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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Broccoli Sprouts & Sulforaphane
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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 😎
❝How much science is there behind sulforaphane / broccoli spirits and its health claims??❞
So, first of all, what it is: sulforaphane is a compound found in Brassica oleracea, of which species broccoli is a cultivar. It’s found in the other Brassica oleracea cultivars too (e.g. cauliflower, various cabbages, Brussels sprouts, kale, etc), but for whatever reason*, most research has been on broccoli and broccoli sprouts.
*Likely the reason is: research begets research—it’s easier to get funding to expand upon previous research, than it is to break ground on researching a different plant, where for the first third of your paper you have almost no existing scientific literature to cite. So once they got started on broccoli sprouts, everything else has been broccoli sprouts too.
And for clarity on what broccoli sprouts are: this means that when broccoli seeds have been germinated and just begun to sprout, they are harvested and eaten. That’s the one-line explanation, anyway; there’s a little more to it than that, so anyone interested should check out our previous main feature:
Good Things Come In Small Packages: Sprout Your Seeds, Grains, Beans, Etc
…and for more depth than we have room for in a one-page article, check out this book we reviewed:
The Sprout Book: Tap Into The Power Of The Planet’s Most Nutritious Food – by Doug Evans
One thing that the science is clear on: sprouts of a given plant indeed have much higher general nutritional density than their “adult” siblings. And in the case of sulforaphane specifically, it’s about 100x higher in broccoli sprouts than in adult broccoli:
Broccoli or Sulforaphane: Is It the Source or Dose That Matters? ← we suggest skipping down to the section “broccoli-based clinical trials”
So, that prompts the next question: do we care?
In other words: is sulforaphane really particularly important?
Sulforaphane vs cancer
The most well-evidenced health-giving property of sulforaphane is its anticancer activity:
Brassicaceae-Derived Anticancer Agents: Towards a Green Approach to Beat Cancer
A lot of the research there is epidemiological rather than RCTs, and where there are RCTs, they are mostly small ones, like this 10-person broccoli soup study about bioavailability (rather than the effects themselves):
Bioavailability of Glucoraphanin and Sulforaphane from High-Glucoraphanin Broccoli
To get into sulforaphane’s anticancer potential in seriousness, we have to look at a lot of in-vitro studies trialling it to limit carcinogenesis, or to shrink tumors with it, or specifically targetting cancer stem cells with it, which make for quite compelling reading:
A quick aside: if you’re reading that and thinking “Why is sonic the hedgehog in here?” it’s because after the observation of the influence of certain genes that influence cuticular denticles (the growth of spikes) on fruit fly larvae (bearing in mind the fruit fly Drosophila melanogaster is used for so much first- or second-line genetic research, being either the go-to or the go-to after the nematode C. elegans) caused the whole group of genes to get called “hedgehog genes” and then it became scientific convention to name each newly researched gene in that set after a different kind of hedgehog. One of them, instead of being named after a real-world hedgehog species like the others, got named after the videogame character.
Unfortunately, this now means that because the gene is associated with a certain congenital brain disorder, sometimes a doctor has to explain to a family that the reason their baby has a brain defect is because of a mutated sonic hedgehog.
Ok, back to talking about cancer. Let’s just quickly drop a few more papers so it’s clear that this is well-established:
- Multi-targeted prevention of cancer by sulforaphane ← this shows how it works on the cellular level
- Cruciferous vegetables: dietary phytochemicals for cancer prevention ← this shows how it works on the population level
However, that’s not the only established benefit:
❝SFN has other beneficial effects in addition to cancer protection. SFN exhibits neuroprotective effects and is implemented in treating conditions such as traumatic brain injury, Alzheimer’s disease and Parkinson’s disease.❞
Source: Sulforaphane in broccoli: The green chemoprevention!! Role in cancer prevention and therapy
Now, after the extract we quoted above, the rest of the section “other health benefits of sulforaphane” includes a lot of speculation, weak science, and/or things attributable to other phytochemicals in broccoli, including various polyphenols, vitamins, and minerals.
