Ask any baby boomer what they worry about as they age and they’ll tell you: it’s about having the physical fitness to keep doing the things they love doing, having enough money to live reasonably comfortably, and their biggest concern, retaining their memory and thinking skills.
With a rapidly ageing population and the forecast for 135 million people to be diagnosed with some form of dementia in 2050 there’s no time like the present to examine what the research has shown to help protect the ageing brain.
Our increasing longevity has come with a caveat, the longer we live the greater our chances of developing dementia, affecting one in four people aged 85 and one in two by the age of 95. While many baby boomers envisage sailing off into the sunset under their own terms the harsh reality is that 50% of those living in aged care facilities have dementia.
Back in 2011 Barnes and Yaffe1 examined the projected effect of risk factor reduction on the prevalence of Alzheimer’s disease. Their analysis suggested a 10-25% reduction in identified vascular and lifestyle risk factors including smoking, obesity, type two diabetes, midlife hypertension, midlife depression, social isolation, hearing loss and cognitive inactivity could lead to a significant reduction in the number of people being diagnosed.
Further review2 now suggests that up to one third of Alzheimer’s disease cases worldwide might be attributable to these potentially modifiable risk factors highlighting the potential for primary prevention strategies to be introduced.
There’s also an indication that the projected statistics need revising. A review3 of trends into how the prevalence and incidence of dementia is changing over time indicates stable or declining prevalence and incidence. The big question is why, though the authors suggest it may reflect societal change along with improved living conditions, education and healthcare.
Evidence supporting the role of lifestyle intervention has been steadily accumulating with the findings from the 2-year multi-domain intervention FINGER4 study confirming how this type of intervention can improve or maintain cognitive functioning in at risk elderly people from the general population.
Being brain fit is about having a fit and healthy brain along with mental wellbeing to provide the means to be fully fit to live and work at our best at every age. Research from the Blue Zones5 backs the idea that following a brain healthy lifestyle can build greater cognitive reserve, helping to preserve good brain function as we age.
For Baby Boomers the difficulties being faced include a lack of awareness of the effectiveness of these brain healthy lifestyle interventions, and the need to incorporate a whole raft of these into a simple framework that can be integrated into busy lives.
Running a Brain Fitness Program doesn’t have to be hard and can readily be set up in a community setting. For the last three years I have contributed to a pilot program for healthy ageing seniors that runs as a weekly half-day session over 8 weeks.
The following provides an overview of what this program includes:
This session is set up to provide participants a basic understanding of the human brain, what brain fitness is, why it matters and how the program will run. The participants undertake an assessment of their current lifestyle and general physical fitness and are introduced to eccentric exercise as a way to help improve their balance and general mobility.
Each subsequent week tackles a different each of lifestyle, providing education, the science that backs it up and some simple tools to get started.
The emphasis here is to encourage the introduction of healthier food choices based on the understanding how food impacts mood, memory and cognition.
Commonly reported obstacles to healthily eating include the perception that fresh food is too expensive or cooking meals for one is time consuming and onerous.
Demonstrating how easy it is to make small changes that don’t break the bank, to get better at reading labels (despite the small print!) builds confidence and a willingness to follow Michael Pollan’s timeless advice to eat real food.
Though the most hotly debated question is usually around how much chocolate and alcohol is safe to consume!
The findings from the SMILES6 trial where following a modified Mediterranean style diet was shown to reduce symptoms of depression, and how a Mediterranean style (plant based) diet can help protect vs. cognitive decline7 and dementia are also discussed.
The key message in any brain fitness program is to keep as active as possible. For those participants with a medical condition that makes exercise difficult, or where they have never liked exercise this can be a challenge.
Rather than letting this be an excuse, every participant to encouraged to find one activity that they might enjoy and start from there. This is where the social support of the group can really help. There’s nothing like seeing someone in their nineties trying out a new activity to encourage the younger participants to also have a go.
The emphasis is in building consistency in the habit by ensuring it’s enjoyable. Low impact, eccentric exercises have been found to be very popular along with some weight and resistance training as per the SMART8 trial that showed this type of exercise improved cognitive function in a group with MCI.
Fitness measurements taken at the beginning and end of the program have shown improved aerobic capacity, increased muscle strength, better balance and a newfound determination to continue exercising after the program has finished.
There is a lot of mythology around sleep as we age. Many of my older clients love the idea of a Power nap and especially the idea that a doze is just as beneficial to boost attention and alertness.
Finding from the world’s largest sleep study undertaken by the University of Western Ontario9 found the association between sleep and cognition does not vary with age. The message shared is that we still need 7-8 hours, but our pattern and ability to sleep may change. The guide to how much is enough being how does the person feel on waking? Stressing about getting enough sleep isn’t helpful, but nor is ignoring sleep difficulties and loud snoring.
Sharing the idea that stress can be healthy will often raise eyebrows until it’s understood that stress is not only normal but a way to prepare us to deal with something different in our environment.
Reframing the experience of feeling anxious into, “this is my body preparing me to handle this” can help alleviate a lot of worry and fear.
Many seniors express ongoing concern whether with finance, health or family matters. They may have the wisdom of their years, but they are not immune to the negative impact of too much stress on their health and cognitive function.
In this class they are taught a variety of stress reduction techniques including controlled breathing, mindfulness and other forms of meditation, listening to music, spending time in nature and with friends. Many report how these simple techniques assist in helping them to retain a sense of control and boost confidence and capability.
Adapting to change is commonly cited as a challenge especially when it comes to handling the new technology. Helping them to understand they can maintain and optimise neuroplasticity10 regardless of age by continuing to learn new skills has seen a number of participants subsequently taking up new hobbies, joining a choir or signing up for a class.
The advent of online brain training programs has led some to believe that this is the only way to train their brain. This session sets out as a reminder that as much if not more is gained from engaging with a variety of offline mental activities.
Music11 and singing12 sessions are greatly enjoyed as is participating in other arts activities. The ARTFUL13 program in Sydney has been examining how art and creativity promote neuroplasticity in people with dementia, improving cognitive function and memory.
The Global Council on Brain Health14 recommends promoting meaningful social engagement to maintain thinking skills and slow cognitive decline.
Matt Lieberman, author of Social15 believes our social networks are16 as important to our survival as air food and water. Backing this up is the research into the Superagers17, those living well into their eighties while retaining the mental agility they enjoyed in their fifties and sixties who have been found to enjoy high levels of psychological well-being and positive social relationships.
An unexpected outcome of the pilot brain fitness program has been that participants often don’t want to leave! They derive so much pleasure from attending and are so keen to continue the journey, an “Alumni” group has been created to allow friendships and participation in other sessions to continue.
Ageing well is the new norm. Helping baby boomers maintain better brain health using community-based brain fitness programs provides an easy, inexpensive and highly rewarding way to enable them to stave off cognitive decline and continue to live life to its fullest.
This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.