Kathy Kissinger

April 26, 2007

Save the Seniors: Save the Financial Bottom Line

Americans are living longer today than they ever have in the past, so why do so many retirement communities' operators and activities [community life] professionals seem to think that seniors only have the desire to play bingo and finger paint? Seniors generally can be described as someone age 65 or over, who obtain discounts on goods and services, with privileges often extended to those as young as age 55 (Answers.com). In 2007, seniors still have a desire for further education and continued brain development. In order to stay competitive in the marketplace, retirement communities, specifically those located in Central Pennsylvania , must find ways to engage and challenge their residents and ride this wave into the future, if not for the good of the residents, then for the good of the “bottom line”, or face disengaged residents and staggering financial decay.

Learning and education is something that is instilled in every being. Whether it is an infant who cries in order to obtain food, toddler learning how to walk, teen who practices three point turns, college student cramming for the final, or the senior learning to use a computer, every one of these examples have a need for learning and education. In order to improve their continued brain development, should seniors in central Pennsylvania in 2007, use computer based programs to enhance memory functions? Should they use long term projects which would elevate cognitive functions, therefore prolonging their daily activities of life, or should they continue to decline as they have in years past in so many retirement communities?

The clientele in retirement communities today is constantly changing. Many facilities face residents with higher levels of acuity needs, which make providing engaging services a challenge for activity professionals, but allows for a stronger financial state, due to the increased healthcare services that are being offered. Many residents in assisted living now would have been candidates for skilled care just a few short years ago, and residents in skilled care would have been in hospital settings, living out their final days of life. The ever-evolving clientele has also elevated the expectations of services provided. According to the American Health Care Association, many assisted living facilities today provide 24 hour nursing coverage and emergency response care; three meals a day in a group dining room, personal care, social and religious services, along with recreational activities, laundry and housekeeping services, as well as transportation and maintenance needs, all of which add to the monthly charges that residents incur in assisted living, which in turn allows for a larger profit for the operators of these facilities. According to Country Meadows President and CEO Michael Leader, the average stay in assisted living is two years. There are some assisted living facilities that are non-profit, which often have church affiliations, but many communities are run by corporations which are for profit, and profits they are making.

Meanwhile, activity co-workers must constantly come up with innovative ways to interlock the residents in remaining independent while fulfilling dreams and keeping the residents active in ongoing educational opportunities; some facilities rely heavily on staples such as bingo along with arts and crafts; residents today are not content with bingo and crafts alone.

In order to fully understand why education is import for seniors, we must have some general knowledge of how the brain functions, as well as the effects of aging to the brain. To assist in this understanding, general knowledge is required of the Hippocampus part of the brain, disintegration of the brain, disorders which affect brain functions, and knowledge of how we age.

While arguments arise over the exact role of the hippocampus (a large part of the brain located inside the temporal lobe, which is shaped like a seahorse), there is agreement that the hippocampus area has an essential role in the formation of new memories about experienced events. Some researchers prefer to consider the hippocampus as part of a larger medial temporal lobe memory system responsible for general declarative memory . Declarative memory is the aspect of human memory that stores facts and experiences , which applies to standard textbook learning and knowledge . It is contrasted with procedural memory , which applies to skills. Declarative memories are created by recallition paired with mnemonic techniques and repetition , this will be important as we learn ways to keep seniors active in learning through the use of computer programs and on-site continuing education (Wikipedia). Not all memories are stored in the Hippocampus. Memories that happened years ago are thought to be stored in the Cerebral cortex.

While damage to the hippocampus usually results in profound difficulties in forming new memories it does not affect some aspects of memory, such as the ability to learn new skills, suggesting that such abilities depend on a different type of memory ( procedural memory ) and different brain regions. This is how it is possible for seniors to still learn and be active.

