Why Brain Health Matters — with Dr. Krystal L. Culler, DBH, MA

‍Terrence Wang (Welbi)   00:00

You're listening to Care: the Resident experience podcast from Welbi. Every month, we chat with some of the best leaders in senior living to discover and share innovative strategies and perspectives that will impact communities for years to come. This week, we're chatting with Dr. Krystal Culler, founder of the Virtual Brain Health Center. Krystal, how are you doing today?

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Krystal Culler (Virtual Brain Health Center)   00:19

I'm good, thank you for having me.

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‍Terrence Wang (Welbi)   00:21

Thank you for taking the time out of your day to join up. It has been a little bit of a struggle for both of us to find the right timing for this, but I'm really glad that we found the time to talk because I'm very excited to talk about brain health and what you've been doing around there.

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Krystal Culler (Virtual Brain Health Center)   00:37

I'm excited to be here. And the nice thing is with chatting brain health, less stress is best.

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‍Terrence Wang (Welbi)   00:44

100%. So it's nice to do this on a Friday afternoon. Nice and relaxed. Before we get too far into small talk, though, how did you start a virtual brain health center? That seems not like the first thing somebody would come up with, but it is something very interesting.

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Krystal Culler (Virtual Brain Health Center)   01:04

I appreciate you asking that question. It really started— I spent about five years in executive roles and health nonprofit organizations and other community-based programs for over a decade, helping adults be healthy as they’re aging. And when I saw what was happening with the pandemic and so many services being abruptly cut off, I wanted to see how I could help. So I thought back on the skills and knowledge that I have and called up a couple of colleagues and said, what if we can take brain health virtually to people in their homes and see what type of impact we could have? And today, it's been a growing journey. It's been wonderful. We've been in 28 countries and 33 states, so we’ve just been realizing the impact that virtual programming can have and the global interest around brain health.

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‍Terrence Wang (Welbi)   01:56

First off, congratulations. That is no small accomplishment to have that wide of a reach, especially as it's only been, what, not even two full years? So that is incredibly impressive.

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Krystal Culler (Virtual Brain Health Center)   02:09

Thank you. We were really excited. We initially had launched this with a small equity grant I received from my global fellowship to essentially serve my local community, Northeast Ohio. So realizing how far we've gone beyond that and that people want to come in and take up the charge for brain health is what keeps us going every day.

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‍Terrence Wang (Welbi)   02:28

That is fantastic. And with brain health specifically, I feel like that can be such a broad term. At a high level, what does that mean to you?

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Krystal Culler (Virtual Brain Health Center)   02:38

For us here at the center, we look at how to optimize our brains to thrive at any age. That’s the way we conceptualize brain health. But it's very true that we've lacked a universal definition of what brain health is and what falls under that. Broadly, thinking, feeling, and doing, anything related to those broad categories of tasks tend to fall in under our brain health. And we usually are asking our brain to do something for us: some type of output, attention, focus, memory, decision making, things that are very complex tasks, that was the older definition of brain health. But I think we've really shifted more to brain care and all the dimensions of wellness, or emotional, spiritual, physical, all of those different domains play a role, as well as environmental, to our overall brain health and well being.

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‍Terrence Wang (Welbi)   03:30

And I think it's really interesting because it's always been something that we've talked about, and I think everybody knows as you age your brain health naturally — you can't be 25 forever, right, but you can keep your brain health up and you can work on it. To me, it feels like the last five to ten years was when it really took off. What do you think prompted that movement?

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Krystal Culler (Virtual Brain Health Center)   03:53

I think you're right. We see all across the board that national surveys, global surveys, echo just the sentiment that you shared which is that people rank brain health as one of their top health concerns, typically under heart health, but they don't know what to do about it. We don't know what exactly all brain health is or the things that are tangible for us to do, but it's a top ranked health concern. So we find that people really are seeking out information to optimize their brains and to continue to thrive. And I think a lot of this is coming from the research where we see how much of a role our lifestyle, the way we live our lives every single day, can impact our brain. And just more recently, we see brain health is 90% lifestyle and 10% genetics. So there's many things we can do that are within our hands to make small, simple changes to help our brains drive and flourish moving forward.

