Navigating the brain fitness landscape: do's and don'ts

The excellent recent article “An idea whose time has (finally) come” (McKnight’s September issue, page 28, explains the multiple benefits that long-term care operators can expect from helping residents slow down or stave off cognitive decline and Alzheimer’s symptoms, and the growing role that  technology-based products are playing.

According to our recent market report, “The State of the Brain Fitness Software Market 2008,” more than 400 senior housing communities nationwide are offering computerized brain fitness tools to their residents, often as part of more comprehensive wellness initiatives. Seniors housing operators such as Senior Star Living, Belmont Village Senior Living, and Erickson Retirement Communities, along with insurance companies such as Humana, and multiple hospitals and health systems have been actively evaluating, piloting, rolling out a variety of products.

In fact, long-term care is one of the areas where high-tech cognitive training can make a significant difference. While much more research needs to be done to identify the right type of cognitive exercise that can help improve the daily functioning of any given individual, it is beyond doubt that novelty, variety and challenge (which the new programs present better than doing one more crossword puzzle or bingo session) contribute to healthy brain aging.

Lessons learned from the pioneers

What can we learn from the real experiences of some of those pioneers who have conducted pilot studies and rolled-out computerized cognitive exercise programs? Let me summarize some of our findings:

1) Use objective, independent assessments to measure benefits: Conducting a pilot study which includes independent pre- and post-cognitive evaluations will help identify the benefits and challenges of a program in your environment and compare the value of different approaches.

2) Provide quality information for staff and residents: Some communities create a library of programs by different manufacturers and a set of resources to assist each resident find an appropriate program. Residents, or their families, can then buy the programs based on the available information and first-hand testing.

3) Finding the right mix between structure, science and fun: There is no panacea, or program that works best for everyone. Some people prefer “fun games,” while others prefer more structured sessions or a more science-based approach. Before you commit to any major implementation make sure some of our residents use several programs for at least a month-and see which ones they are still using after a month.

4) The importance of structured classroom settings: “Build it and they will come” only works with a minority of highly motivated and functioning individuals. Offering the program as a structured class with a trained facilitator helps provide the motivation many residents need to complete the program. You can find facilitators among staff, volunteers and residents.

5) Positive feedback: Pioneers report a variety of benefits-from the increased satisfaction among residents who share their stories of mental improvement, to the families who are happy to see their loved ones engaged in new activities, to the resulting media coverage that often helps position the organization as a leading healthcare provider.

Knowing the product landscape

A growing number of vendors are offering products and solutions to long-term care organizations. Some options require purchasing a device. Others require installing software in PCs in existing or new computer labs. Others are fully available online. And still others may be technology-free, promising engaging combinations of interactive, group-based, activities with pen-and-paper exercises.

How can you navigate this landscape?

We suggest using our SharpBrains Checklist as you prepare your business case:

1. Early users:
Who among our residents is ready and willing to do the program? How are they reacting to the pilot testing of the program?

2. Cognitive benefits:
What are the specific benefits claimed for using this program? Under what scenario of use (how many hours/week, how many weeks)? What specific cognitive skill(s) does the program train? How will we measure progress?

3. Return on investment:
What are our key objectives, and how will we independently measure the progress due to this program so we can evaluate the business case to expand, maintain, or change course?

4. Appropriate challenge
: Do the exercises adjust to the individual and continually vary and challenge residents at an appropriate pace?

5. Scientific credentials: Are there scientists, ideally neuropsychologists, behind the program? Is there a clearly defined and credible scientific advisory board? Are there published, peer-reviewed scientific papers?

6. Product road map: What is the product roadmap for this company? What is the company developing and planning to offer next year, and in 2-3 years?

7. Technical requirements: What are the technical requirements needed to successfully deploy and maintain the program? Does it require an Internet connection? Who will help solve potential glitches?

8. Staff training: What type of training will my staff need, and who will provide it?

9. Total cost of ownership: What may be the total cost of ownership over the next three to five years if we go with this vendor: upfront fees, ongoing fees, hardware, software, training and support fees, cost of additional modules and staff time? How many residents will likely end up using the system, and therefore what is the cost of ownership per user?

10. References:
What similar communities have used this specific program? What proportion of their residents use it regularly? What benefits have they measured and observed in their residents, and as a community? Is the use of the program growing, or is it flat or declining?

Start early

Early adopters are able to differentiate themselves today by providing state-of-the-art information and tools. They are often rewarded with very positive testimonials by residents and their families. Additionally, they are preparing their communities for the future by moving up the learning curve required to find the best mix of products and practices for their unique environments.

Having said that, no program currently offers a dream combination of ideal characteristics, so you need to take into account your specific circumstances, priorities and budget. That’s why we typically suggest launching a pilot and measure results in objective, independent ways before embarking on major rollouts.

In other words, your organization will need to learn as much as your residents will.

* This article has been adapted from the special report “Brain Fitness Centers in Seniors Housing – A Field in The Making” (September 2008), prepared by Alvaro Fernandez, CEO of market research firm SharpBrains, for the American Seniors Housing Association (ASHA) and available at

Alvaro Fernandez is the co-founder and CEO of SharpBrains, a market research and consulting firm focused on applications of cognitive science and neuroscience. Fernandez is a member of the Global Agenda Councils initiative run by the World Economic Forum, and recently wrote the acclaimed special report Brain Fitness Centers in Seniors Housing: “A Field in the Making” <> for the American Seniors Housing Association. Alvaro has an MBA and MA in Education from Stanford University, and enjoys teaching The Science of Brain Health at UC-Berkeley Lifelong Learning Institute. To find out more, go to