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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Health Promotion for Seniors

The Healthy Brain Program

Stephen J. Kiraly, MD, FRCPC

Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp.31-32

The Healthy Brain Program (HBP) was first developed for seniors in British Columbia and has since been adapted for all age groups. In the beginning, it was sponsored by St. Vincent’s Hospital Foundation in Vancouver, and the primary message conveyed by the program was: “add life to your years.” The communities of Coast Garibaldi and Sunshine Coast have had presentations and workshops from the program, which trained geriatric mental health workers to use this innovative approach for health promotion and disease prevention.

Currently, we are working with the University of British Columbia (UBC) and Centre for Telehealth at the Mental Health Evaluation and Community Consultation Unit (MHECCU) to bring the Healthy Brain Program to Fort Nelson, Fort St. John, Dawson Creek, Squamish, Sechelt and Powell River. We thank the participating communities and seniors for sharing their insights and reinforcing all that has been positive in the HBP. Young and old continue to benefit.

The Problem

Brain disease is reaching epidemic proportions.1,2,3 It is already the leading cause of age-adjusted disability worldwide and is projected to become the leading cause of death by 2040. 4 While we successfully reduced mortality from heart disease5 and major killers,6 we have little success in reducing the occurrence of brain disorders. The brain is an organ of the body, yet compared to other organs, medicine has little to offer to guide people who are at risk for or who are developing brain disease. We believe that physicians and consumers must develop a new perspective on the brain — one that goes beyond mere, often-too-late diagnosis; we must incorporate principles of health promotion and disease prevention specific to the brain.

Recently, researchers have generated well-designed, large scale studies of healthy and diseased, aged human brains,7 resulting in a rapidly expanding amount of data. Sifting this information, and translating it into prevention and treatment options is important for care providers and health care consumers alike. We all need fundamentally sound advice and practical approaches to improve brain health. Unfortunately, we are bombarded by conflicting and competing claims about treatments and procedures offering health and longevity. This information explosion is taking place in a disorganized, anti-intellectual environment where “junk science” proliferates. 8 Accessible, accurate information is often unavailable.

The Solution

That the HBP evokes memories of the Healthy Heart Program is not a coincidence. We use strategies that underlie highly successful healthy heart programs and apply them to the most important organ: the brain.

The HBP draws from evidence-based knowledge, debunks junk science, is user-friendly and client-focused. The aim of the HBP is to give people a fresh look at the brain and to help people to understand the brain as an organ of the body.

The program is based on eight categories of brain health, each of which is supported by sound empirical research. Through workshops, participants are introduced to each category and are provided both basic information and practical heath strategies to improve their function in each area:

  1. Safety: Even mild head injuries are risk factors for early onset depression and dementia. Care practices begin at birth. Concussion and mild traumatic brain injury (MTBI) may initially be asymptomatic but subsequent impacts carry increasing risk. The young and old are high risk groups for head injury. 9

  2. Nutrition: There is nothing that a person who is in a good state of nutrition can eat to improve brain health. Mild nutrient deficiency states are common, however, and they do have psychiatric presentations. Obesity, which is now an epidemic, is a risk factor for diabetes and vascular disorders, both of which lead to brain disease. We need to be aware of the dangers of ‘natural’ remedies which can interact with medications.10

  3. Physical exercise: The effects of exercise are so profound that exercise comes closest to what might be a fountain of youth. It improves circulation and produces many natural brain-boosting chemicals. Hormone balance, insulin resistance, sleep and general body chemistry are all improved. Exercise slows age-related organ deterioration.11

  4. Mental exercise: Brain stimulation increases blood flow and growth of specific brain regions and supports cells which feed neurons. Activity supports brain development and builds brain reserves against dementia.12

  5. Sleep: Sleep is a complex process that is vital not only to rest, but to consolidation of learning, optimal cognitive function, mood regulation, and feeling of well-being. Most people do not get enough sleep: those under stress, children and the elderly need more, not less sleep.13

  6. Stress management: While stress is ubiquitous, as are diseases related to it, most people are unaware of either the mechanisms of stress or the effects of stress on the brain. Excess stress hormones cause brain cell shrinkage and neuron death.14

  7. Hormone management: The brain is exquisitely sensitive to hormones. We need accurate information on the relationship between hormones and brain function. Orientation to benefits as well as hazards are very important.15

  8. Treatment of risk factors: The most common causes for doctor’s visits are depression, hypertension and diabetes — all risk factors for early-onset dementia. Physicians should be more assertive to educate and treat because evidence indicates that treatment will not only delay end-stage manifestations affecting the body, but what is more important, treatment delays premature deterioration of life quality accompanying early onset of brain impairment.16

There is collateral evidence for the efficacy of this type of health promotion. Healthy Heart Programs have been thoroughly studied17,18 with results generally indicating that these programs have positive impact on management of health risk factors and health care costs.19,20,21

Conclusions

Working with the HBP has taught us two clear lessons. First, when people encounter brain impairment they are totally unprepared. Second, the average person has no idea of how to care for the brain. People simply do not know how the brain is built, what the brain does, nor how to take care of it. The unfortunate result is that people often turn to junk science for explanations of the brain and to dangerous quack treatments. The HBP’s response to this is to teach people more about the brain, providing information at a very basic level of how the brain works and about safe, useful brain health practices.

The HBP is the first program of its kind. It has been accepted as the platform for mental health promotion by the [former] Coast Garibaldi Health Region.

 
About the author
Stephen is a geriatric psychiatrist with the Department of Psychiatry at St. Vincent’s Hospital and a Clinical Assistant Professor in the Department of Psychiatry at UBC. He also works with the mental health team in Squamish, at Squamish General Hospital, and with the West Side Team of Vancouver Community Mental Health Services
Footnote

For a full list of references, see www.healthybrain.org

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