Award Winning Memory Care Program: The Science Behind Whole Brain Fitness Beverly Sanborn | VP Program Development Belmont Village Senior Living
Strategic External Assessment: The Customer Demands a Hybrid 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
HYBRID WELLNESS MODEL
Wellness Philosophy
Whole Brain Fitness is a Key Component of a Comprehensive Wellness Program
Hospital Data Link
Whole Brain Fitness
Data Mgt All Programs
Training Mentoring
WHOLE BRAIN FITNESS IN ASSISTED LIVING
Independent Living
Assisted Living
Late Stage Dementia
Mild Cognitive Impairment common, but live in open environment
Live in open environment, but need supervision
Restricted environment: Adapted programming and Specialized training for staff
Whole Brain Fitness programs to maintain cognitive functioning
Whole Brain Fitness programs to maintain highest functioning & keep residents in least restrictive environment
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.
TWO ASPECTS OF COGNITIVE RESERVE Amount of available brain “hardware” (the number of neurons and synapses) This cannot be changed
Degree of efficiency and flexibility in the brain to process information
This YOU can change
WHOLE BRAIN FITNESS: A COMPREHENSIVE PROGRAM
Strong Social Network
Aerobic & Strength Exercise Mental Workout
Sense of Purpose and Feeling Useful
Heart-Healthy Diet
Lifelong Learning
Healthy lifestyle: Reduced Stress
Constant emphasis on frontal lobe exercises
You need daily exercise of your frontal lobe, which gives you: •REASONING •JUDGMENT •PROBLEMSOLVING
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. 2. 3.
LEISURE
To provide recreation and leisure To enhance social and spiritual No measured goal or outcome
THERAPEUTIC GOALS: 1.
2. 3.
4.
To maintain/improve psychosocial, physical, spiritual, creative, cognitive To provide learning opportunities that are a Just Right Challenge To enhance sense of purpose To measure goals/outcomes: quantify enjoyment, socialization, mental and physical function
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 GOAL: To enhance short and long term memory; judgment; sequencing skills; problem-solving skills; speed of processing and verbal skills Critical Thinking
Step-by-Step Sequencing
Memory-Body Movement
Learn Something New
Long-Term Memory
Analytic Solutions
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
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Consulting with Vanderbilt Center on Quality Aging
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Data collected every year
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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
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ESTABLISHED in 23 buildings
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SERVING 499 residents
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CONTROLS are matched sample of 176 in AL
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71% WOMEN
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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, Îą=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 Râ&#x20AC;&#x2122;s for Quality
Right Residents
Right Staff 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
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MoCA, CDT and Animal Naming resident Assessment every 6 months
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Goals for residents and each activity
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Daily activities in The Six Domains
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Emphasis on physical exercise
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Educated staff; continuous training
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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