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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The Cold Truth About Respiratory Infections
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The Pathogens That Came In From The Cold
Yesterday, we asked you about your climate-themed policy for avoiding respiratory infections, and got the above-depicted, below-described, set of answers:
- About 46% of respondents said “Temperature has no bearing on infection risk”
- About 31% of respondents said “It’s important to get plenty of cold, fresh air, as this kills/inactivates pathogens”
- About 22% of respondents said “It’s important to stay warm to avoid getting colds, flu, etc”
Some gave rationales, including…
For “stay warm”:
❝Childhood lessons❞
For “get cold, fresh air”:
❝I just feel that it’s healthy to get fresh air daily. Whether it kills germs, I don’t know❞
For “temperature has no bearing”:
❝If climate issue affected respiratory infections, would people in the tropics suffer more than those in colder climates? Pollutants may affect respiratory infections, but I doubt just temperature would do so.❞
So, what does the science say?
It’s important to stay warm to avoid getting colds, flu, etc: True or False?
False, simply. Cold weather does increase the infection risk, but for reasons that a hat and scarf won’t protect you from. More on this later, but for now, let’s lay to rest the idea that bodily chilling will promote infection by cold, flu, etc.
In a small-ish but statistically significant study (n=180), it was found that…
❝There was no evidence that chilling caused any acute change in symptom scores❞
Read more: Acute cooling of the feet and the onset of common cold symptoms
Note: they do mention in their conclusion that chilling the feet “causes the onset of cold symptoms in about 10% of subjects who are chilled”, but the data does not support that conclusion, and the only clear indicator is that people who are more prone to colds generally, were more prone to getting a cold after a cold water footbath.
In other words, people who were more prone to colds remained more prone to colds, just the same.
It’s important to get plenty of cold, fresh air, as this kills/inactivates pathogens: True or False?
Broadly False, though most pathogens do have an optimal operating temperature that (for obvious reasons) is around normal human body temperature.
However, given that they don’t generally have to survive outside of a host body for long to get passed on, the fact that the pathogens may be a little sluggish in the great outdoors will not change the fact that they will be delighted by the climate in your respiratory tract as soon as you get back into the warm.
With regard to the cold air not being a reliable killer/inactivator of pathogens, we call to the witness stand…
Polar Bear Dies From Bird Flu As H5N1 Spreads Across Globe
(it was found near Utqiagvik, one of the northernmost communities in Alaska)
Because pathogens like human body temperature, raising the body temperature is a way to kill/inactivate them: True or False?
True! Unfortunately, it’s also a way to kill us. Because we, too, cannot survive for long above our normal body temperature.
So, for example, bundling up warmly and cranking up the heating won’t necessarily help, because:
- if the temperature is comfortable for you, it’s comfortable for the pathogen
- if the temperature is dangerous to the pathogen, it’s dangerous to you too
This is why the fever response evolved, and/but why many people with fevers die anyway. It’s the body’s way of playing chicken with the pathogen, challenging “guess which of us can survive this for longer!”
Temperature has no bearing on infection risk: True or False?
True and/or False, circumstantially. This one’s a little complex, but let’s break it down to the essentials.
- Temperature has no direct effect, for the reasons we outlined above
- Temperature is often related to humidity, which does have an effect
- Temperature does tend to influence human behavior (more time spent in open spaces with good ventilation vs more time spent in closed quarters with poor ventilation and/or recycled air), which has an obvious effect on transmission rates
The first one we covered, and the third one is self-evident, so let’s look at the second one:
Temperature is often related to humidity, which does have an effect
When the environmental temperature is warmer, water droplets in the air will tend to be bigger, and thus drop to the ground much more quickly.
When the environmental temperature is colder, water droplets in the air will tend to be smaller, and thus stay in the air for longer (along with any pathogens those water droplets may be carrying).
Some papers on the impact of this:
- Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections
- A Decrease in Temperature and Humidity Precedes Human Rhinovirus Infections in a Cold Climate
So whatever temperature you like to keep your environment, humidity is a protective factor against respiratory infections, and dry air is a risk factor.
So, for example:
- If the weather doesn’t suit having good ventilation, a humidifier is a good option
- Being in an airplane is one of the worst places to be for this, outside of a hospital
Don’t have a humidifier? Here’s an example product on Amazon, but by all means shop around.
