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2014 Senior Care Innovation Scholarship Winner Nicholas Bott

Tina Gunn
By Tina GunnMay 3, 2014

A Place for Mom is proud to announce the winning essays of our annual $1,000 scholarship for the advancement in the field of gerontology. 10 finalists were narrowed down to 5 winners whom are being awarded with a financial donation. Applicants were required to write a compelling essay about senior care innovation in preparing for America’s “Silver Tsunami” of aging Baby Boomers.

Congratulations to Nicholas Bott, 2014 Senior Care Innovation Scholarship Winner! We invite you to read Nicholas’ essay below and comment with your thoughts.

Senior Care Innovation Winner 2014 Nicholas Bott

Nicholas’ Essay

On a recent day in clinic I was struck by the juxtaposition of two consecutive patients. The first, Mrs. Z, was 75 years old and had some concerns about her memory. The results of the neuropsychological testing I performed were reassuring. Her memory was fine. Actually, better than fine, it was great. And not only that, her processing speed was phenomenal. Her concerns about memory difficulties may have been more attributable to her endorsement of some symptoms of anxiety. My next appointment was with Mr. S, also 75 years old, who also had concerns about his memory. But this time the results of testing were more sobering. Mr. S was having difficulty with short-term memory, and showed generalized cognitive slowing, or bradyphrenia. And while Mr. S’s difficulties were best described as mild cognitive impairment (MCI), an underlying neurodegenerative disease may already have been present. What struck me were the starkly differing cognitive trajectories of these patients, even in the absence of a dementia diagnosis. Why was Mrs. Z doing so well cognitively, and why was Mr. S beginning to experience cognitive slippage?

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Over the next forty years, the cumulative cost of care for individuals with Alzheimer’s disease has been estimated at $20 trillion in today’s dollars. And long before the diagnosis of Alzheimer’s our aging population will be experiencing healthy, or typical cognitive aging. While healthy cognitive aging is accompanied by declines in memory, one of the most salient cognitive changes associated with typical aging is a decline in processing speed. If declines in these areas continue unabated, it can progress to MCI, and dementia – characterized by functional impairment in the face of cognitive decline. It is not surprising, then, that declining cognition as a result of aging is of great concern for the individual in question, as well as those who may care for them. Interestingly, though, declines in the areas of memory and processing speed are not uniform; there is considerable variability in the degree to which processing speed and memory changes with age. So-called “super-agers” have been variously defined as older adults with memory or processing speed performances comparable to adults 20-50 years younger. In the absence of disease-modifying therapies, which will play a crucial role in stemming the tide of neurodegenerative disease in our population, interventions that extend an individual’s healthy cognitive aging trajectory, if even for 6 months or a year, will significantly reduce the economic burden associated with neurodegenerative disease.

Research into the biological and lifestyle factors, which contribute to cognitive aging, have preliminarily suggested that lifestyle factors such as physical activity, not smoking, and healthy nutritional patterns may be protective against the effects of cognitive aging. In much the same way that cardiovascular health interventions such as diet, exercise, and not smoking have been embraced at a societal level to promote physical health, public awareness and campaigning for cognitive health is beginning to build momentum. The awakening of the public consciousness to the impending “tsumani,” and the role that lifestyle factors can play in mitigating the impact once the storm makes landfall.

Additionally, cognitive training has been consistently and negatively associated with age-related cognitive decline. While cognitive training, popularized by companies like Lumosity, has enjoyed much of the press and research focus as an intervention to counter the effects of cognitive aging, less attention has been paid to contemplative practices such as focused attention, yogic meditation, mindfulness-based interventions (e.g., Mindfulness-based cognitive therapy; Mindfulness-based stress reduction), progressive muscle relaxation, or transcendental meditation, as interventions to remediate or slow the process of cognitive aging. While still in its infancy, contemplative interventions for older adults have found modest support in their ability to offset age-related cognitive decline. Contemplative-based interventions have the potential to effect cognitive and extra-cognitive domains, such as physical activity, the promotion of healthy lifestyles, and social interaction. And while motivating older adults to engage in contemplative practices has its own unique challenges, it offers its own set of unique benefits. The processes of age-related cognitive decline and pathological aging due to neurodegenerative disease are bound up with significant questions around meaning, existence, and often lead to the evaluation or reevaluation of beliefs about spirituality. Contemplative interventions for older adults hold promise for offering dedicated time and space for these important aspects of life to be addressed, within the context of extending cognitive functioning.

The importance of preventative healthcare for an aging population cannot be underestimated. In addition to typical preventative measures such as routine checkups and vaccinations, preventative interventions designed to keep aging individuals cognitively engaged are a huge area of intervention that needs to be pursued in tandem with continued research on potential disease-modifying pharmacotherapies. The upside of pursuing such preventative cognitive interventions is the potential to involve the larger community beyond professional caregivers in senior care and living facilities. The possibilities for involving younger generations are much greater when aging individuals have not already received a diagnosis of dementia. In short, preventative healthcare for an aging population starts before an individual is known to be at risk.

This vision for innovation in the senior care industry focuses on preventative interventions that promote cognitive resilience and extend the time of healthy cognitive aging, thereby decreasing the overall length of time required to care for individuals with pathological cognitive aging. And while it can be hard to motivate others to engage in preventative actions, I have been fortunate enough to see just how powerful preventative interventions can be.

Finally, my research in the Memory and Aging Center at the University of California San Francisco has focused on identification of specific lifestyle, cardiovascular, and neuroanatomical factors associated with superior cognitive aging. This experience has allowed me to contribute to the scientific understanding cognitive aging, and gain a better understanding of the importance of interventions to promote cognitive health. And while I will continue my line of research investigating superior cognitive aging, I am excited to experimenting with ways to disseminate the knowledge we already have regarding the importance of cognitive and behavioral interventions to benefit cognitive health. My hope is that one day, public awareness of the importance of cognitive health maintenance and longevity will be translated into cultural maxims that embrace the factors we are continuing to uncover that contribute to healthy cognitive aging.

View and read all of the 2014 Senior Care Innovation Scholarship finalists and congratulate them on making it closer to the scholarship prize.

Did Nicholas’ essay inspire you? Don’t forget to share your thoughts below.

Tina Gunn
Tina Gunn
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