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‍Terrence Wang (Welbi)   04:49

And I think, like me personally, I've seen so many of these articles. One concerning part for me, I haven't really read into the research too much, which always worries me because articles can be a little bit embellished or flourished. But a lot of these things are very scary, right? Like there's things that are like, oh, if you do this one thing for 30 years, then you're going to have memory loss or your cognitive function is going to be 60% of what it could be and then that's scary, right? So how do you approach that? Something that can be very scary and very non-tangible?

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Krystal Culler (Virtual Brain Health Center)   05:22

I'm glad you mentioned that because when we hear brain health, many times we have this positive outlook towards it, which we try to do with many things coming from a wellness perspective, but also taking time to reflect their sensitivity around a lot of aspects that come to our brain health and wellness, and you hit the top one. How our memory is, how we can talk with people about that, or when we should start noticing our memory health or our decision making. Another topic that might fall in that area that is a little touchy is nutrition. Not many people want to be told what they can't eat or what they should eat. It's all part of our lifestyle, how we connect with other people, heritage that comes down the years to us. So we tackle a lot of topics that have some level of sensitivity for people. And really what we try to do, and what I've done through most of my career is, how do we take that science as it becomes available online? So there’s research articles that you might be reading but maybe not many other people are digging that deep and realizing, what is it telling you that you can do today to have an impact on your health and well being?

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Krystal Culler (Virtual Brain Health Center)   06:27

And we're in that translational space of saying here's the latest science, here's the things you can do now, and here's what we're waiting to still find out. Because we've really been learning so much about our brain in the last two decades.

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‍Terrence Wang (Welbi)   06:38

I always like to talk about actual examples here. So what's something that you've come across recently that you've been featuring that is a new piece of research that people might not know about, but that they should know about their brain?

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Krystal Culler (Virtual Brain Health Center)   06:51

Yes, for us we really try to look into all the different topics that fall in under the brain. I think many times we just don't relate that what's on our plate or what's in our cup can impact our brain. Or the ways we move our bodies or if we're too sedentary, that has an impact on our brain. And I think the latest one we're seeing a lot more of really with the pandemic was how important our social health and well being is. It's been a part of the World Health Organization's definition of health is your physical, your social and mental since the mid 1940s. But really with the pandemic, just seeing all the ways that being social stimulates our minds and how it uplifts our spirits and seeing that really coming to light.

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‍Terrence Wang (Welbi)   07:38

That's really interesting that you mentioned it's been part of WHO's definition since the 40s because I hear about physical health all the time and I hear about mental health now. I think over the last 20 years there's been this big push that mental health is a very real thing. It's not something that's to be thrown under the bus. But social health I think is just starting to come into its own now. And I think that's especially true in senior living where a lot of the times traditionally that's been the most neglected, right? And people can feel isolated or they can feel lonely.

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Krystal Culler (Virtual Brain Health Center)   08:10

I think it’s really acknowledging the experiences that people have and seeing the ways we connect with each other. And like you said, we didn't always link it to our health. But having that awareness, even realizing most of this pandemic, it's simple, but the words we use are so important. We were really encouraging people to stay physically distant while socially connected. And you could see some of that language shift change over the first few months of the pandemic, because we were saying, well, stay socially distant. That was the wrong message. We wanted people to just be physically apart, but still find ways to engage in that social connection and their relationships with others and stay in touch.