A crock pot with hot water in and the lid off is also a very workable workaround too
Take care!
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Can you die from long COVID? The answer is not so simple
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Nearly five years into the pandemic, COVID is feeling less central to our daily lives.
But the virus, SARS-CoV-2, is still around, and for many people the effects of an infection can be long-lasting. When symptoms persist for more than three months after the initial COVID infection, this is generally referred to as long COVID.
In September, Grammy-winning Brazilian musician Sérgio Mendes died aged 83 after reportedly having long COVID.
Australian data show 196 deaths were due to the long-term effects of COVID from the beginning of the pandemic up to the end of July 2023.
In the United States, the Centers for Disease Control and Prevention reported 3,544 long-COVID-related deaths from the start of the pandemic up to the end of June 2022.
The symptoms of long COVID – such as fatigue, shortness of breath and “brain fog” – can be debilitating. But can you die from long COVID? The answer is not so simple.
Jan Krava/Shutterstock How could long COVID lead to death?
There’s still a lot we don’t understand about what causes long COVID. A popular theory is that “zombie” virus fragments may linger in the body and cause inflammation even after the virus has gone, resulting in long-term health problems. Recent research suggests a reservoir of SARS-CoV-2 proteins in the blood might explain why some people experience ongoing symptoms.
We know a serious COVID infection can damage multiple organs. For example, severe COVID can lead to permanent lung dysfunction, persistent heart inflammation, neurological damage and long-term kidney disease.
These issues can in some cases lead to death, either immediately or months or years down the track. But is death beyond the acute phase of infection from one of these causes the direct result of COVID, long COVID, or something else? Whether long COVID can directly cause death continues to be a topic of debate.
Of the 3,544 deaths related to long COVID in the US up to June 2022, the most commonly recorded underlying cause was COVID itself (67.5%). This could mean they died as a result of one of the long-term effects of a COVID infection, such as those mentioned above.
COVID infection was followed by heart disease (8.6%), cancer (2.9%), Alzheimer’s disease (2.7%), lung disease (2.5%), diabetes (2%) and stroke (1.8%). Adults aged 75–84 had the highest rate of death related to long COVID (28.8%).
These findings suggest many of these people died “with” long COVID, rather than from the condition. In other words, long COVID may not be a direct driver of death, but rather a contributor, likely exacerbating existing conditions.
The symptoms of long COVID can be debilitating. Lysenko Andrii/Shutterstock ‘Cause of death’ is difficult to define
Long COVID is a relatively recent phenomenon, so mortality data for people with this condition are limited.
However, we can draw some insights from the experiences of people with post-viral conditions that have been studied for longer, such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS).
Like long COVID, ME/CFS is a complex condition which can have significant and varied effects on a person’s physical fitness, nutritional status, social engagement, mental health and quality of life.
Some research indicates people with ME/CFS are at increased risk of dying from causes including heart conditions, infections and suicide, that may be triggered or compounded by the debilitating nature of the syndrome.
So what is the emerging data on long COVID telling us about the potential increased risk of death?
Research from 2023 has suggested adults in the US with long COVID were at greater risk of developing heart disease, stroke, lung disease and asthma.
Research has also found long COVID is associated with a higher risk of suicidal ideation (thinking about or planning suicide). This may reflect common symptoms and consequences of long COVID such as sleep problems, fatigue, chronic pain and emotional distress.
But long COVID is more likely to occur in people who have existing health conditions. This makes it challenging to accurately determine how much long COVID contributes to a person’s death.
Research has long revealed reliability issues in cause-of-death reporting, particularly for people with chronic illness.
Determining the exact cause of someone’s death is not always easy. Pixabay/Pexels So what can we conclude?
Ultimately, long COVID is a chronic condition that can significantly affect quality of life, mental wellbeing and overall health.
While long COVID is not usually immediately or directly life-threatening, it’s possible it could exacerbate existing conditions, and play a role in a person’s death in this way.
Importantly, many people with long COVID around the world lack access to appropriate support. We need to develop models of care for the optimal management of people with long COVID with a focus on multidisciplinary care.
