SbrPECIAiLe ISSfUE SUMMER 2008 Brain Fitness Centers in Seniors Housing: A Field in the Making Prepared by SPECIAL ISSUE BRIEF SUMMER 2008 Table of Contents I. EXECUTIVE SUMMARY 1 II. A FIELD IN THE MAKING: OPPORTUNITIES AND OPEN QUESTIONS 2 III. CASE STUDIES: SENIOR STAR LIVING, BELMONT VILLAGE, ERICKSON RETIREMENT COMMUNITIES 5 IV. NAVIGATING THROUGH THE BRAIN FITNESS PROGRAM LANDSCAPE 12 V. CONCLUSIONS 13 I. Executive Summary You may be wondering, “Why is it that ‘brain fitness centers’ are being announced in press releases and covered by the media almost every week lately?” According to our recent market report, The State of the Brain Fitness Software Market 200 8,1 over 400 senior housing communities nationwide are offering computerized brain fitness tools to their residents, often as part of more comprehensive wellness initiatives. Pioneers such as Senior Star Living, Belmont Village Senior Living, and Erickson Retirement Communities have been actively evaluating and implementing options, conducting pilot programs and learning the ropes, and offering an expanding menu of stimulating high-tech (and low-tech) programs. How can technology enhance and complement existing health and wellness programs? How will this trend affect your organization? How will it affect the future of seniors housing as a whole? Addressing those questions is the purpose of this Special Issue Brief. Let’s start by asking: Who are the seniors housing customers of tomorrow and the influencers or decision-makers of today, and how are they currently voting with their wallet? The “worried well,” particularly those who have been exposed to family or friends suffering from Alzheimer’s disease, are today actively seeking solutions that will help delay potential Alzheimer’s symptoms and improve their quality of life. They are used to the idea that we can play an active role in reducing the effects of aging, 2 and would in fact welcome the idea of an annual brain health check-up to complement their physical check-ups. 3 They are quickly coming to see, spurred by recent research reports and tremendous media coverage, that lifelong mental stimulation is a key factor to consider, and that technology can play an important role. Think: the Nintendo Brain Age phenomenon, which has sold over 20 million units worldwide since 2005. 4 The ubiquitous “crossword puzzles and bingo games” of tomorrow will not be the same crossword puzzles and bingo games of today. The research behind this emerging trend is still tentative but with more substance than first meets the eye. Accumulating evidence shows how lifelong mental engagement can reduce the probability of developing Alzheimer’s symptoms. 5 A recent major scientific study showed how a 10-hour 1 SharpBrains, The State of the Brain Fitness Software Market 2008, March 2008. http://www.sharpbrains.com/market-report/ 2 Mintel’s Self Diagnostics- US Consumer Intelligence, March 2004 3 American Society on Aging. ASA-MetLife Foundation Attitudes and Awareness of Brain Health Poll, 2006. http://www.asaging.org/asav2/mindalert/brainhealthpoll.cfm 4 IGN, NPD Group 5 Stern, Yaakov. Cognitive reserve and Alzheimer’s disease. Alzheimers Dis Assoc Disord. 2006, 20:112-117. American Seniors Housing Association 1 regime of well-directed computerized cognitive exercise resulted in measurable cognitive benefits five years down the line. 6 Seniors housing is one of the areas where high-tech cognitive training can make a significant difference. Early adopters are already able to differentiate their programs in the eyes of potential residents and their families. Pioneers are also boasting increased resident satisfaction rates. They are preparing their communities for the future by moving up the learning curve required to find the best mix of products and practices that can improve their residents’ brain health. II. A Field in the Making: Opportunities and Open Questions THE SCIENCE A series of important media and research events took place in 2007 to move the brain fitness field into the public eye. Extensive media coverage started in January when many media publications, such as Time Magazine and CBS News , published major stories on neuroplasticity and the role of mental exercise. Results from the large-scale Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) controlled clinical trial were published in the Journal of the American Medical Association on December 20, 2006. 