There are two types of aging, according to gerontologists, which are biological and pathological. The differences can affect the ability to learn and be productive active memebers of society. Biological aging can be defined as the result of predictable changes that occur in our cells, organs, and body systems over time, while pathological aging is caused by abnormal processes that can result in susceptibility to fatal or disabling diseases. Many times pathological diseases can be prevented (Ettinger, Michell, and Blair 28). The aging process is also affected by genetic and environmental factors, which link closely to the biological and pathological factors respectively. Seniors had no control over who their parents were, but they could control wether or not they chose to use alcohol, worship the sun, or use cigarettes, all of which have some bearing on the way they have aged and in turn on the ability to learn at an older age.

One problem for aging seniors is the belief that brain functions start to slow as people age, giving many people the reason to have a “Why bother?” approach toward the senior population. I feel that Richard Leviton hits it on the head in his introduction to “Brain Builders” where he states, “Scientists who study the elderly tend to focus on only a very small percentage (about 6-15 percent) who are technically frail and in a mental decline; but they they too often take their results from studying this group and project it onto the population at large.” Even though the brain may slow its processing speed, show weakening of brain signals from the senses, and have a decrease in the production of key brain chemicals, there are still ways seniors can slow these signs of aging. In a study by Professor Arthur Kramer, it has been found that exercise such as walking, will increase the volume of the brain, as well make improvements in cognitive functions such as memory and attention. In a study of 60 participants, Kramer “was surprised how much plasticity, how much flexibility older brains have, because the general belief up until a decade ago was that brains deteriorated as we age. That's not true.” The plasticity in the brain will actually strengthen connections between brain functions, which may reverse memory loss. Exercise does not need to by physical, even though physical exercise offers other health benefits, mental exercises are also of importance (Gupta). In a study funded by the MacArthur Foundation, Dr.'s Guy McKhann and Marilyn Albert studied 1,200 seniors who were performing in the top third of the 70-80 year age group and kept track of them over the course of ten years to see what factors contribute to excellent mental functions. Their findings were similar to Arthur Kramer, in that the seniors with the highest mental functions were more mentally active, more physically active, and they continued to maintain a sense of control over their lives, while feeling like they were still contributing to their families or society, and generally felt good about themselves. These areas need to be addressed by retirement facilities if operators want to keep the resident living in peak condition, (mind, body and soul), which will aid in the financial benefits to the company. “By providing the means for residents to remain independent and active, we are rewarded by seeing people of advanced age functioning at a high level” states Michael Leader. Happy, healthy residents equal more referrals to Country Meadows and other communities, which in turn equals increased revenue!

In this research I am limiting my information to include only “healthy seniors”, (those without Alzheimer's or Dementia), over the age of seventy five, in Central PA. It is important to understand that certain diseases such as Alzheimer's and Dementia, do play a role in cognitive disorders and the ability for seniors to have continued learning. With these diseases, the hippocampus is one of the first regions of the brain to suffer damage. Syptoms often include memory loss, and disorientation. Other causes of damage may include oxygen starvation and encephalitis , which is not a “natural” result of the aging process, so what does this all mean?

Brain fitness and continuing education is a hot commodity. If you perform a search on yahoo, you will find over 15 million results to those two simple words. There are many different ways to promote brain fitness and many of them target the aging population and those that want to remain young in mind. Companies from Nintendo to the dot com genre want to get in on the action. Brain fitness is one way to keep seniors intellectually motivated and able to function to the highest capabilities. In their book “Brain Longevity” Dharma Singh Khalsa and Cameron Stauth, discuss an interview with Dr. Marian Diamond, where they deduce the more we use our brains the more function we have, which was substianciated in a thirty year study, competed by Dr. K. Warner Schaie, in which he offered a group of pre seniors, a brief mental training program that was to improve inductive reasoning and spatial orientation. The subjects were taught “how to think.” After just a few short weeks, Dr Schaie, concluded that “old dogs can be taught new tricks.” Since this research many others have come to the same conclusion, that support the basic idea that intelligence in humans can be increased, at any age, with mental training.

There are several ways to keep the brain active including classes, to computer games, hand held games, and simple mind exercises. Facilities such as Country Meadows, Bethany Village , and Ecumenical Community, are using a multitude approach to keeping the brain sharp for seniors including: community crossword puzzles, to Posit Science computer classes, and general classroom lectures, but which is the best for seniors?

As far as cognitive interaction for the residents, “communal activities such as the crossword puzzles and regular puzzle games work nicely,” according to Community Life Coordinator Wendy Nelson. “Some residents are hesitant to try computer programs and are scared of trying new things. They also seem to enjoy the continuing education classes,” stated Nelson. Country Meadows of Hershey has an entire committee designated to education, which is lead by ninety-year old resident Esther Leedecker. Her four person committee consists of other residents, many of whom were former educators, who develop the schedule of ongoing educational opportunities, including lectures from local college professors. Leedecker enjoys “planning the speakers, and getting feedback from the other residents as to what interests them.” Current planned activities include: a CPR course for seniors, a lecture on local government, a travelogue on the culture of India , along with another edition of Texas Hold'em poker, which was one of the highest attended programs in the past. Leedecker states that the committee tries to have one course per quarter, with classes scheduled once a week, for about one to two hours in length. While the residents drive the programming, Community Life Coordinator Nelson, says “there is heavy support from the Home Office to provide multiple learning opportunities so much so, they have even budgeted money to obtain the speakers, so that the residents have quality presentations. If presenters are hard to come by we have DVDs that have college level lectures on a variety of topics.” Attendance, according to Leedecker and Nelson, depends on the topic. In the past average attendance have been around 20 residents, although the series on the Middle East and Civil Rights were attended by almost one hundred percent of the sixty five residents who live at Country Meadows Colonnades building. Nelson states these two courses had interest to a broad range of residents due to current world events and also the presenter for Civil Rights was one of the residents! One interesting note came from Charles Leedecker (Esther's husband) who is ninety plus years in age and has resided at Country Meadows for six years. He states, “that there are two kinds of people here at Country Meadows. Those who are retired and want no responsibility and another group who wants to keep learning and be active.” These programs are well attended and seem to keep the residents engaged in continuing education, something I would have thought they would have no interest in.

With this being said, residents at Bethany Village according to Janice Cook, do enjoy some of the retirement community staples such as bingo, pokeno, cards, trivia, and crafts, but they expect challenges as well. Country Meadows has faced that challenge by offering an individualized computer program called Posit Science. Posit Science is a San Francisco based company, which offers a brain fitness program which includes a series of computer-based exercises that are scientifically proven to improve important brain functions (Positscience.com). The program uses “brain gyms” to promote cognitive health in adults and to help seniors keep the brain working as long as the physical body is working. “Posit Science was an answer to my hopes of finding a memory enhancement program for the senior population. I had read about computer based brain stimulating programs in the past, but none were scientifically validated. Posit Science has been scientifically proven by Dr. Michael Merzenich, to improve auditory and language systems processing in the brain” according to Rita Altman. With this program, the residents are using the computer for five days a week for eight weeks at one hour increments (positscience.com). Country Meadows is leading the way for this type of programming in Pennsylvania . At the present time only ten other retirement facilities offer this particular program. Bethany Village Retirement Community, located in Mechanicsburg, is currently in the process of researching a “Posit Science” type program for their residents, but has yet to sign on with a specific program, according to activities professional Dixie Brown.

You may ask why is a computer exercise so important for seniors? “The most beneficial part of offering Posit Science is the feeling of accomplishment the residents feel. It is an amazing transformation to watch. One resident suffers from Parkinson's disease and has bad headaches. After completing Posit Science, his shaking was less and his headaches went away. All of the residents are more than eager to share testimonials at [their] “graduation” [from the program], because they are so surprised by the changes they've seen in themselves” stated Country Meadows Regional Directors of Community Life Kris Pollock and Hope Rice. While this is a great personal example of success, there is also clinical research that reinforces why continuing education is important. Some studies suggest that after age 40, with each passing decade, people produce an average of 13 percent less of the critical brain functions (third age.com). Posit Science is designed to keep the mind sharp, studies show that people who remain active with brain functions stay cognitively sharp. By staying sharp, it may help to stave off memory related illnesses such as Alzheimer's and Dementia.

