Baby boomers can hardly believe it themselves. In 10 short years -- by 2020 -- they will hold that unthinkable collective title of "the older generation."

Just as that milestone looms large, so do statistical realities. According to the U.S. Census Bureau, in 2020 almost 20 percent of the U.S. population will be older than 65; more than 12 million people will be over 85; more than 500,000 will be older than 100 -- the fastest growing age group of all. A projection on Southern Illinois University School of Medicine's Web site proclaims "older adults will utilize over one-half of the nation's healthcare services."

How fast can you say "geriatrics"? The field is exploding by necessity. And providers are realizing the best way to tame projected healthcare needs is by taking preventive measures -- now.

The Promise of Brain Health

One area rife with possibility is brain fitness.

Yet baby boomers live in fear of Alzheimer's disease and its accompanying dementia, rating it second only to cancer as their most dreaded medical diagnosis. There is good news: There's plenty that can be done to prevent cognitive loss by keeping the brain enriched. Clearly, nurse practitioners need to be on the cutting edge of awareness to help aging patients and families stay on the healthy aging highway.

Paul Nussbaum, PhD, associate adjunct professor in the department of neurologic surgery at the University of Pittsburgh School of Medicine, has been lecturing across the country in an effort to educate health care providers, senior specialists and the public of the necessity for brain fitness.

The Brain Rules

"Historically the brain has not been the epicenter of our health. But guess what? It is the epicenter," Nussbaum tells ADVANCE. "Going back to the Egyptians, humans thought the heart was the universe. We still say things like 'I love you with all my heart.' We give the heart meaning it doesn't deserve. It's a pump. Emotions, feelings, intellect, memory? That's the brain."

Nussbaum pointed to 1998 as a turning point in brain knowledge. "That's when science discovered the brain can actually generate new brain cells," says Nussbaum. "The so-called critical period of brain development was flushed down the toilet. The real critical period of brain development? It's called 'life.'"

Offering hope to boomers, Nussbaum adds, "Chronological age is all made up. The brain doesn't know how old it is, and it doesn't care. It's irrelevant."

What it does care about, he noted, is being in an environment in which it is stimulated, shaped, reinforced. "The brain is dynamic, constantly reorganizing; it needs environmental input that's health-promoting."

A Fitness Club for the Brain

Peggy Bargmann, RN, specialized in gerontology and worked with Alzheimer's patients for 20 years before opening her consulting business. She's also the medical fortitude behind the Brain Fitness Club, housed at First United Methodist Church in Winter Park, Fla., offering 8 hours per week of brain stimulation. Club members with varying degrees of memory loss are referred to Bargmann by physicians.

"If there is even a helpful hypothesis out there, we look at it," says Bargmann of the club's underlying philosophy. "For example, some research says exercise stimulates brain health; so we go with that. We wear pedometers and have a goal of a certain number of steps per semester. We can't cure people, can't even promise improvement for sure. What we promote is brain health. If something could help, it's worth a shot."

Cognitive exercise is offered at the club as well, via games and various mental exercises. Ever read an article upside down? Members of the Brain Fitness Club have. It's just one of many brain-stimulating tasks they've tackled.

The club also works closely with the department of communication sciences and disorders at the University of Central Florida in Orlando. Graduate students provide 30 minutes of therapy each week for club members. In addition, the students assess the members' cognitive strengths and weaknesses and design stimulation workbooks for them to use at home on days when the club is not in session.

Nussbaum's Approach to Brain Health

Bargmann credits Nussbaum's teachings as being central to the club's brain fitness thrust. His influence is also at the core of many other brain fitness efforts, including those at Wilmington Senior Center in Wilmington, Del., ("His ideas are accessible and without cost," noted Susan Getman, executive director), and the Boost Your Brain Initiative supported by Winter Park Health Foundation in Winter Park, Fla., ("His approach is a good fit for us. It's holistic," explained Diana Silvey, program director for older adults).

Indeed, Nussbaum offers a five-pronged approach to brain health, for use across the life continuum. Here they are, with his commentary following each one:

Physical Activity

"Aerobic activity several times a week decreases the risk of dementia. Walking or dancing for 30 minutes a day does the trick. Every time the heart beats, 25 percent of the blood pumped goes to the brain. When you exercise, the heart beats more, so more blood goes to the brain and it is enriched."

