitness Program

o 8-hour, 7 day-a-week group activities of whole brain fitness

o Corporate calendar ensures quality, 6 domains, & Just Right Challenge

o Groups consist of 12-16 residents

o Certified Enrichment Leaders

o Bi-annual program evaluation of cognition, participation, medication & behaviors

o Tracking & trending of outcomes for QA and program improvements

Physical

Mental

Social

Nutrition

The Six Domains of a Mental Workout

Analytic Solutions

Memory-Body MovementCritical Thinking Learn Something New

Step-by-Step Sequencing Long-Term Memory

GOAL: To enhance short and long term memory; judgment; sequencing skills; problem-solving skills; speed of processing and verbal skills

DOMAIN 1, Challenge 1: Innovative Thinking

Awesome: today’s cliché of the year is the number one lazy brain word

• Dictionary definition: extremely impressive or daunting; inspiring great admiration, apprehension, or fear.

• BUT, today it is used to mean good, excellent, thank you, O.K., I agree, and anything else that acknowledges something positive or affirmative

• The challenge: Can you describe the best part of the conference without using the word AWESOME?

DOMAIN 1, Challenge 2: Integrated Reasoning

Integrated Reasoning is organizing ideas.

TASK: In one minute, explain in your own words the meaning of the following proverb:

“Mounted Beggars race their steed.”

Domain 2: Memory-Body Movement

GOAL: To engage both memory and body movement simultaneously

DOMAIN 2 Challenge: Mind/Memory/Body

TASK: Look at the image for 11 seconds, then draw it from memory.

DOMAIN 3: Learn Something New

Define the word: make up a definition if you do not know this word.

Palimpsest

When you know the answer: use the word in a sentence.

Domain 4: Step-by-Step Sequencing

GOAL: To follow a hand-eye task that requires directions

Domain 5: Long Term Memory

GOAL: To enhance speed of processing by recalling knowledge learned long ago

Domain 6: Analytical Solutions

GOAL: To exercise analytic thinking

DOMAIN 6 Challenge: Analytic and Problem Solving

HOMONYMS

1. Wept noisily; and hairless

2. Sandy shore; and a large tree with smooth bark

3. To strike repeatedly; and a red root

4. A large rock; and more courageous, riskier

5. Sicken; and a bitter beer

EVIDENCE-BASED FINDINGS

LAUNCHING EVIDENCE-BASED INITIATIVE for Circle of Friends

• Consulting with Vanderbilt Center on Quality Aging

• Data collected every year

• Two data collections: March & September

Consultant: Dr. Sandra Simmons, Ph.D.

Associate Professor of Medicine,Vanderbilt University

www.VanderbiltCQA.org

DEMOGRAPHICS OF CIRCLE OF FRIENDS

• 8 YEARS in the making: 3 ITERATIONS

• ESTABLISHED in 23 buildings

• SERVING 499 residents

• CONTROLS are matched sample of 176 in AL

• 71% WOMEN

• 91% WHITE

FIRST BASELINE DATA March 2015

Collected data on:

• Medications

• MMSE, MOCA, Clock Drawing Test, Animal Naming

• Geriatric Depression Scale

• Activity Participation

• Problem behaviors (Cohen-Mansfield)

Activity Participation for MMSE 18+

Chi-square: DF=2, α=0.05, p<0.0001

Percent Depressed for MMSE 18+

Activity Participation for MMSE 18+ and Depressed

CLOCK DRAWING TEST AFTER 6 MONTHS OF COF

Pre Circle of Friends Post Circle of Friends

CLOCK DRAWING TEST AFTER 6 MONTHS OF COF

Pre Circle of Friends Post Circle of Friends

LESSONS LEARNED: What You Need To Know to Create A Therapeutic Program

The 5 R’s for Quality

Right StaffRight

Residents

Right Programs

Right Training

Right Evaluations

The Circle Configuration

The ideal arrangement for frontal lobe-oriented discussion sessions

The U Configuration

The ideal configuration for discussion sessions that involve writing. In this arrangement, the feeling of a circle is maintained.

Six Principles for Programs that Build Cognitive Reserve

• Activities new to the brain and a mental stretch

• MoCA, CDT and Animal Naming resident Assessment every 6 months

• Goals for residents and each activity

• Daily activities in The Six Domains

• Emphasis on physical exercise

• Educated staff; continuous training

• Ongoing evaluation to ensure quality

A society grows great when old men plant trees whose shade they know they shall never sit in.~Greek Proverb