Dr Natalie Jovanovski, Vice Chancellor’s Senior Research Fellow in the School of Health and Biomedical Sciences at RMIT University, contributed to this article.
Rose (Shiqi) Luo, Postdoctoral Research Fellow, School of Health and Biomedical Sciences, RMIT University; Catherine Itsiopoulos, Professor and Dean, School of Health and Biomedical Sciences, RMIT University; Kate Anderson, Vice Chancellor’s Senior Research Fellow, RMIT University; Magdalena Plebanski, Professor of Immunology, RMIT University, and Zhen Zheng, Associate Professor, STEM | Health and Biomedical Sciences, RMIT University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why Your Brain Blinds You For 2 Hours Every Day
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…and then covers its tracks so that you don’t notice:
Now you see it…
The world you experience is not an accurate representation of reality. Your brain actively constructs your perception, editing your memories as they happen and manipulating your sense of time. What you perceive as the present moment is actually a processed and reconstructed version of past events.
Nor is your vision anywhere near as detailed as it seems. Only a small central portion is in high resolution, while the rest is blurry. Your brain compensates for this by filling in the gaps with its best guess and/or what it believes is there from the last time you saw it. Your eyes constantly make rapid movements called saccades, and during these (i.e. when your eyes are moving), your vision momentarily shuts down—making you effectively blind for (in total, if we add them all up) about two hours every day (according to this video, anyway; our calculations find it to be more than that, but you get the idea). Your brain stitches together the visual input, creating a seamless experience that feels continuous (much like an animation reel composed of still images).
Why does it do this?
It’s because your senses operate at different speeds—light reaches your eyes in nanoseconds, sound in milliseconds, and touch signals in tens of milliseconds. However, your brain processes these inputs together, creating the illusion of a smooth and simultaneous experience. In reality, what you perceive as the present is actually a delayed and selectively edited version of the past.
Instead of showing you the world as it is, your brain predicts what will happen next. In high-speed situations, such as playing table tennis, if your brain relied on past sensory data, you wouldn’t react in time. Instead, it estimates an object’s future position and presents that prediction as your visual reality.
This also means that because your brain effectively sees things slightly sooner than you do, your brain has already prepared multiple possible responses and when an event occurs, it quickly selects the most likely course of action, deleting the alternatives before you are even aware of them. By the time you think you’ve made a decision, your body has already acted.
This goes for more than just the things we think of as requiring quick reactions!
Walking is a complex task that involves multiple time layers—your brain processes past feedback, assesses your current state, and predicts future movements. That’s why it was something that cyberneticists found difficult to recreate for a very long time. If something unexpected happens, like slipping cartoon-style on a banana peel, your body reacts before you consciously notice the danger. Your spinal cord and brainstem trigger emergency reflexes to stabilize you before your conscious mind even catches up.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
This Main Feature Should Take You Two Minutes (and 18 Seconds) To Read ← There’s a problem nobody wants to talk about when it comes to speed-reading; can you guess what it is based on what we just talked about above?
Take care!
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How To Avoid Slipping Into (Bad) Old Habits
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Treating Bad Habits Like Addictions
How often have you started a healthy new habit (including if it’s a “quit this previous thing” new habit), only to find that you slip back into your old ways?
We’ve written plenty on habit-forming before, so here’s a quick recap before we continue:
How To Really Pick Up (And Keep!) Those Habits
…and even how to give them a boost:
How To Keep On Keeping On… Long Term!
But how to avoid the relapses that are most likely to snowball?
Borrowing from the psychology of addiction recovery
It’s well known that someone recovering from substance addiction should not have even a small amount of the thing they were addicted to. Not one sip of champagne at a wedding, not one drag of a cigarette, and so forth.
This can go for other bad habits too; make one exception, and suddenly you have a whole string of “exceptions”, and before you know it, it’s not the exception anymore; it’s the new rule—again.