About those broccoli spirits
Ok, we know it was a typo, but… Actually, there is something worth mentioning here, and that’s that sulforaphane is only activated when glucoraphanin (its inactive form) comes into contact with myrosinase (an enzyme that’s only released when the plant is damaged).
In other words, it’s necessary to injure the broccoli before consuming it, in order to release the
spiritsmyrosinase. Now, while very few people are out there swallowing adult broccoli plants whole, it could well happen that people might wolf down uncut broccoli sprouts, since they are only small, after all.For this reason, it’s best that broccoli, even if it’s broccoli sprouts, be cut while raw before consumption.
In terms of cooking, heat in excess of 140℃ / 284℉ will destroy the glucoraphanin, and less/no glucoraphanin means less/no sulforaphane.
So, enjoying them raw or lightly steaming them seems to be best for this purpose:
Impact of thermal processing on sulforaphane yield from broccoli (Brassica oleracea L. ssp. italica)
Just want a supplement?
Many studies (including some cited by the research reviews we cited above) deal with sulforaphane in extract form, rather than whole plants, so there’s no shame in taking it that way if you’re not a fan of broccoli.
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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Total Fitness After 40 – by Nick Swettenham
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Time may march relentlessly on, but can we retain our youthful good health?
The answer is that we can… to a degree. And where we can’t, we can and should adapt what we do as we age.
The key, as Swettenham illustrates, is that there are lifestyle factors that will help us to age more slowly, thus retaining our youthful good health for longer. At the same time, there are factors of which we must simply be mindful, and take care of ourselves a little differently now than perhaps we did when we were younger. Here, Swettenham acts guide and instructor.
A limitation of the book is that it was written with the assumption that the reader is a man. This does mean that anything relating to hormones is assuming that we have less testosterone as we’re getting older and would like to have more, which is obviously not the case for everyone. However, happily, the actual advice remains applicable regardless.
Swettenham covers the full spread of what he believes everyone should take into account as we age:
- Mindset changes (accepting that physical changes are happening, without throwing our hands in the air and giving up)
- Focus on important aspects such as:
- strength
- flexibility
- mobility
- agility
- endurance
- Some attention is also given to diet—nothing you won’t have read elsewhere, but it’s a worthy mention.
All in all, this is a fine book if you’re thinking of taking up or maintaining an exercise routine that doesn’t stick its head in the sand about your aging body, but doesn’t just roll over and give up either. A worthy addition to anyone’s bookshelf!
Check Out Fitness After 40 On Amazon Today!
Looking for a more women-centric equivalent book? Vonda Wright M.D. has you covered (and her bio is very impressive)!
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Delicious Daily Daal
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You’re not obliged to eat this every day, but you might want to. The reason we called this one this, is because it’s a super simple recipe (don’t be put off by the long ingredients list; it’s mostly spices making it look long) which, after you’ve done it a couple of times, you could practically do it in your sleep quickly and easily.
The name “lentil daal” is a bit like “naan bread”—a redundant tautology repeated more than once unnecessarily, but it helps for international clarity. The dish is usually served with naan, by the way, and rice. We don’t have room for those today, maybe we’ll do them another day; for now, you can just cook rice how you normally do, and buy naan if necessary.
Writer’s note: I love strong flavors; many people don’t. For this reason I’m going to give a “basic” version. Please feel free to multiply the spices if you feel so inclined. Where I give “one teaspoon” of a spice below, I’d use a tablespoon at home. Chili peppers can vary in heat a lot even within the same type, so what I do for any given batch is taste one (raw), judge the heat, and use an appropriate number of peppers accordingly. If you don’t want to do that, I suggest just guessing low (as per the instructions below) and if you find at the end you want more heat, you can always stir in a little hot sauce. I know that sounds heretical, but at the end of the day, the primary goal of cooking is to have the meal you want at the end of it.
