Is it OK to lie to someone with dementia?
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There was disagreement on social media recently after a story was published about an aged care provider creating “fake-away” burgers that mimicked those from a fast-food chain, to a resident living with dementia. The man had such strict food preferences he was refusing to eat anything at meals except a burger from the franchise. This dementia symptom risks malnutrition and social isolation.
But critics of the fake burger approach labelled it trickery and deception of a vulnerable person with cognitive impairment.
Dementia is an illness that progressively robs us of memories. Although it has many forms, it is typical for short-term recall – the memory of something that happened in recent hours or days – to be lost first. As the illness progresses, people may come to increasingly “live in the past”, as distant recall gradually becomes the only memories accessible to the person. So a person in the middle or later stages of the disease may relate to the world as it once was, not how it is today.
This can make ethical care very challenging.
Is it wrong to lie?
Ethical approaches classically hold that specific actions are moral certainties, regardless of the consequences. In line with this moral absolutism, it is always wrong to lie.
But this ethical approach would require an elderly woman with dementia who continually approaches care staff looking for their long-deceased spouse to be informed their husband has passed – the objective truth.
Distress is the likely outcome, possibly accompanied by behavioural disturbance that could endanger the person or others. The person’s memory has regressed to a point earlier in their life, when their partner was still alive. To inform such a person of the death of their spouse, however gently, is to traumatise them.
And with the memory of what they have just been told likely to quickly fade, and the questioning may resume soon after. If the truth is offered again, the cycle of re-traumatisation continues.
A different approach
Most laws are examples of absolutist ethics. One must obey the law at all times. Driving above the speed limit is likely to result in punishment regardless of whether one is in a hurry to pick their child up from kindergarten or not.
Pragmatic ethics rejects the notion certain acts are always morally right or wrong. Instead, acts are evaluated in terms of their “usefulness” and social benefit, humanity, compassion or intent.
The Aged Care Act is a set of laws intended to guide the actions of aged care providers. It says, for example, psychotropic drugs (medications that affect mind and mood) should be the “last resort” in managing the behaviours and psychological symptoms of dementia.
Instead, “best practice” involves preventing behaviour before it occurs. If one can reasonably foresee a caregiver action is likely to result in behavioural disturbance, it flies in the face of best practice.
What to say when you can’t avoid a lie?
What then, becomes the best response when approached by the lady looking for her husband?
Gentle inquiries may help uncover an underlying emotional need, and point caregivers in the right direction to meet that need. Perhaps she is feeling lonely or anxious and has become focused on her husband’s whereabouts? A skilled caregiver might tailor their response, connect with her, perhaps reminisce, and providing a sense of comfort in the process.
This approach aligns with Dementia Australia guidance that carers or loved ones can use four prompts in such scenarios:
- acknowledge concern (“I can tell you’d like him to be here.”)
- suggest an alternative (“He can’t visit right now.”)
- provide reassurance (“I’m here and lots of people care about you.”)
- redirect focus (“Perhaps a walk outside or a cup of tea?”)
These things may or may not work. So, in the face of repeated questions and escalating distress, a mistruth, such as “Don’t worry, he’ll be back soon,” may be the most humane response in the circumstances.
Different realities
It is often said you can never win an argument with a person living with dementia. A lot of time, different realities are being discussed.
So, providing someone who has dementia with a “pretend” burger may well satisfy their preferences, bring joy, mitigate the risk of malnutrition, improve social engagement, and prevent a behavioural disturbance without the use of medication. This seems like the correct approach in ethical terms. On occasion, the end justifies the means.
Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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On This Bright Day – by Dr. Susan Thompson
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This book is principally aimed at those who have struggled with emotional/comfort eating, over-eating, and/or compulsive eating of some kind.
However, its advices go for the “little compulsions” too, the many small unhealthy choices that add up. Thus, this book has value for most if not all of us.
The format is: each day has a little quotation, followed by a short discussion of that, which is then underlined by an affirmation for the day.
The main thrust of the book is to promote mindful eating, and it does this well with daily reminders that are helpful without being preachy.
Bottom line: if you enjoy “daily reader” type books and would like a daily reminder to practice mindful eating, then this book is for you!
Click here to check out On This Bright Day, and enjoy your food mindfully, every day!
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Creamy Fortifying Cauliflower Soup
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As delicious as it is super-easy to make, this one is full of protein, fiber, healthy fats, and some of the most health-giving spices around.