At the Country Meadows location where I work, we were the first in our company to pilot this new product. The results were amazing! All of the residents showed signs of improvement and many actually enjoyed going to “school”, especially after so many years. None of this is to say that these “students” take life sitting down, but for the average 85-90 year old, this is good stuff.

A group of five “independent living” residents at the Hershey facility took part in the program in addition to five residents from the “assisted living”, the demographics were eight women and one man. All of the residents are over the age of 80. Their backgrounds are very varied from high school education only, to college and university graduates. I would have thought that the participants would have been more of the “professional types”, yet the “independent living” residents that I spoke with all had held very “blue color” jobs such as telephone operators, secretaries, and bank tellers. When asked why they choose to participate, the reasons varied from “I could tell my mind was starting to slip, and wanted to see if this would help stimulate it in some way” from Viola Davison, to “ I wanted to learn interesting and new mental exercises” stated Irene Czarny. Irene's husband Fred, noticed improvement in Irene, after just a few sessions, and encouraged her to continue.

The Posit Science program costs around $500 to administer, and Country Meadows paid 50 % of the cost for the program. This cost did not prove to be a deterrent, the program was full with a waiting list according to Wendy Nelson. While Posit Science is geared for seniors, there are many other programs on the market for a variety of cognitive learning functions. A few include: Mind Fit ™ Brain Workout which goes through 14 different cognitive functions and skill areas in twenty minutes a day, three times a week. The Freeze-Framer ® Interactive learning system which is designed to aid in stress management. The Basketball IntelliGym™ Cognitive Trainer which is claims to help improve core basketball abilities and claims to improve academic skills (Brain fitness).

The differences between these products depend on what the end result is to be, although some could claim that the Mind Fit ™ program may be comparable to what Posit Science has to offer. The ability to spend only sixty minutes a week verses five hours could be a draw to encourage more residents to participate in the programs. Some residents did think the time commitment with Posit Science was a little much. “There was no flexibility with Doctors appointments or other activities. You were expected to be there each day at your time” explained Luba. Davison stated “After the first day, you knew what to expect, so it was all right.”

Another player in the market is from the designers at Nintendo. Some could claim that Nintendo has been in the “brain fitness” business for many years with the video games they offer including: Tetris, Duck Hunt, Super Mario Brothers, which use hand eye coordination, memory skills, and other components that link heavily to cognitive science. But with the April 2006 release of Brain Age, they have moved full force in the brain fitness market. The game was inspired by the research of Dr. Ryuta Kawashima, a prominent Japanese neuroscientist. His studies evaluated the impact of performing certain reading and writing exercises to stimulate the brain. Brain Age presents quick mental activities that help keep you young. Since the invention of Brain Age, the developers at Nintendo have released two more games into the market, so it appears that they are seeing a market for this type of invention (Brain age).

Just as the mental activity is important, physical activity is also imperative for seniors as many studies have shown a direct correlation to improved cognitive skills. Many retirement facilities are attacking this by offering daily on-site exercise classes, trips to local swimming pools, and walking incentives for residents. At Bethany Village, according to Dixie Brown an activities coordinator, “they are working on a “culture change” to offer continuing education opportunities and anything to keep the seniors active, they are doing so by getting to know each resident, because what is offered and successful really comes down to meeting the residents interest.” Kim Eichinger from Country Meadows stated that “{We} recognize that our residents are capable adults and deserve a well balanced calendar that meets their needs physically, emotionally, socially, intellectually, and spiritually. We offer adult level activities with a variety to suit everyone's likes and dislikes.”

In an article published by Gabby Hyman on yahoo, she cites research by Dr. Gary Small, Director of the UCLA Center on Aging, has found a research niche in what he calls "Mental Aerobics." Using physical fitness training language, Small encourages everyone to "cross train" their minds to keep them in peak condition. Dr. Small's popular anti-aging book, The Longevity Bible, proposes an eight-step game plan to keep your body supple and your mind in peak condition. Number one on the list: "Sharpen Your Mind. Mental aerobics cross train your brain to significantly improve memory skills and brain efficiency. If you fix your brain for longevity, your body will follow in kind." Lifelong learning combined with exercises to stimulate the mind, builds on what Small calls a cognitive reserve. Small says, "It's the use-it-or-lose-it theory. If you keep your brain cells active it improves their efficiency” (Small).

