How Providers Can Go After ‘Low-Hanging Fruit’ in Memory Care

Some senior living providers now are offering robust programming to earlier-stage memory care residents, but even simple initiatives can sometimes enhance these residents’ lives. And taking basic steps to address mild cognitive impairment also could give providers’ bottom line a boost, according to one expert in the field.

One place to start could be the dining room. Many residents routinely show up half an hour before mealtimes and then sit around with nothing to do. Why not put sudoku puzzles out for them to solve?

That suggestion came from Robert Winningham, Ph.D., a professor at Western Oregon University who has done extensive research on memory in older adults, and who authored the books Train Your Brain: How to Maximize Memory Ability in Older Adulthood and Cranium Crunches.


Sudoku has proven to be beneficial to improving cognitive functioning in seniors with mild cognitive impairment, so that’s a good choice of activity to offer in those pre-meal times, Winningham said last week in Minneapolis, at the Senior Living Summit hosted by Life Care Services LLC (LCS), one of the nation’s largest senior living companies.

Activities such as sudoku have been shown in high-quality research studies to help delay the onset of dementia in seniors with mild cognitive impairment, Winningham said. That’s because—unlike crossword puzzles or trivia, which rely mostly on retrieval of memories—sudoku engages the brain in a problem-solving task that hones the ability to pay attention and form new memories, he explained.

Providers who find that residents are resistant to sudoku may want to start them out with simpler versions of the puzzle, which Winningham has made available for free. Helping seniors feel successful is a key part of getting them to engage in the kind of cognitive exercise that can improve their quality of life and potentially delay their need for more intensive and costly care, he emphasized.


Here are three other examples of basic initiatives that providers may be overlooking to help this resident population:

1. Better Tech Support

The introduction of the iPad and similar tablet devices has been a “game changer,” Winningham said. Whereas providers in the past had to pay steep prices for computer-based cognitive exercise programs that have benefits similar to sudoku, now there’s a wide array of applications that can be downloaded at a very low cost on tablets. Fit Brains, Brain HQ, Tetris, and Brain Lab are among those name-checked by Winningham at the LCS event.

While rolling out an iPad program may not exactly be a simple initiative, many providers are failing residents who have a tablet by not offering good tech support, he said.

“It’s so hodge-podge,” he said. “I ask these questions [about tech support], and I get all these random answers. ‘Bill does that for us.’ ‘Oh, we don’t have that.’ ‘Once a month we have someone come in.’ ‘Someone’s child does that.’”

The senior living industry needs to invest in better support for residents, Winningham argued, by having dedicated staff focused on this area. Helping seniors with devices get connected to WiFi and the cloud and set up their passwords is “low-hanging fruit” that providers can focus on to start down the road to better cognitive stimulation, he said.

“I think [using a tablet] can be even better than doing sudoku, because in sudoku there’s no meaning, no purpose,” he said. “But if you’re [using a tablet] because you want to get in contact with your old friends, that’s meaning and purpose that can come from that, and that meaning and purpose also has cognitive [benefits].”

2. Free Physical Fitness Training

Of all the activities that benefit cognition, the National Institutes of Health says physical exercise is the one that has the strongest, clearest research backing it up, Winningham said.

Among the research he cited: a 2001 study found that a walking program increased attention in seniors; a 2009 study found that older adults were 61% less likely to get dementia if they were in the top third of their peer group in terms of getting physical exercise; a 2012 study found that twice-a-week resistance training in older women with mild cognitive impairment resulted in “significant improvement” in attention and memory.

The importance of having fitness centers and staff in senior living is driven home by these findings, and many communities indeed have these amenities. However, they may be making it harder than they should for residents to take advantage of them, Winningham said.

For example, one community he visited had trainers available to residents but charged $30 an hour for sessions (“not an LCS community,” he joked).

Those providers who think that these charges are necessary may be interested in yet another study, published in JAMA-Internal Medicine in 2013. High-quality physical exercise programs undertaken by those with Alzheimer’s saved $12,000 per year in health costs compared to a control group, the researchers found. That’s in part because these individuals remained more independent and capable of performing activities of daily living, and were less likely to experience conditions such as heart disease.

“It doesn’t make any sense to me—$12,000 a year savings, and you’re putting a barrier, charging $30 to spend time with this person who could change the course of aging, could change how independent they are the rest of the time they’re in the community?” Winningham said. “So we need to invest in that and make it available to them, in my opinion. It will pay for itself.”

3. Enable Social Connections

Other opportunities for easy and powerful interventions relate to residents’ social lives.

The correlation between having strong social connections and maintaining cognitive sharpness is supported by research, including some of his own, Winningham pointed out. Leaders in the senior living industry often say that one major advantage of living in a community is the opportunity to be social, and yet providers may not be taking basic steps to maximize strong social connections among residents.

As part of a cognitive exercise study that Winningham and his colleagues did in assisted living communities, they took steps to facilitate more socialization. Their initiatives could be adopted by providers:

– Putting notes on neighbors’ doors when a new resident arrives, to encourage people to get to know those around them

– Having “treasure hunts” around the community, as a way for residents to learn things about each other

– Organizing “affinity group” events, such as ice cream socials for people interested in cars, or retired teachers

“Some of your communities are huge, and it’s hard to find like-minded individuals,” Winningham pointed out.

At the end of the three-month study done by Winningham, the residents who had been in the intervention group had increased social support and decreased loneliness, compared with a control group.

While further research is needed to support these findings, Winningham believes that enormous benefits could stem from simple steps to increase residents’ social engagement. He again invoked the “low-hanging fruit” image to drive home his point.

“It’s just a little effort,” he said. “This is low-hanging fruit. It’s not hard to set up these programs, but the effects could be huge.”

Written by Tim Mullaney

Photo Credit: “Morning Routine” by Liz West, CC BY 2.0

Companies featured in this article: