Many people think of a healthy brain as an aging-related issue, but nurses know how important brain health is across the life span. Some of the habits and practices people develop early in life can impact their brain health decades later. If you know of a few habits you’d like to change, it’s never too late to start focusing on small steps to get you to a goal.
There are many diseases, conditions, and stages that impact the brain–including Alzheimer’s, stroke, injury, or even menopause–so supporting your brain health is essential. Luckily, it’s not an all-or-nothing approach.
Keep Everything Moving
Whether it’s your body with physical activity or your brain with mental activity, staying in motion and engaged with the world makes a difference. According to the Alzheimer’s Association, the brain benefits from all the good things you do for the rest of your body. Keeping your body healthy with exercise also keeps your brain healthy, so continue to keep moving. And you don’t have to run marathons or bike dozens of miles. Taking a short walk on most days is more important for your brain than running 10 miles twice a month.
Stay Socially Connected
If you’re going for a walk, invite a friend. Prefer to walk alone? Call someone you’d like to catch up with this week. Even a short 15-minute phone call with someone you care about delivers important brain benefits. You’ll reduce stress, maintain those important connections, and probably laugh–one of the most healing parts of friendships.
Be Open to Learning
Our brains like new stimulation and, in fact, thrive on it. New activities, unusual facts, a different hobby, or learning a new language all bestow a real impact on the brain. As you learn something new, you’re forcing the brain to adapt and that helps keep your mind sharp. Like the other suggestions, this habit doesn’t require a lot of time. You can spend a half hour on your commute listening to podcasts about something you know nothing about or to begin the foundation of understanding a new language. You can try a new route to a familiar place or see how well you do at crosswords or Wordle. Resist the urge to stick with what’s familiar–shaking things up rewards you in many ways.
See Sleep as Medicine
If someone said you can take a pill to help prevent memory loss, improve your mood, and even keep your weight regulated, would you do it? If you start to look at sleep as medicine, you’ll realize why prioritizing your sleep can improve the quality of your life now and in the future. Even young, busy nurses should realize that a bad night’s sleep can have a significant impact on their on-the-job tasks as it can dull your ability to remember and recall important tasks the next day. Start by going to bed 15 minutes earlier and resisting the urge to watch one more show or scroll through one more post. Sleep and brain health are closely linked.
Keeping your brain healthy is important throughout your life. It’s always a good time to make changes–and any change is better than no change at all. The benefits are worth it now, and your future self will thank you.
Nurses in all specialties and in all areas will, at some point, work with patients who have Alzheimer’s disease or dementia. Because the disease impacts each person in a different way, caring for patients can be challenging, especially for nurses who aren’t used to the intricate interactions that might give them the most success.
Families often find out how their loved one responds best through their own trial and error. The music that may soothe one person may trigger agitation in another. A soft wrap that one person finds comforting may feel confining to another. But nurses who haven’t worked with that person before don’t have the same advantage. And sometimes what worked last week won’t work this week with the same patient.
Keith suggests nurses begin by meeting the patient where they are. “First and foremost, they live in an alternate reality, and it does more harm than good to try to orient them to the current reality,” she says. “You must get into their reality and work with them on that level.”
What does that mean for a typical interaction? Keith suggests that when a patient with Alzheimer’s disease repeatedly calls for a loved one, a nurse can ask about that person in a calm manner to redirect the conversation. Sometimes that will redirect a patient enough so that they are able to talk about their loved one and they do not continue to want the person with them, but not always. If, for instance, a patient repeatedly calls out for his wife or wants to see his wife and redirecting doesn’t work, Keith suggests a different approach for nurses who are especially aware of the patient’s memory. “Then if he persists and his mind cannot be redirected, say something like ‘Your wife has told us she is on her way and will be here in an hour or so. She asked that we remind you that she loves you and is on her way,’” she says.
This kind of “therapeutic fib,” she says, can often defuse a tense or ongoing situation. It also helps build trust so you’re able to provide the care they need. The important “if” factor is that you must be sure the patient won’t remember what you told them in an hour. If that approach works, then other staff can use it to help calm the patient at other times. “Remember that a smile and gentle touch go a long way to getting them to trust you,” she says.
Nurses can also use a team approach to help patients cope with processes or procedures they may not understand or may not like. “If the person is in the ER and the lab staff has just drawn blood and the elder is furious about it—then you can be the good guy and tell the elder you’ll make sure that person never touches you again,” Keith says. Having that kind of balance helps caregivers, the patient, and the family who can become upset when their loved one is upset or agitated.
What other tips come in handy? Keith says you don’t have correct patients when they talk about being in a different time. “Get into their reality,” she says. “If the guy thinks he’s back in the war in a POW camp, then act like a comrade who is going to help get him out. Say anything to help calm the person.”
Nurses who work with patients who have Alzheimer’s or dementia, should recognize that delirium is quite frequently present along with the dementia, says Keith. People may think they are in a time that was decades ago—situations like that are common when you’re working with patients with Alzheimer’s disease.
And, says Keith, nurses have to learn that patients aren’t going to always say nice things to you, but it’s best to not take it personally. Again, their reality is altered and they may think they are perfectly healthy or okay and that you are actually the one with a problem or causing a problem.
“They know they are an adult,” she says, “and they will get angry if you treat them like a child. They will do childlike things, but you will make the situation worse if you talk to them or treat them like a child.” So redirect your instructions and continue to check in with yourself to see if you are communicating with respect and humor and with a calm, gentle manner. Watch for how you say something, especially when you’re frustrated. (Saying “No, you can’t do that! You have to do this whether you want to or not!” will probably not result in your patient complying and may, in fact, make things worse.)
As you work with each new patient, you’ll find ways of communicating effectively when you aren’t sure how they are going to present to you. Learning how to navigate each case is going to help your team give the best care which is the end result everyone wants.
Nurses often care for patients with Alzheimer’s disease, and they also help families who are looking for guidance and resources. But many nurses also care for their own family members who have Alzheimer’s disease, and the high amount of energy spent caregiving on the job and at home is often challenging and can leave nurses depleted at home and at work. Designated as World Alzheimer’s Month, the focus on Alzheimer’s disease in September helps call attention to this devastating disease.
“This type of caregiving is likely the toughest thing they will ever have to do,” says Keith about nurses who care for family members. “Not only must they balance their jobs with the ‘work’ at home, but they must also be cognizant of the fact that they may be (likely are) running themselves ragged trying to keep all the balls in the air.” Keith advocates for building mental health breaks into your schedule so you can continue to find the energy for so much. “Nurses cannot be a good caregiver when they are running on empty,” she says.
Accept You Aren’t Superhuman
There is virtually no one who can take on the role of caregiver at work and at home singlehandedly without losing something in the process. “Get others to help,” she says. “Do not be shy about asking for help and then schedule that help in.” If a neighbor offers help, ask them to take the elder for a walk or just sit with your loved one while you go for a walk or run an errand. If you’re able to hire any kind of help, doing that will free up some time, and therefore, energy for your own life.
Keith says looking into resources including Meals on Wheels or something similar can take a big load off a caregiver. Faith communities often have members who drive elders to appointments, cook occasional meals, or offer companionship while you run an errand, catch up on laundry, or just take time for a cup of coffee. When you have others help you, make sure you use some of the time to recharge your own energy. “Just be sure to schedule in some time for yourself to do something you like that will reset your brain,” says Keith. Caregiving is exhausting.
Gather Information Everywhere
Keith says you’ll find information in all kinds of places and in formats most useful to you. “Join a support group,” says Keith. “So many of my clients have been dragged kicking and screaming to support groups only to find they are a lifeline for them—and some continue to go to help others even after their loved one has passed on.” Sometimes a group may not be the right fit—for example you may want a group where the majority of the members are at a similar stage as you. If you find one group isn’t helping you, find another one and give it at least three tries, she says.
Keith also says the Alzheimer’s Foundation of America has excellent information for caregivers and there are many books that offer targeted information. Keith wrote her first book, “Love, Laughter & Mayhem – Caregiver Survival Manual for Living with a Person with Dementia,” to help answer some common caregiver questions. She also says “Elder Rage or Take My Father…Please!” is helpful for if a loved one is abusive or combative. “Creating Moments of Joy” by Jolene Brackey is also one she recommends.
Take Care of Yourself
The constant demands of caregiving are stressful and can lead to burnout. Your level of stress has nothing to do with your love of the person you are caring for, it has to do with your need to take care of your own physical and mental health. “Don’t be afraid to seek professional help for yourself or your loved one,” says Keith. “This is a life situation that can quickly become a crisis and the more you know about it, the better prepared you will be when. not if, the crisis hits.”
Alzheimer’s disease and other brain conditions and diseases continue to affect ever-greater numbers of people. And while scientists are making advances in treatments, the cure for these complex, devastating diseases is still uncertain.
But there are things you can do to protect your brain health. June is Alzheimer’s and Brain Awareness Month, so it’s a good time to check in on your own self-care and also to see how your patients are taking care of their brain health. African Americans and Latinos bear greater risk of developing Alzheimer’s than older whites, so it’s especially important for some minority populations to understand their increased risk.
According to the Alzheimer’s Association, Alzheimer’s is not a normal aging process that happens to everyone as they get older. People may have typical memory slips, but Alzheimer’s involves much more than just forgetting where you put your keys.
With early detection, Alzheimer’s treatment can begin earlier and hopefully slow the progression, but as of right now, there is no cure for Alzheimer’s.
Learn the Signs
There are warning signs for Alzheimer’s that will let you know you, a loved one, or a patient is struggling with more than a little memory loss. While it’s normal aging to forget someone’s name, it’s not normal aging to forget who the person is. Other things to consider are disruptive mood changes (more than irritability about the dog walker being late), poor self care, and severe confusion about where they are or even what year it is.
Know How to Protect Your Brain
Experts say what’s good for your heart is good for your brain. Take care of yourself by getting rest, eating nutritious foods, socializing with people you enjoy, staying hydrated, not smoking, drinking alcohol minimally, and keeping at a healthy weight and blood pressure. But there’s more you can also do. Keep your brain active. As a nurse, you’re days are hardly ever the same and that’s good for your brain. Check in with your patients to see if they are keeping their brains stimulated with anything from hobbies to social clubs to trying new puzzles, reading or listening to new books, or even listening to unfamiliar music.
Brain injury is serious and some of it is preventable. Wear a helmet while biking, skiing, skateboarding, rollerblading, for any extreme sports, or riding a motorcycle or ATV (and make sure family members and friends do the same). Always wear a seat belt in the car. Check your home for tripping dangers like loose carpets, items on the stairs, or things on the floors. Take care in winter weather for icy spots. Anything you can do to prevent brain injury is good for both your long-term and short-term brain health.
Alzheimer’s and other brain diseases are a real health threat to all aging Americans, so you have a right to be concerned. But there are promising therapies on the horizon and there are things you can do now to help protect yourself as much as is possible. Spread the word about brain health and chat about it with your patients to pass along a few tips.
The New York City Chapter of the Alzheimer’s Association had been trying for years to reach out to the local Latino community to provide information and support for people with Alzheimer’s disease and their families. The group translated educational literature about the disease into Spanish and held mini workshops at its Midtown Manhattan headquarters on a regular basis. But despite these efforts, people just weren’t responding.
The problem, says Isabel Guzman, BSN, RN, who has focused her practice on dementia care since 1990, is that the chapter wasn’t able to culturally connect with Hispanics until it partnered with the Latino Alzheimer’s Coalition of New York (LAC-NY), an organization Guzman co-founded in 1998.
“When you want to do health education in the Hispanic community, you have to put a Hispanic face on the presenter, because there’s a trust that’s automatically present [when you do],” explains Guzman, who works as a home health nurse and serves on a volunteer basis as assistant vice president of LAC-NY.
Another barrier to participation, she continues, was that many Hispanic elders living with Alzheimer’s disease were intimidated, even terrified, by the prospect of getting on a subway or bus to travel to an unfamiliar part of Midtown Manhattan. Some of them couldn’t even travel by themselves. Therefore, getting the message to the Hispanic community would mean that someone would have to travel into the neighborhoods where Hispanics lived.
That’s where the Latino Alzheimer’s Coalition and volunteers like Guzman were able to help. Armed with outreach materials provided by the Alzheimer’s Association, and a bilingual, bicultural program Guzman created in 1995, she and others made their way to Hispanic churches and senior centers, where they talked to people about memory problems, different types of dementias, Alzheimer’s research, diagnosis and treatment.
“In that way, we helped make a dent in the problem,” she says.
This is just one example of how nurses of color can play a crucial role in providing culturally and linguistically competent care, education and support to minority Alzheimer’s patients, family caregivers and communities. Whether they work in hospitals, nursing homes, home health care, public health or academic research centers, their contributions are urgently needed, because Americans of color bear a disproportionately high burden of Alzheimer’s disease and begin to show symptoms of this devastating illness much earlier than their Caucasian counterparts.
Research by the Alzheimer’s Association has found that Alzheimer’s disease, the most common form of dementia, is more prevalent in African Americans than among white Americans, with estimates ranging from 14% higher to almost 100% higher. According to the association’s report African Americans: The Silent Epidemic of Alzheimer’s Disease, black Americans also have a greater familial risk of the disease.
Several recent studies have shown that Hispanics, too, have a higher rate of Alzheimer’s than non-Hispanic whites, and that the problem is increasing at an alarming rate. The Alzheimer’s Association estimates that the number of Hispanic elders suffering from Alzheimer’s and related dementias could increase more than sixfold by the year 2050, from fewer than 200,000 today to as many as 1.3 million.
Why the disparities? Cardiovascular disease, which is more prevalent in the African American community, may be an important risk factor in that population. People with a history of high blood pressure or high cholesterol levels are twice as likely to develop Alzheimer’s disease, and those with both risk factors are four times as likely to suffer from some form of dementia.
Hispanics also have a high incidence of chronic conditions, including vascular disease and diabetes, that may be risk factors for Alzheimer’s disease and stroke-related dementia. The prevalence of diabetes is 64% higher in Hispanics than in non-Hispanic white Americans, the Alzheimer’s Association reports, and 43% of Hispanics with dementia had diabetes, stroke or both.
In response to this growing health crisis, organizations across the country—from Alzheimer’s Association chapters, medical schools and state departments of elder affairs to federal agencies like the National Institute on Aging—are developing innovative programs and initiatives aimed at closing the gap of racial and ethnic Alzheimer’s disparities. Programs such as El Portal, developed by the Alzheimer’s Association’s California Southland Chapter, have become recognized as national models of culturally and linguistically sensitive outreach projects.
El Portal, which means “Gateway” in Spanish, is a partnership of more than 100 community organizations and service providers that offer “dementia-friendly services” to the Hispanic community in South Central and East Los Angeles. These services include adult day care, in-home respite, support groups for families and caregivers, case management, education, training, legal assistance, transportation, home safety intervention and a Spanish-language helpline.
Initially, El Portal began with a network of five adult day care centers, two legal clinics and seven support groups, and grew from there. The project’s success eventually led the chapter to create a sister program, the West Central Dementia Care Network, to serve the needs of the local African American community.
“[Both programs] are designed to create services for an underserved population,” says Debra Cherry, PhD, the chapter’s executive vice president. “We share knowledge, teach people about dementia and [help community organizations develop and deliver] services to serve that community.”
Culturally Sensitive Interventions
While large-scale community outreach efforts are important, Cherry believes minority nurses can perhaps make their biggest contributions on a more personal level—by providing one-on-one care to Alzheimer’s patients of color and helping their families learn to understand and cope with the disease.
“So many people get a diagnosis [of Alzheimer’s] and then get nothing, so there’s clearly a role for the nurse,” she says. “[Dementia] is often viewed as a normal part of aging, so we need to raise people’s awareness that it is actually a disease and not just part of the human condition.”
For many Alzheimer’s patients, simple day-to-day activities such as eating, bathing, dressing and communicating with others can be a source of confusion, fear and anxiety. Gloria Rodriguez Adams, RN, MSG, a clinical manager at the Sports Concussion Institute’s Memory Disorders Clinic in Los Angeles, says nurses of color are often in a better position to help minority dementia patients cope with a world they no longer understand, because they share a common culture.
“Having nurses who can relate to [the patient’s culture], whether it’s music or food or a saying or places, just allows the anxiety level to decrease,” she explains. “If we’re able to relate to things that are familiar, I think we can help the patient relax more and decrease the medicine administration for behaviors that are difficult.”
Gloria Rodriguez Adams, RN, MSG (left) with the late Dorthy Thomas, a patient who participated in an Alzheimer’s disease research study for ten years.
For example, music is an important tool nurses can use to help calm anxious Alzheimer’s patients, says Rodriguez Adams. Often, the only memories these patients have are from their childhood days, and playing music from those days can bring them solace. For African American patients, that might mean spirituals or church music, while Hispanic patients born outside the United States often benefit from hearing music from their native country.
“You start putting on some regional music from their country and you now have a person who is happy instead of agitated,” Rodriguez Adams says. She remembers one African American patient who would sometimes scream at the top of her lungs, partly because of dementia and partly because of metabolic changes brought on by diabetes. “But then I found that if I would bring her to the nurses’ station, just her and I, and we would start to sing ‘Swing Low, Sweet Chariot’ or ‘Amazing Grace,’ it would help bring her down to a level of calm.”
Nurses who share cultural connections with their patients are also likely to be more attuned to the role religion and spirituality play in a minority Alzheimer’s patient’s life. For example, says Guzman, many Hispanics believe in leaving things up to God. Therefore, they may be reluctant to seek treatment or take advantage of available support services.
“They believe very strongly that the Lord will provide and they’re very reluctant to go beyond that,” she explains. “They feel, ‘This is the Lord’s way, this is what the Lord has brought and I believe the Lord will take care of it.’”
Being familiar with this cultural tradition can help a nurse communicate the importance of treatment, Guzman continues, because the nurse can couch it in language that doesn’t conflict with the family’s or patient’s beliefs. He or she can say, for example, that God is strong but that certain medications can help, too.
Understanding the Family’s Needs
Because Alzheimer’s disease can have a devastating effect not only on patients but also on their family caregivers, another key aspect of culturally competent dementia care is being sensitive to traditional family roles. Guzman says it’s important to understand the family hierarchy in the Hispanic culture, and that this hierarchy cannot be ignored or undermined. That applies to both the parents with Alzheimer’s and the children who are caring for them.
“No matter how incapacitated [the parents] are, they still have to feel that they are in control of their lives,” she says. “Even though they’re totally dependent on your care, there’s still the parental hierarchy that you have to really, really be careful with when you take care of them, because you cannot take that pride and respect away from them.”
According to the Alzheimer’s Association, large numbers of Hispanic elders are first-generation immigrants with little or no formal education and limited English-language proficiency. In addition, says Guzman, they are generally less well-informed about health issues than the Caucasian population and they don’t have as strong a support system of family members who are informed. “Their education level is usually much lower and they’re not as assimilated into this country as their Caucasian counterparts,” she notes.
The Caucasian population has been bombarded with information about Alzheimer’s disease for years, and yet information targeted to the Hispanic population didn’t even exist until 1993, she maintains. Furthermore, many immigrant and low-income Hispanic families are so busy just trying to support themselves and survive that they don’t have time to read or watch television or surf the Internet for information.
These family dynamics also make it harder to recruit patients of color into Alzheimer’s disease research studies, Rodriguez Adams believes. Many caregivers in minority families are children rather than spouses, and they tend to bear a disproportionate burden of dementia care responsibilities compared to the majority population. Asking an Alzheimer’s patient to participate in a study requires participation from the caregiver, she says. “They have the demands of their own life and they say: ‘And now you want me to go to how many visits to UCLA to do what?’”
Closing the Research Gap
Another reason why racial and ethnic minority elders are so underrepresented in Alzheimer’s disease research is their lack of trust in the medical system, Guzman says. Here, too, culturally and linguistically competent minority nurses can make a difference in breaking down barriers to participation and replacing them with bridges.
“Once you establish that trust [with Hispanic patients], then recruiting them into research is much easier,” she says. “Unless you have the ability to teach them, the ability to diagnose them, the ability to treat them in their language and establish that trust, you’ll never get them into research.”
Increasing the participation of black Americans in memory disorders research is the focus of the African American Community Outreach Program (AACOP) at Duke University Medical Center’s Bryan Alzheimer’s Disease Research Center in North Carolina. The outreach program was created in 1995, a decade after the Bryan center was established, because African Americans were underrepresented in the center’s research, says the Rev. Henry Edmonds, MEd, program coordinator for the AACOP.
“Our major objectives are to make people more aware of Alzheimer’s disease and that African Americans contract the disease at almost twice the rate of the general population, and also to get more African Americans involved in our research protocols,” he states. Many elderly blacks who grew up during the era of racial segregation and Jim Crow still harbor fear and mistrust of medical research, Edmonds continues. “[In those days], African Americans weren’t even permitted to go into an institution [like this],” he explains. “The population that we serve, the older population, still remembers the Tuskegee Experiment where African Americans with syphilis were left untreated .”
Still another reason for the low participation of African Americans in Alzheimer’s research is that black Americans have historically had shorter life expectancies than whites—although this gap has begun to narrow in recent years. Age is a predominant risk factor for dementia “and in many cases African American didn’t live long enough to get Alzheimer’s disease,” says Edmonds. “Also, when African Americans are diagnosed with Alzheimer’s, they are often in the very later stages of the disease when the treatments that are available can’t do much good.”
Sharing Cultural Knowledge
Prior to accepting her current position, Rodriguez Adams spent several years working with African American Alzheimer’s disease patients at Centinela Freeman Regional Medical Center, one of the providers in the West Central Dementia Care Network. She was able to form close bonds with many of her patients despite their cognitive impairment. Although she is Hispanic, Rodriguez Adams says she had no trouble building relationships with these patients.
“When I first started working with the African American population, I thought: ‘Will they be willing to accept me even though I’m Latina?’” she recalls. “[It was wonderful to see] how the African American community has embraced the Latino staff for all these years.”
Rodriguez Adams believes minority nurses can help raise awareness of the importance of providing culturally sensitive dementia care by making sure they pass their specialized cultural knowledge on to their majority colleagues, including administrators and other nurses.
“It is important for minority nurses to communicate with those who can effect change,” she says, adding that she often leaves notes for administrators about patients’ cultural needs after working a weekend shift at a nursing home for Alzheimer’s patients. “I also think it’s important for minority nurses in supervisory positions to really connect with their [support] staff. [We need to] pass along that passion and pull them up so they will become the ones who will go on to further their education and become the next group of minority nurses.”