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‍Terrence Wang (Welbi)   08:49

That's really important, because I think the pandemic made the shift faster to where immediately everybody had to embrace virtual and embrace digital. But I think that was a transition that was happening already, right? Like more and more people living by themselves or maybe more migration so that people aren't growing up in their hometown and staying in their hometown. So now all of a sudden, there's a lot more you by yourself, kind of sitting wherever you are, and you don't have that social aspect of your life anymore, right? I think it's especially true once you stop working. You can imagine somebody who's just recently retired. Now they're just at home. What's something that you can do to help stimulate your social health? Is stimulate your social health the right word, or improve your social health?

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Krystal Culler (Virtual Brain Health Center)   09:36

For many people, we focus on either strengthening connections we already have with people that are important to us or spending our time with people who just simply bring us joy and realizing how important it is. My rule of thumb I try to recommend to people is just if you can have one type of social connection a day. It doesn't necessarily have to be— I mean, we're fortunate we're here having a chat, or we can jump on with Zoom. But it could be reaching out to someone with a letter. Mailing a birthday card. A quick text. Somehow, whatever way you're communicating or having that, nurturing those relationships. Reaching out to others. And one point of contact a day seems pretty feasible for most people when you do it with the intention and purpose to strengthen those relationships as well as what you receive from others. When you have those relationships, that joy, that uplift, that spark.

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‍Terrence Wang (Welbi)   10:28

I think one point a day is very doable for anybody, whether they're living in a community or they're living at home. But there can be challenges, right? Because obviously, people do kind of fall into that trap of three, four, or five days without really interacting with somebody or interacting with somebody in a meaningful way. So what are some of those challenges, and how can we address them better?

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Krystal Culler (Virtual Brain Health Center)   10:50

No, I think you're really right on that. And we hear more about the digital divide. So the access that people may have to technology in order to engage with relationships. And we noticed that when we first launched our center, when we put out a virtual brain health center. We weren't sure how people would respond to the program. We heard there was a need and wanted to give back. But then in the first week of our launch, when we had people come in, and that was October of 2020, we were their first connection to someone else for months or weeks. And it was the fact they could still get on or they sought out and joined on Zoom. And we were so grateful to have people there and to start to be a resource for some, and then they can make other connections from there. But really recognizing that there are so many people out there who don't have those opportunities, and seeing how we can get technology to them, internet to them, even a phone sometimes, and supply that so we can do small things that bring us joy and help us connect with other people.

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‍Terrence Wang (Welbi)   11:54

Exactly. And I feel like one of the interesting things about brain health, specifically, is that so much of it, like you said, comes from that social aspect. And whether it's long term care homes or retirement homes, whether it's assisted or independent living, a lot of the social aspect falls on resident engagement or life enrichment or recreation, whatever you call it. It doesn't fall on traditional care like nursing, right? So it's really interesting, that shift of needing to provide more engagement, that being a health and wellness topic, not just a fun and boredom relieving process. But the investment in recreation, I don't think has been matched by the need for more recreation. So why do you think that there's that divide between what we choose to invest our money into as communities and what's actually super important that we should be investing money in? And why do you think there's that divide?

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Krystal Culler (Virtual Brain Health Center)   12:48

I think that's a great question. I know I experienced it with some of my previous job positions as well is that when we're thinking about the tangibles of our health and wellness and how we're connecting, it's hard to get an ROI on that. So it's hard to say if you spend X amount of dollars, this is what you get in a return. And like you said, many people, we have to just acknowledge it's an investment. And as we're getting more data, as there's more companies that are following when people do programs, and what are some health outcomes? How are people engaging? How can you better stretch your funds in different ways? And when you're getting information to do that in real time, then hopefully that will shift to having people say, this is the investment. Because on the front side, many times the way we get people into communities or tell them about our organization is all the great things you offer. All the wonderful things you're doing. Which would include, majorly, your life enrichment department as well. But also those social activities. People want to move in somewhere where they have access to things that they wouldn't have at their own home a lot of the time. So we use it for marketing on the front end, and how do we make it a really good investment for all communities at all levels?