Three things that can help guard against this are:
- Absolutely refuse to romanticize the bad habit. Do not fall for its marketing! And yes, everything has marketing even if not advertising; for example, consider the Platonic ideal of a junk-food-eating couch-potato who is humble, unassuming, agreeable, the almost-holy idea of homely comfort, and why shouldn’t we be comfortable after all, haven’t we earned our chosen hedonism, and so on. It’s seductive, and we need to make the choice to not be seduced by it. In this case for example, yes pleasure is great, but being sick tired and destroying our bodies is not, in fact, pleasurable in the long run. Which brings us to…
- Absolutely refuse to forget why you dropped that behavior in the first place. Remember what it did to you, remember you at your worst. Remember what you feared might become of you if you continued like that. This is something where journaling helps, by the way; remembering our low points helps us to avoid finding ourselves in the same situation again.
- Absolutely refuse to let your guard down due to an overabundance of self-confidence in your future self. We all can easily feel that tomorrow is a mystical land in which all productivity is stored, and also where we are strong, energized, iron-willed, and totally able to avoid making the very mistakes that we are right now in the process of making. Instead, be that strong person now, for the benefit of tomorrow’s you. Because after all, if it’s going to be easy tomorrow, it’s easy now, right?
The above is a very simple, hopefully practical, set of rules to follow. If you like hard science more though, Yale’s Dr. Steven Melemis offers five rules (aimed more directly at addiction recovery, so this may be a big “heavy guns” for some milder habits):
- change your life
- be completely honest
- ask for help
- practice self-care
- don’t bend the rules
You can read his full paper and the studies it’s based on, here:
Relapse Prevention and the Five Rules of Recovery
“What if I already screwed up?”
Draw a line under it, now, and move forwards in the direction you actually want to go.
Here’s a good article, that saves us taking up more space here; it’s very well-written so we do recommend it:
The Abstinence Violation Effect and Overcoming It
this article gives specific, practical advices, including CBT tools to use
Take care!
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Calm Your Mind with Food – by Dr. Uma Naidoo
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From the author of This Is Your Brain On Food, the psychiatrist-chef (literally, she is a Harvard-trained psychiatrist and an award-winning chef) is back with a more specific work, this time aimed squarely at what it says in the title; how to calm your mind with food.
You may be wondering: does this mean comfort-eating? And, well, not in the sense that term’s usually used. There will be eating and comfort will occur, but the process involves an abundance of nutrients, a minimization of health-deleterious ingredients, and a “for every chemical its task” approach. In other words, very much “nutraceuticals”, as our diet.
On which note: as we’ve come to expect from Dr. Naidoo, we see a lot of hard science presented simply and clearly, with neither undue sensationalization nor unnecessary jargon. We learn about the brain, the gut, relevant biology and chemistry, and build up from understanding ingredients to dietary patterns to having a whole meal plan, complete with recipes.
You may further be wondering: how much does it add that we couldn’t get from the previous book? And the answer is, not necessarily a huge amount, especially if you’re fairly comfortable taking ideas and creating your own path forwards using them. If, on the other hand, you’re a little anxious about doing that (as someone perusing this book may well be), then Dr. Naidoo will cheerfully lead you by the hand through what you need to know and do.
Bottom line: if not being compared to her previous book, this is a great standalone book with a lot of very valuable content. However, the previous book is a tough act to follow! So… All in all we’d recommend this more to people who want to indeed “calm your mind with food”, who haven’t read the other book, as this one will be more specialized for you.
Click here to check out Calm Your Mind With Food, and do just that!
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The CBT Workbook for Mental Health – by Dr. Simon Rego & Sarah Fader
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We have often reviewed psychology books here with a note saying “and no, it’s not just a book of the standard CBT techniques that you probably already know”.
So today, this one’s for anyone who was ever thinking “but I don’t know the standard CBT techniques and I would like to know them!”.
The authors outline specific solutions to many common quantifiable problems, with simple exercises that are well-explained and easy to implement.
Cognitive Behavioral Therapy (CBT) is not a panacea, but for the things it can be used for, it’s very effective and is a very good “first thing to reach for” to see if it works, because its success rate for a lot of problems is very high.
What kinds of things is this book most likely to help with? A lot of common forms of stress, anxiety, self-esteem issues, cravings, shame, and relationship issues. Other things too, but we can’t list everything and that list already covers a lot of very high-incidence stuff.
Bottom line: if CBT isn’t something already in your toolbox, this book will help you add all its best tips and tricks.
Click here to check out The CBT Workbook for Mental Health, and get tooled up!
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