Brain Awareness Month

For more than a year, I completed 470 assessments of mostly homebound older people.  Like being a bartender, my work involved listening to people’s long life stories—except I met clients in their homes and asked about their functional abilities, health conditions, home environment, support systems, etc.  Many clients told me that they preferred their impaired physical mobility over “losing" their minds or developing dementia.  One client casually reported that she was taking Donezepil for dementia; but after I read a letter (in plain view, posted on her bedroom wall) from her neurologist stating that she scored 15/30 in MMSE and diagnosing her with moderate to severe Alzheimer’s disease, she became visibly upset, clutching her head with both hands and repeatedly saying, “no, no, no ...”

Anyone with a brain is vulnerable to dementia, which remains the most expensive disease in America.  Alzheimer’s is the most common form of dementia, affecting 1 in 10 people age 65+, and the most feared disease in America. 

Hundreds, including yours truly, showed up at Jewish Community Center of San Francisco (JCCSF) for its inaugural Brain Fitness Forum, a full day scheduled with speakers and stimulating activities (coloring craze, growing herbs at home, tai chi, etc.). 

In “Growing and Managing Your Brain Health,” brain plasticity researcher Michael Merzenich, PhD, shared this list of “vicissitudes across the life course” that add to brain noise, making us vulnerable to dementia.  He advised that our brains need exercise to sustain high function and boost our cognitive reserve. 

Lunch break performance by Community Music Center 30^th Street Senior Chorus, part of Community of Voices research study by UCSF on the impact of choir participation on senior health, including memory.  

JCCSF Adult Programs Manager Shiva Schulz introduced neuroscientist Robert F. Halliwell, PhD, who provided tips on “How to Maintain a Healthy Brain without Really Trying”:

1. good night’s sleep
2. reading
3. avoid stress
4. enjoy healthy diet including chocolate!

The Forum ended with a screening of the documentary, My Love Affair with the Brain: The Life and Science of Dr. Marian Diamond.  Better than Wonder Woman, Dr. Diamond is known for her pioneering research on how brain development can be stimulated by an enriched environment: 

1. diet
2. exercise
3. challenge
4. newness
5. love

With fellow neuroanatomist Arnold Scheibel (her husband died in April), Dr. Diamond co-authored, The Human Brain Coloring Book (1985).  The documentary showed Dr. Diamond teaching neuroanatomy at UC Berkeley, using the old school way of handwriting on blackboard as she explained that learning is kinesthetic so we better absorb information when using pen/pencil to paper.  The Forum included kinesthetic Coloring Craze session by Martha Russell, who provided colored pencils, coloring pages (download free mini coloring book at National Coloring Book Day) and research on the cognitive benefits of coloring (which works like mindfulness to calm and stimulate the brain). 

Stimulated to learn more about Dr. Diamond, I checked out Magic Trees of the Mind: How to Nurture Your Child's Intelligence, Creativity, and Healthy Emotions from Birth Through Adolescence (1999), which is actually intended to inspire all age groups for a lifetime of learning, as Dr. Diamond and co-author Janet Hopson wrote in “Introduction – Experience is the Best Sculptor”:

“Fully two-thirds of American adults have sedentary lifestyles; and the majority have high-fat, high-calorie diets; seldom read or create things for pleasure; and watch television for hours every day. It would be surprising, then, if the average child had a regimen any different. If our book has the kind of positive effect we envision, it will inspire a new level of mental and physical activity in all age groups.
It doesn’t take money to create a climate for enchanted minds to grow. It just takes information, imagination, motivation, and effort. Once the habit of active involvement is entrained, experience will take over and those stimulated minds will do the rest for themselves in surprising and delightful ways.”

I thought about putting Dr. Diamond’s research on enriched environments into practice in my own life, including work with clients.

Diet

The Mediterranean and MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diets were recommended “Brain Food,” in the June/July 2017 issue of Neurology Now. Both focus on eating plants (whole grains, nuts, legumes, fruits, vegetables), fish, monounsaturated fats (olive oil), red wine in moderation.  MIND diet focuses on 10 brain healthy food groups (green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, wine) and restricts red meats, butter/margarine, cheese, pastries/sweets, fried/fast food.  Home-delivered meals often do not include nuts, which should be soaked for proper digestion.  

Hot lunch delivered by On Lok (funded by Medicare + Medicaid) to homebound client, who also received home-delivered meals from Meals on Wheels (suggested donation $5 for 2 subsidized meals) and The Salvation Army Meals that Heal (suggested donation $20 per month for weekday hot meals).

This client also received CalFresh, or federally known as Supplemental Nutrition Assistance Program (SNAP), which may be used to purchase nuts (if one does not have nut allergy) that are recommended “brain food.”  In early 2018, SNAP is launching a pilot program to allow recipients to buy food online from retailers like Amazon.  One wonders if this month’s Amazon-Whole Foods deal means better access to organic foods?

Some clients, who reside in Tenderloin SROs without access to kitchens, told me they never received proper nutrition until they became seniors eligible for elderly nutrition programs.  However, a lifetime of poor nutrition (see Chin Jou’s Supersizing Urban America: How Inner Cities Got Fast Food with Government Help) contributed to chronic conditions (osteoarthritis, COPD, obesity, urinary incontinence, shortness of breath) that limit their mobility, so they have difficulty getting to senior congregate meal sites where they could also benefit from social support instead of isolation. Some chronic conditions also make chewing/swallowing food or feeding oneself difficult. 