In a utopian world, the operators of assisted living facilities would be able to insist that residents participate in the computer programs as well as ongoing artistic, physical, and cognitive exercises, which would only enhance the learning from the computer exercises. But in 2007, the operators are not able to force residents to do anything that they do not want to do. Yet there are ways that residents could be challenged to do more while continuing to contribute to society, such as running gift shops, holding long term art classes which would lead to “gallery style” art showings all organized by residents, teaching youth new skills such as crocheting or cross stitch as just a few examples, where the possibilities are endless. At Bethany Village , “They try to keep each resident involved in the life of the facility. Regardless of our abilities, we all have something to offer, and by providing and encouraging residents to remain involved helps make them feel useful as well as keeping them more alert and oriented. All of our activities have a purpose, and the simplest activity can provide stimulation” states Brown. Even with this being said, are the facilities providing enough stimulation, encouragement, and guidance to strive toward the utopian goal?

Johann Wolfgang von Goethe once said “No skill or art is needed to grow old; the trick is to endure it.” and he should know a thing or two about being a senior. Over the course of history several seniors have gained their fame during their later years, such as Goethe, Winston Churchill, Ronald Reagan, Nelson Mandela, Grandma Moses among countless others. What all of these people have in common, other than the fact they are all seniors, is the fact that they all used parts of their brain to be able to achieve greatness late in life! I am not stating that we have the next war hero or President of the United States, living in a retirement facility in Central PA, but who knows maybe the a future literary giant or famous painter, is not too far out of reach! All of these great seniors had long range projects that kept them active and involved in each day of their life. According to Elkhonon Goldberg, in her book The Wisdom Paradox: How your mind can grow stronger as your brain grows older , she cites some of the above examples to enhance her thoughts as to why it is important to value the knowledge that older citizens bring to our culture. Humans are among the only living mammals that live to old age with possibly the exception of the Asian Elephants whose average life expectancy is seventy four years and the Galapagos Tortoise which may live to over one hundred (Ettinger, Mitchell, and Blair 30). So why do so many people share in the beliefs of Goldberg's friend's nineteen year old son who stated” I am surprised when people your and my father's age are capable of learning anything new at all!” (Goldberg 51)? A study conducted by Mellanie V. Springer and Cheryl Grady, PH.D revealed that the brains of older adults rely on the frontal cortex for memory and cognitive activity. Grady reported, " The higher the education , the more likely the older adult is to recruit frontal regions, resulting in a better memory performance." Researchers have showed that the idle mind, like muscles in the body, atrophies from nonuse. With the exponential explosion of online colleges and classes, even homebound adults can keep their minds at play in the fields of learning. A 2006 Harris Poll found that of the 172 million American adults online, some 14 million were over the age of 65. Now more than ever, people of all ages can access a wide variety of educational choices to help keep their minds active and engaged (Hayman).

A great example of continuing education can be found in the founder of Country Meadows; eighty-nine year old Former Governor of Pennsylvania and poet, George M. Leader in his poem Reaching Your Goal which reads:

For the good of your body, your mind and your soul,

You need to be searching for life's greatest goal.

Then if you do what you've found to be right,

You'll find that good heath will come into sight.

We all know it's better to take a nice walk

Than to sit in a chair and just doze or talk;

For walking does much to perk up your health

Which is truly our richest God-given wealth.

So keep right on walking those two miles a day

You'll find those big dividends, it really will pay;

For in mind and body to the depth of your soul,

You are reaching life's highest and most perfect goal. (Leader 105)

While the retirement and the continuing education options in the market are growing; only time will tell what will be the most beneficial and enjoyable to today's seniors. But in the words of Country Meadows resident Esther Leedecker, “I really enjoy good old fashioned reading and writing, none of this computer fancy smancy!” I guess the makers of the new computer games could take this pearl of wisdom to heart, while Community Life Coordinators can be planning the next book review club and CEOs can look forward to years of financial gain from engaged, and educated residents!
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