You will need
- 1 quart low-sodium vegetable stock
- 1 large cauliflower, cut into florets
- 1 large onion, finely chopped
- 2 cans cannellini (or other white) beans, drained and rinsed
- 1 cup raw cashews, soaked in hot water for at least 5 minutes, and drained (if allergic, substitute chickpeas)
- 1 bulb (yes, a whole bulb) garlic, roughly chopped
- 5 tbsp nutritional yeast
- 10 fresh sprigs of thyme (keep them whole!)
- 1 large fresh sprig of rosemary (keep this whole too!)
- zest of 1 lemon
- 1 tbsp red chili flakes
- 1 tbsp black pepper, coarse ground
- 1 tsp MSG or 2 tsp low-sodium salt
- ½ tsp ground turmeric
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Tightly tie up the sprigs of rosemary and thyme with kitchen twine (shining a bright light on it and asking it invasive questions is optional)
2) Heat some olive oil to a medium heat in your biggest sauté pan or similar. Add the onions, and cook for about 10 minutes, stirring as necessary. We are not trying to outright caramelize them here, but we do want them browned a little.
3) Add the garlic and cook for another 2 minutes, stirring frequently.
4) Add the vegetable stock, and stir, ensuring no onion is stuck to the base of the pan. Add the cauliflower, cashews, beans, nooch, pepper, turmeric, and MSG/salt, stirring to combine. Don’t worry if the cauliflower isn’t all submerged; it’ll be fine in a little while.
5) Add the herbs, submerging them in the soup (still tied up bouquet garni style).
6) Bring to a boil, reduce to a simmer and cook for 15–20 minutes; the cauliflower will be soft when it’s ready.
7) Remove the bouquet garni, and blend the soup until thick and creamy. You can do this with an immersion blender, but to get the smoothest soup, you’ll need to use a stand blender. Either ensure yours is safe for hot liquids, or else allow to cool, blend, and reheat later. This is important, as otherwise your blender could explode.
8) Serve, using the lemon zest and chili for the garnish:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Some Surprising Truths About Hunger And Satiety
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Early Bird Or Night Owl? Genes vs Environment
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A Sliding Slope?
In Tuesday’s newsletter, we asked you how much control you believe we have over our sleep schedule, and got the above-depicted, below-described, set of responses:
- 45% said “most people can control it; some people with sleep disorders cannot
- 35% said “our genes predispose us to early/late, but we can slide it a bit
- 15% said: “going against our hardwired sleep schedules is a road to ruin”
- 5% said “anyone can adjust their sleep schedule with enough willpower”
You may be wondering: what’s with those single-digit numbers in the graph there? And the answer is: Tuesday’s email didn’t go out at the usual time due to a scheduling mistake (sorry!), which is probably what affected the number of responses (poll response levels vary, but are usually a lot higher than this).
Note: yes, this does mean most people who read our newsletter don’t vote. So, not to sound like a politician on the campaign trail, but… Your vote counts! We always love reading your comments when you add those, too—often they provide context that allow us to tailor what we focus on in our articles
However, those are the responses we got, so here we are!
What does the science say?
Anyone can adjust their sleep with enough willpower: True or False?
False, simply. It’s difficult for most people, but for many people with sleep disorders, it is outright impossible.
In a battle of narcolepsy vs willpower, for example, no amount of willpower will stop the brain from switching to sleep mode when it thinks it’s time to sleep:
❝Narcolepsy is the most common neurological cause of chronic sleepiness. The discovery about 20 years ago that narcolepsy is caused by selective loss of the neurons producing orexins sparked great advances in the field
[There is also] developing evidence that narcolepsy is an autoimmune disorder that may be caused by a T cell-mediated attack on the orexin neurons and explain how these new perspectives can inform better therapeutic approaches.❞
~ Dr. Carrie Mahoney et al. (lightly edited for brevity)
Source: The neurobiological basis of narcolepsy
For further reading, especially if this applies to you or a loved one:
Our genes predispose us to early/late, but we can slide it a bit: True or False?
True! First, about our genes predisposing us:
…and also:
Gene distinguishes early birds from night owls and helps predict time of death
Now, as for the “can slide it a bit”, this is really just a function of the general categories of “early bird” and “night owl” spanning periods of time that allow for a few hours’ wiggle-room at either side.
However, it is recommended to make any actual changes more gradually, with the Sleep Foundation going so far as to recommend 30 minutes, or even just 15 minutes, of change per day:
Sleep Foundation | How to Fix Your Sleep Schedule
Going against our hardwired sleep schedule is a road to ruin: True or False?
False, contextually. By this we mean: our “hardwired” sleep schedule is (for most of us), genetically predisposed but not predetermined.