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‍Terrence Wang (Welbi)   13:59

I think you hit on those two major points, right? Which is that communities are either looking at it as a marketing or sales tool ROI, where it's like, hey, if we invest more in life enrichment, then we'll have more residents coming in, they'll stay for longer and be happier, and that’ll boost ROI. Or, they look at it as a care component where it's like, if I spend more on this, there are long term health benefits. But I think for both of them, part of the challenge is that it's just so hard to measure this effect. Like, how can you be sure that it's these specific activities that convince somebody, this is why I want to come to this community and stay here? Or how can you measure such a specific health benefit over such an extended period of time, right? How are you communicating that to communities when you do talk to them?

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Krystal Culler (Virtual Brain Health Center)   14:48

I think that's the double edged sword of certain questions is what is in place where we can track engagement or how people are planning their programs and making those decisions? And even asking, what are some things that may not be so expensive, but are smaller, tangible, small wins you could have? And seeing if you put out a topic and people are coming, then, okay, where do we go from there? How do we get our residents engaged or the community people that we're working with? How do we get them to open up and let us know what they would like to see and be a part of, co creating some of those programs and services? I know for us, at times, it's really looking at what organizations think they need, and we start there, and then we realize what other people are asking for is a little different than what they had in mind. So how to ask questions differently but open ended so people can get involved, and letting residents be a part of that experience as well, and recognizing that to many people brain health, luckily, is like the kitchen sink of just about everything under health and well being, because you're always going to be learning something new and trying different things. But it's also something now that people have on their radar.

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‍Terrence Wang (Welbi)   15:58

And I find that really interesting because more than anything else with the social aspect, you have to involve your residents, right? Like, you can't just come up with these activities and these social programs and social activities in a vacuum where it's just a recreation staff coming up with it. You really need to involve the residents. And like you said, it's all about good question-asking. Do you ever work with staff themselves on how to ask those questions?

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Krystal Culler (Virtual Brain Health Center)   16:24

Yeah, we've worked with some organizations to help design what brain health might look like on their campus and what they're doing and what areas they would like to highlight based on needs as they ebb and flow. One example I have is in one of my previous roles, we rolled out a brain health program under lifelong learning. And as part of that, we invited staff, we invited the residents’ family members, and we invited some of their caregivers to come in. And what we found was as people were learning more about brain health, they would take it up. So carers could help get them [residents] more engaged in doing mentally stimulating activities in their room or also encourage them like, “hey, why don't we go check out this program down the hall?” when it's a movement based program or a musical program, things that we know can help stimulate the mind. And so as we educated pretty much all of the levels we were finding that families were coming in to get that information for themselves as well as how to use it with their loved one. We trained up some of our direct caregiver staff and then we trained up the organization to know you can come in and unplug for a little bit and learn about things you can do for your own brain health and wellbeing.

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Krystal Culler (Virtual Brain Health Center)   17:41

So really trying to hit it at all levels of people that can be involved. And I will say one pleasant surprise we learned is the lynch pins to some of this were people in housekeeping and engineering department because they're commonly in residents’ rooms or where people are living and seeing people in the halls. So they can mention a great something event that's going on when they know about it and they just have a little snippet of hey, go check this out down the hall, or this is great for you to maybe do to boost your physical activity. And they would walk people down to the room because they all knew what was going on and knew some different and innovative things that were happening to support people living there.

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‍Terrence Wang (Welbi)   18:23

That's really powerful. I think that is very powerful because I guess life enrichment isn't just about maybe like the two or three or four staff that are specifically there to manage activities. But everybody in the community has a piece to play in that from, like you said, people working in the halls all the way to people's family sitting at home who might chat with residents one, two, three times a week. Like everybody has a place to play in making sure everybody is socially engaged and everybody's active, right?