7 They revealed that participants, all aged 65 years and older, who had trained for five weeks using three separate cognitive exercise programs (two of them workshop- based, one computerized) had not only improved their skills-trained memory, reasoning and information processing speed, but that a significant portion of that improvement remained even after five years. The publication of these results was accompanied by an editorial titled “Behavior-Based Interventions to Enhance Cognitive Functioning and Independence in Older Adults,” by Sally A. Shumaker, Ph.D., and colleagues from Wake Forest University Health Sciences, Winston-Salem, N.C. They explained: “Cognitive training programs, once standardized and developed for mass market application, might be made available to seniors through non-health care facilities (e.g., senior centers, churches, schools) and health care facilities. Importantly, cognitive training programs may give individuals a greater sense of control over the disturbing prospect of cognitive decline and have a beneficial effect on their quality of life.” Dr. Shumaker’s predictions are starting to come true, and they are happening faster than expected. 6 Willis et al: “Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults.” Journal of the American Medical Association. Volume 296, 23: 2805-2814, 2006. 7 Willis et al, 2006. 2 What is the specific clinical validation supporting the brain fitness products sold today? Are these products working? It depends how “working” is defined. If "working" is defined as quantifiable short-term cognitive improvements, then yes, a number of the brain fitness software programs do seem to work. If, on the other hand, "working" means measurable long-term brain health benefits or lower incidence of Alzheimer's symptoms, then the answer is that it is still too early to tell. One of the reasons for this, to be fair, is the fact that most of the commercially available products have not been on the market long enough to prove out longer term claims. The Cognitive Reserve Theory offers indirect support, given the novelty and challenge that the products present. This theory suggests that it is possible to build up the brain’s resilience to neuronal damage and delay the onset of Alzheimer’s symptoms by performing mentally stimulating activities - and the more, the better. Since 1989, analysis of hundreds of people who were diagnosed post mortem with Alzheimer’s disease showed that many patients had exhibited fewer clinical symptoms than their actual pathology suggested (as measured by the telltale plaques and tangles in their brains). The brains of the patients not exhibiting Alzheimer’s symptoms weighed more and had a greater number of neurons when compared to age-matched control groups. Researchers hypothesize that the patients had a larger “reserve” of neurons and abilities that offset the losses caused by Alzheimer’s, and that a main reason for this had been that those specific patients had led more mentally stimulating lives than the others whose cognitive decline had been more severe. 8 In a related study, results showed that people who spent time on stimulating leisure activities throughout their lives had a thirty eight percent less risk of developing dementia, and that risk was reduced by approximately twelve percent for each additional leisure activity adopted. A FIELD IN THE MAKING The implications from these research findings is leading to the growing number of in-house “brain fitness centers” as a “must have” benefit in seniors housing communities around the country. These centers complement and expand existing wellness, social and enrichment activities and are usually composed of one or several software programs installed in computers and a series of classes led by a trained facilitator. Based on multiple interviews with industry experts and program manufacturers, 9 we estimate that over 400 communities, mostly independent living and CCRCs, with some assisted living residences as well, are already offering science-based computerized brain fitness programs to their residents. It seems that not a week goes by without at least one such community issuing a press release announcing the use of these programs. In a highly competitive business such as seniors housing, it can be expected that over the next several years seniors housing operators will increasingly need to evaluate a growing number of options to offer residents their own “brain fitness centers.” 8 Joe Verghese, “Leisure Activities and the Risk of Dementia in the Elderly”, 2003, The New England Journal of Medicine. 9 SharpBrains interviews, November 2007 –March 2008 American Seniors Housing Association 3 As any emerging technology field, this one presents opportunities and open questions: » What are the potential benefits from doing something today vs. waiting five to ten years for the results to be borne out? First of all, we hear consistent, if anecdotal, reports of higher resident satisfaction rates and subjective feelings of improvement in communities with the programs. Second, many potential residents