Also, genetic predispositions are not necessarily always good for us; one would not argue, for example, for avoiding going against a genetic predisposition to addiction.
Some genetic predispositions are just plain bad for us, and genes can be a bit of a lottery.
That said, we do recommend getting some insider knowledge (literally), by getting personal genomics tests done, if that’s a viable option for you, so you know what’s really a genetic trait (and what to do with that information) and what’s probably caused by something else (and what to do with that information):
Genetic Testing: Health Benefits & Methods
Take care!
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Why Has Nobody Told Me This Before? – by Dr. Julie Smith
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Superficially, this can be called a “self-help” book, but that undersells it rather. It’s a professionally-written (as in, by a professional psychologist) handbook full of resources. Its goal? Optimizing your mental health to help you stay resilient no matter what life throws your way.
While the marketing of this book is heavily centered around Dr. Smith’s Internet Celebrity™ status, a lot of her motivation for writing it seems to be precisely so that she can delve deeper into the ideas that her social media “bites” don’t allow room for.
Many authors of this genre pad their chapters with examples; there are no lengthy story-telling asides here, and her style doesn’t need them. She knows her field well, and knows well how to communicate the ideas that may benefit the reader.
The main “meat” of the book? Tips, tricks, guides, resources, systems, flowcharts, mental frameworks, and “if all else fails, do this” guidance. The style of the book is clear and simple, with very readable content that she keeps free from jargon without “dumbing down” or patronizing the reader.
All in all, a fine set of tools for anyone’s “getting through life” toolbox.
Get Your Personal Copy Of “Why Has Nobody Told Me This Before?” on Amazon Now!
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Intermittent Fasting, Intermittently?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Have you come across any research on alternate-day intermittent fasting—specifically switching between one day of 16:8 fasting and the next day of regular eating patterns? I’m curious if there are any benefits or drawbacks to this alternating approach, or if the benefits mainly come from consistent intermittent fasting?❞
Short and unhelpful answer: no
Longer and hopefully more helpful answer:
As you probably know, usually people going for approaches based on the above terms either
- practise 16:8 fasting (fast for 16 hours each day, eat during an 8-hour window) or
- practise alternate-day fasting (fast for 24 hours, eat whenever for 24 hours, repeat)
…which latter scored the best results in this large meta-analysis of studies:
There is also the (popular) less extreme version of alternate-day fasting, sometimes called “eat stop eat”, which is not a very helpful description because that describes almost any kind of eating/fasting, but it usually refers to “once per week, take a day off from eating”.
You can read more about each of these (and some other variants), here:
Intermittent Fasting: What’s The Truth?
What you are describing (doing 16:8 fasting on alternate days, eating whenever on the other days) is essentially: intermittent fasting, just with one 16-hour fast per 48 hours instead of per the usual 24 hours.
See also: International consensus on fasting terminology ← the section on the terms “STF & PF” covers why this gets nudged back under the regular IF umbrella
Good news: this means there is a lot of literature into the acute (i.e., occurring the same day, not long-term)* benefits of 16:8 IF, and that means that you will be getting those benefits, every second day.
You remember that meta-analysis we posted above? While it isn’t mentioned in the conclusion (which only praised complete alternate-day fasting producing the best outcomes overall), sifting through the results data discovers that time-restricted eating (which is what you are doing, by these classifications) was the only fasting method to significantly reduce fasting blood glucose levels.
(However, no significant differences were observed between any IF form and the reference (continuous energy restriction, CER, i.e. calorie-controlled) diets in fasting insulin and HbA1c levels)
*This is still good news in the long-term though, because getting those benefits every second day is better than getting those benefits on no days, and this will have a long-term impact on your healthy longevity, just like how it is better to exercise every second day than it is to exercise no days, or better to abstain from alcohol every second day than it is to abstain on no days, etc.
In short, by doing IF every second day, you are still giving your organs a break sometimes, and that’s good.
All the same, if it would be convenient and practical for you, we would encourage you to consider either the complete alternate-day fasting (which, according to a lot of data, gives the best results overall),or time-restricted eating (TRE) every day (which, according to a lot of data, gives the best fasting blood sugar levels).
You could also improve the TRE days by shifting to 20:4 (i.e., 20 hours fasting and 4 hours eating), this giving your organs a longer break on those days.
Want to learn more?
For a much more comprehensive discussion of the strengths and weaknesses of different approaches to intermitted fasting, check out:
Enjoy!
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How Much Does A Vegan Diet Affect Biological Aging?
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Slow Your Aging, One Meal At A Time
This one’s a straightforward one today, and the ““life hack” can be summed up:
Enjoy a vegan diet to enjoy younger biological age.