Even when this SRO building elevator is operational, my frail clients cannot safely open the heavy cage door, so they rely on home-deliveries of food.  While physical frailty is associated with cognitive impairment and dementia, researchers at National University of Singapore found that a combination of good nutrition, physical training and mental exercise can reverse frailty in elderly.

Exercise

Not everyone aspires to be like Charles Eugster, who took up bodybuilding for 10 years until his death at age 97 this year. According to neuroscientist Agnieszka Burzynska, activities involving moving and socializing might improve mental abilities in aging brains. 

In commemoration of its 10^th anniversary, Hope Mohr Dance collaborated with Shaping SF to produce Precarious: Labor History Walking Tour  --awesome community engagement for all ages that provided outdoor walking exercise, singing, learning labor history and advocacy! Starting at Edwin Klockars Blacksmithing (built 1912, to support railroad, bridge and ship building through the 1950s) in South of Market area, we received lyric sheets and joined sing-along with Community Music Center’s Aquatic Park Senior Choir, led by Beth Wilmurt and Josh Pollock playing guitar to Bob Dylan’s “The Times They Are A-Changing.”  

We strolled on Tehama Street and sang Joe Glazer’s “Too Old to Work” (The Social Security Song) ... 

passed by sheet metal works building, built 1902     

Rest stop to hear Shaping SF co-director Chris Carlsson talk about Douglas Tilden’s Mechanics’ Monument, which survived 1906 earthquake, and 1907 San Francisco Streetcar Strike.  

Market Street Trolley stopped, but too full to board, so we remained at the stop and sang “Trolley Song” to the amusement of passengers… 

hopped on next Muni bus and sang “Trolley Song” again. 

Finale with Pete Seeger’s “Tomorrow is a Highway.”

Challenge

Every new challenge presents an opportunity to think and do something: adapt (“Making Solitude out of Loneliness” ), advocate (“Challenges of Being an Advocate”), innovate (“I Remember Better When I Paint”), persist in hope (“Breaking Out of Locked In Syndrome”), etc.  For example, I suggest that clients, recently diagnosed with some form of dementia, document their advance care directive, life history, favorite music and activities.  This documentation will serve as a foundation for person-centered care to guide future caregivers with a better understanding of who they are and how to engage them when they lose capacity to verbally express themselves.  

At this month’s SF Bay Area Network for End-Of-Life Care meeting, Professor Nate Hinerman (who taught Death and Dying course at SFSU) introduced Isabel Yuriko Stenzel Byrnes, Mission Hospice bereavement social worker who leads writing groups for those who are grieving.  Isabel and her identical twin sister Anabel published their memoir, The Power of Two: A Twin Triumph over Cystic Fibrosis (2007), which was made into a documentary film (2011) focused on advocacy for organ donations after learning that their double lung transplants would have been more challenging in their mother’s native country Japan for legal (brain death requirement) and cultural (Buddhist belief not to divide body after death) reasons.  In 2014, Isabel delivered a moving TED talk, “The Art of Saying Goodbye” on the challenge of coping with Anabel's death. 

Housing in San Francisco remains a challenge, especially for older people who are long-term tenants targeted for eviction by landlords who seek higher profits.  At Rosa Parks Senior Center, SF Anti-Displacement Coalition (“Fighting to Make San Francisco Affordable to All”) hosted Western Addition Tenant Convention In Honor of Iris Canada, the 100-year-old Western Addition resident who died a month after being evicted from her apartment where she lived for more than half her life.  

Western Addition resident and activist Wade Woods introduced excerpts from documentary, Redevelopment: A Marxist Analysis, showing how redevelopment in the 1960s displaced African-Americans in the once vibrant Fillmore, and talked about need for more affordable housing.  With its transition zone microclimate, flat surface friendly to walkers and wheelchair users, proximity to retail and access to several Muni bus lines, Western Addition remains a desirable neighborhood for older people.  

Iris Canada’s niece, Iris Merriouns, said her late aunt’s body remains in a morgue since her death three months ago, because Canada’s family is unable to pay storage fees to access her prepaid funeral contract. Senior & Disability Action (SDA) Housing Organizer Theresa Flandrich talked about forming Neighborhood Speculator Watch to defend against speculators (aka sucking octopus) by identifying common evictor tactics:

1.     buying a building

2.     eviction threats & harassment

3.     short-term rentals

4.     luxury development 

Tommi Avicolla Mecca, Director of Counseling Programs at Housing Rights Committee of SF, recommended education about tenant rights and community organizing.

SDA Housing Organizer Tony Robles reinforced our learning by asking us to write our takeaways on post-it notes to "Stick It to the Speculator" poster.

Newness

In direct service work with older people, the best part of the job is listening so I am always learning something new.  As people age, they become more different, present multiple comorbidities, and often share their life lessons. As geriatricians say, “If you’ve seen one 80-year-old, then you’ve seen one 80-year-old.”  With clients who have cognitive impairment, interactions are often like improvisation!

Love

This is not puppy love, but senior dog love at Muttville Senior Dog Rescue, which is dedicated to improving the lives of senior dogs through rescue, foster, adoption and hospice.

Muttville’s Seniors for Seniors Program offers free senior dog companions for senior humans age 62+: perfect match for shut-in clients! 

Senior dogs for adoption are often described as shy, sweet and mellow.

Some shut-in clients have told me they avoid human interaction, but bond better with animals, especially dogs who provide unconditional love to reduce anxiety, depression and social isolation.  Some studies indicate that people with dementia who received dog therapy improved cognition, as measured by MMSE.