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Krystal Culler (Virtual Brain Health Center)   18:54

Yeah, and I think when we empower people to recognize the influence they can have, but also that this information is relevant for them too, it can hit so many levels. And in the first year of one of the programs we did get over 70% resident engagement in brain health but it was because we had all these other legs underneath it supporting it. So other people champion it, people within the communities, and just learning the overall interest that when they came up with a topic and said, “hey, we want to know more about the gender risk differences in the brain.” We did one about that. It's getting a person back in to continue that conversation once there's an interest that's been piqued, and that may have been flowing over time, but being able to be responsive and shift your programs to what your community is responding to in a way that suits their knowledge and keeps them seeking out more ways to engage with what you're offering.

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‍Terrence Wang (Welbi)   19:49

Yeah, and I think that's the golden goal, right? To be able to not just personalize your programs but have them evolve over time to fit exactly what the residents want, and what they're learning, and the pace of that learning. But that can also be extremely challenging to do right, especially at a personal level. So what are some of the strategies that you've used at the Virtual Brain Health Center and that you've seen in other programming to kind of do that and to evolve and personalize, and change over time?

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Krystal Culler (Virtual Brain Health Center)   20:21

Yeah, I think it's so wonderful. I mentioned earlier, brain health encompasses all these different topics, but really when we reach out and see what expertise is available within your community or your organization and how they can give gifts back. So when we've educated some communities up on brain health, finding out they have someone that's very advanced in knowing energy medicine and meditation and then asking them, would you like to give this back to the community? And next thing you know, they're starting to do the meditation or run a short program. So really leveraging some of the skill sets that are available. But especially for life enrichment. I mean, when they have the skills and the knowledge, they can do so many things, they wear so many hats already, but giving them some different support and saying, well, maybe we want to educate about nutrition, but most people don't want to hear talk just about diet. They're going to want to taste food, they're going to want to smell food, they're going to want to do something where they can put together a healthy plate. So thinking about all these different components that can tie in — the dietary department, your life enrichment departments, and other people that would want to come in to make some of these experiences really holistic and broader, and then knowing at times too, you could just break it down into something small where it's just maybe smoothie making in the afternoon for a brain boost.

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Krystal Culler (Virtual Brain Health Center)   21:45

So you might have started bigger but they're small things. We had learned a funny fact when we did that, people liked the smoothies but not the green ones, for some reason. It's just like you said, you evolve with your community. When it had one that had the rich berry colors, if it was red, if it was blue, they were willing to taste it. And despite leafy green being a really important part of a lot of smoothies, when it looked green, people were really hesitant to want to try. But you learn that from your communities. So I think a lot of it’s keeping an open mind on putting a program out there, getting feedback and evolving over time. So I will admit, the following year, we did not serve green smoothies. We put the leafy greens in, but they were hidden with things that would bring out more vibrant colors so the community could enjoy them. And that was the happy medium win.

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‍Terrence Wang (Welbi)   22:37

That's awesome. It's all about learning and improvising along the way, right? It can't be too easy to be hiding greens. I know, I've tried it before, and they always turn out this weird brownish purple color. Not the most appetizing thing, but they taste good, right?

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Krystal Culler (Virtual Brain Health Center)   22:53

Yeah. And I think you bring up the important part, too, is we eat with our eyes at times, so if it looks appealing, we're more open to try it or try even more of something. And if it's good for us, that's what we're trying to do. We want to get people the healthy nutrients that they can where they're at. And so really keeping in mind the visual system, its impact on our brain, and how all different elements throughout our community can help better boost that. For people you're trying to get engaged with your programs, for people you want to educate or to get people in on, you see something and you're like that's interesting, oh, food is involved. You might be a little more likely to go. So how can you leverage some of those wins to get more engagement?

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‍Terrence Wang (Welbi)   23:36

I think we've talked about a lot of the different ways that if you're running a community, you could start implementing elements of brain health into your programming, into your community. But if you were talking to somebody who had never implemented anything before and they were looking at taking that first step, what would be something that you would recommend to them?