First, what is biological age?
Biological age is not one number, but a collection of numbers, as per different biomarkers of aging, including:
- Visual markers of aging (e.g. wrinkles, graying hair)
- Performative markers of aging (e.g. mobility tests)
- Internal functional markers of aging (e.g. tests for cognitive decline, eyesight, hearing, etc)
- Cellular markers of aging (e.g. telomere length)
We wrote more about this here:
Age & Aging: What Can (And Can’t) We Do About It?
A vegan diet may well impact multiple of those categories of aging, but today we’re highlighting a study (hot off the press; published only a few days ago!) that looks at its effect on that last category: cellular markers of aging.
There’s an interesting paradox here, because this category is:
- the most easily ignorable; because we all feel it if our knees are giving out or our skin is losing elasticity, but who notices if telomeres’ T/S ratio changed by 0.0407? ← the researchers, that’s who, as this difference is very significant
- the most far-reaching in its impact, because cellular aging in turn has an effect on all the other markers of aging
Second, how much difference does it make, and how do we know?
The study was an eight-week interventional identical twin study. This means several things, to start with:
- Eight weeks is a rather short period of time to accumulate cellular aging, let alone for an intervention to accumulate a significant difference in cellular aging—but it did. So, just imagine what difference it might make in a year or ten!
- Doing an interventional study with identical twin pairs already controlled for a lot of factors, that are usually confounding variables in population / cohort / longitudinal / observational studies.
Factors that weren’t controlled for by default by using identical twins, were controlled for in the experiment design. For example, twin pairs were rejected if one or more twin in a given pair already had medical conditions that could affect the outcome:
❝Inclusion criteria involved participants aged ≥18, part of a willing twin pair, with BMI <40, and LDL-C <190 mg/dL. Exclusions included uncontrolled hypertension, metabolic disease, diabetes, cancer, heart/renal/liver disease, pregnancy, lactation, and medication use affecting body weight or energy.
Eligibility was determined via online screening, followed by an orientation meeting and in-person clinic visit. Randomization occurred only after completing baseline visits, dietary recalls, and questionnaires for both twins❞
~ Dr. Varun Dwaraka et al. ← there’s a lot of “et al.” to this one; the paper had 16 collaborating authors!
As to the difference it made over the course of the 8 weeks…
❝Various measures of epigenetic age acceleration (PC GrimAge, PC PhenoAge, DunedinPACE) were assessed, along with system-specific effects (Inflammation, Heart, Hormone, Liver, and Metabolic).
Distinct responses were observed, with the vegan cohort exhibiting significant decreases in overall epigenetic age acceleration, aligning with anti-aging effects of plant-based diets. Diet-specific shifts were noted in the analysis of methylation surrogates, demonstrating the influence of diet on complex trait prediction through DNA methylation markers.❞
~ Ibid.
You can read the whole paper here (it goes into a lot more detail than we have room to here, and also gives infographics, charts, numbers, the works):
Were they just eating more healthily, though?
Well, arguably yes, as the results show, but to be clear:
The omnivorous diet compared to the vegan diet in this study was also controlled; both groups were given a healthy meal plan for their respective diet. So this wasn’t a case of “any omnivorous diet vs healthy vegan diet”, but rather “healthy omnivorous diet vs healthy vegan diet”.
Again, the paper itself has the full details—a short version is that it involved a healthy meal kit delivery service, followed by ongoing dietician involvement in an equal and carefully-controlled fashion.
So, aside from that one group had an omnivorous meal plan and the other vegan, both groups received the same level of “healthy eating” support, guidance, and oversight.
But isn’t [insert your preferred animal product here] healthy?
Quite possibly! For general health, general scientific consensus is that eating at least mostly plants is best, red meat is bad, poultry is neutral in moderation, fish is good in moderation, dairy is good in moderation if fermented, eggs are good in moderation if not fried.
This study looked at the various biomarkers of aging that we listed, and not every possible aspect of health—there’s more science yet to be done, and the researchers themselves are calling for it.
It also bears mentioning that for some (relatively few, but not insignificantly few) people, extant health conditions may make a vegan diet unhealthy or otherwise untenable. Do speak with your own doctor and/or dietician if unsure.
See also: Do We Need Animal Products To Be Healthy?
We would hypothesize, by the way, that the anti-aging benefits of a vegan diet are probably proportional to abstention from animal products—meaning that even if you simply have some “vegan days”, while still consuming animal products other days, you’ll still get benefit for the days you abstained. That’s just our hypothesis though.
Take care!
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