Mental Stimulation

"Take on something novel and complex. Those two words are key. When something is new, complex and just plain hard, you stimulate the cortex of the brain -- the outer shell where we build brain reserve and develop new cellular connections. Learn a new language or to play the piano -- something you are not talented at doing. For me, it would be learning to change the oil in my car."

Nutrition

"The brain is 60 percent fat and needs healthy fats -- omega 3 fats found in fish. Look at evolution; you'll see the brain developed very quickly when we were close to water [ingesting a seafood diet] rather than when we became landlocked. The greatest civilizations in the history of man were near water. The brain also needs fruits and vegetables to flush out toxins."

Spirituality

"Stress causes hormones to explode in your body. Over a period it will do damage to your brain structurally and functionally. Meditation and prayer go a long way to reducing stress. We need to help people turn inward to quiet their stressors."

Socialization

"As you age, if you isolate and segregate -- retirement has a way of doing that to folks -- your brain also isolates and segregates, becomes passive and doesn't develop brain reserve; thus, you have higher risk for dementia. Keep connected with other people; find your purpose in this world, have a reason to get up in the morning."

Building a Brain Reserve

So what is this "brain reserve" to which Nussbaum refers?

"Think of flying over a jungle with trees and foliage so dense you can't even see the ground," says Nussbaum. "That's what you want for your brain, massive cellular foliage. Now think of flying over an island with only two little palm trees. Not good brain-wise. We need to grow the foliage of our brains so that even if we are struck by Alzheimer's disease, we have enough cellular connections so that the disease will not manifest."

Sound like a fairytale? Not so.

Case in point: The Nun Study, begun in the late 1980s by neurologist David Snowden, examined brains of more than 600 nuns who donated their organs posthumously for the purpose of aiding medical science. The nuns were studied during life for cognitive abilities; following their deaths their brains were explored for insights into Alzheimer's and other dementia.

"One of the findings," says Nussbaum, "was that even though there was Alzheimer's present in the brains of many of these nuns, they never manifested the disease outwardly. Clearly, at autopsy, the disease was there. But these nuns had what I call 'brain reserve.' They had lived lives of passionate beliefs, human connection, spirituality; they wrote detailed essays. Even though the disease was in their brains, they had enough reserve to fight off the effects."

Some Practical Strategies

Kathy Ruane, a nurse practitioner in community outreach at the department of geriatrics at the Greater Baltimore Medical Center in Maryland, works with seniors living independently in the community. She admits "senior moments" come to most people, due to stimulation extremes. "Sometimes we're overstimulated by having too many responsibilities. I call that having too many penguins on the ice floe. Some are bound to fall off.

"But usually memory loss is caused by decreased brain stimulation. As we age we have fewer things to stimulate our minds -- the kids are gone, so you don't have to keep track of them; maybe your husband's gone, too, so you don't have to keep track of him either. We must find alternative ways to stimulate the brain."

Ruane suggests reading, as well as mind games such as word searches, crossword puzzles, Sudoku and memory association games (example: name songs from the 40s, fads from the 50s or TV shows from the 60s.)

Ruane also encourages seniors to continue daily activities on their own. Health care professionals tend to do for their patients. Don't, Ruane cautions. "Encourage them to do for themselves. Make them figure out what they want for lunch; let them put on their gowns themselves. As much as we worry it will take longer -- and it will -- allow these patients to be active and stimulated. The more we can engage people in their own decision making, no matter how small, the better."

Continue to Educate

"Help patients identify stressors and find ways to reduce stress; teach them about nutrition and exercise and explain why it is important -- personalize it for every patient. Healthcare is traditionally good at telling people what to do, but not as good at explaining why," says Nussbaum.

Revealing his own braincentric preferences, Nussbaum proclaims, "With the brain 'it's all about me.' The brain is the central nervous system, not peripheral. Everything is about it. That heart pumping that blood is about the brain. That's why CPR is so important. Let's face it, when we're administering CPR we're not worrying about the big toe. When you've got a couple of minutes without blood flow, you've got problems cognitively.

"The brain is king."

Valerie Neff Newitt is senior associate editor at ADVANCE for Nurses. Reach her at vnewitt@advanceweb.com.