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Krystal Culler (Virtual Brain Health Center)   23:55

I think that's a great question. One is they're excited to get involved in brain health, but to know that there are so many different elements that you can pick one area and build that up really well and go to the next area of brain health. So maybe you start with hydration stations to help people get hydrated better, educate on the importance of hydration. And then as that's gone out through your community, doing something else in a different realm, such as resting the mind, how can you use rest to your own benefit? So it can be meditation that's passive, it can be meditation that's active. Sometimes it's the coloring or the painting, the creative arts are a great resource for that, and letting them know and educating them up on how those tasks that they are doing, those programs they are participating in, can have an impact on their health and well being and asking them to let you know what they think later on. How was that program experience for you? What could we do a little differently? But I think many people need that education that links it together, of knowing oh, I did this because it's good for my brain and I feel better afterwards.

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Krystal Culler (Virtual Brain Health Center)   25:03

We might not always make that connection after we take a little rest or after a meditation, and having those prompts to help us really think about how this is beneficial to our health and wellbeing can go a really long way. So I think for anyone looking to get started is to pick one area and start it and do it really well, and then you can move on to the next thing. And for some of it, it just may be rebranding or renaming something you're already doing, just putting the health purpose and intent at the front of it.

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‍Terrence Wang (Welbi)   25:34

I think that's very powerful and I think very approachable, not having to create whole new programs or open up a whole new division to handle this, but just bring a new aspect into your existing programming, I think is a really simple step that a lot of communities can take. And if they want to take that next step and actually involve you guys at the Virtual Brainhouse Center, what's the best way they can start to get involved?

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Krystal Culler (Virtual Brain Health Center)   25:58

So we do some free event weeks throughout the year that's open to communities. We do Brain Awareness Week in March, we have a Summer Brain Health Boot Camp in June and Active Aging Week in October. So we do lots of different programs for free with other leaders in industry to help just show all the different things that are available for brain health and wellness and really the diversity of topics that you can do. And we invite communities to try that as well. But also we have other programs available throughout the year with specific topics that people are really interested in like memory and color reading in the brain. Why is that so important? Brain Games is always one people ask about. Where can you get the bang for your buck and what you should be doing? So really the questions that your communities may be asking and those that you serve, and how you can get them answers in creative engaging programs and keep those going on.

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‍Terrence Wang (Welbi)   26:58

That is awesome. So I will include the link to the Virtual Brainhouse Center in the description. What's the link again? If people want to just visit the URL.

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Krystal Culler (Virtual Brain Health Center)   27:08

We are at virtualbrainhealthcenter.com. 

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‍Terrence Wang (Welbi)   27:14

Nice and simple. You guys got a good domain with that one. That's an easy, nice domain.

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Krystal Culler (Virtual Brain Health Center)   27:19

We try to make it practical and simple for people. That's really our goal. There's so much information out there about brain health and wellness, but really making it as accessible as we can to more people. Knowing we're in a virtual environment has really allowed us to reach out to more people broader than Northeast Ohio, but also knowing we can do some things in person with people, we can help provide a lot of resources that are available. So I think the second takeaway for people to know is brain health is not expensive. It shouldn't be something that would blow your budget, but maybe it's shifting around some things or using what's already in your existing budget, and there's a lot of different ways you can approach that from a programming standpoint or resources standpoint. But to keep in mind, it costs a little, but it shouldn't be some high cost that's so off putting that most people can't try one piece of it to share with others.

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‍Terrence Wang (Welbi)   28:15

And the return on that investment is like we talked about. It is massive and it is such a big help for your community in terms of elevating the experience for all of your residents just with all the information that you shared today. Thank you so much, Krystal, for taking the time. It was lovely having you on the show and hopefully we can involve you more down the line.

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Krystal Culler (Virtual Brain Health Center)   28:34

Thank you for being here. I appreciate the opportunity to share a little bit more about brain health with your communities and your following.