You will need
- 1 1/2 cups red lentils
- 1 large onion, chopped
- 1 large bulb garlic, minced
- 1 oz ginger, grated
- 2 hot peppers (e.g. serrano), chopped
- 1 tsp ground cumin
- 1 tsp ground coriander
- 1 tsp ground turmeric
- 1 tsp garam masala (this is also ground, but it doesn’t come any other way)
- 1 tsp chili flakes (omit if you’re not a fan of heat)
- 2 tsp cracked black pepper
- 1 tsp salt ← I wouldn’t recommend multiplying this one unless later, to taste. In fact, instead of 1 tsp salt I use 2 tsp MSG, which has less sodium than 1 tsp salt. But “1 tsp salt” is the “easy to find in the store” version.
- 2 large or 3 small tomatoes, chopped (or 1 can chopped tomatoes)
- 2 shallots, thinly sliced
- 1 tsp cumin seeds
- 1 tsp mustard seeds
- 1 tsp coriander seeds
- 1 tsp black peppercorns
- 1 lime
- 1/2 cup fresh cilantro, or if you have the “that tastes like soap” gene, parsley, chopped
- Coconut oil for cooking (if you don’t like coconut, consider springing for avocado oil—if you use olive oil, it’ll add an olivey taste which changes the dish a lot; not inherently bad, but it feels a lot less like traditional daal; seed oils are less healthy and we don’t recommend them; ghee is a traditional option and not bad in moderation, but not as healthy as the oils we mentioned first)
- Water for cooking the lentils
Method
(we suggest you read everything at least once before doing anything)
1) In a saucepan, boil water and add the lentils; let them simmer while doing the next things.
2) Sauté the onions until translucent. This should only take a few minutes.
3) Add the garlic, ginger, and hot peppers, and keep stirring for another couple of minutes.
4) Add the ground spices (cumin, coriander, turmeric, garam masala) chili flakes, and cracked black pepper, as well as the salt or MSG if using (not both), and stir them in quickly but thoroughly.
For the next step, you may need to transfer to larger pan if your sauté pan isn’t big enough to take the volume; if so, that’s fine, the sauté has done its job and can have a rest now. If your sauté pan is big enough, just carry on in the same pan; this is perfect.
5) Add the lentils with the water you cooked them in (there might not be much water left now, as the lentils will have absorbed a lot of it; this is fine) as well as the chopped tomatoes.
6) Simmer until it has the consistency of a very thick sauce (you can add a splash more water here and there if it seems to need more). In the West it’s common to serve lentils “al dente”, but in the East it’s usual to (for dishes like this) cook them until they start to
7) Add the juice of at least 1/2 of your lime, or the whole lime if you feel so inclined.
8) In a pre-heated skillet, flash-fry the sliced shallots and the seeds (cumin, coriander, mustard, black peppercorns) at the hottest temperature you can muster. Don’t worry if the oil smokes; we’re only going to be at this tadka-making stage for a moment and nothing will stick provided you keep it moving. When the seeds start popping, it’s ready. Add it all to the big pan and stir in.
9) Add the cilantro-or-parsley garnish once you’re ready to serve.
Enjoy!
Learn more
For those interested in some of the science of what we have going on today:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- How Much Spice Is Right?
- Tasty Polyphenols
Take care!
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Women don’t have a ‘surge’ in fertility before menopause – but surprise pregnancies can happen, even after 45
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Every now and then we see media reports about celebrities in their mid 40s having surprise pregnancies. Or you might hear stories like these from friends or relatives, or see them on TV.
Menopause signals the end of a woman’s reproductive years and happens naturally between age 45 and 55 (the average is 51). After 12 months with no periods, a woman is considered postmenopausal.
While the chance of pregnancy is very low in the years leading up to menopause – the so called menopausal transition or perimenopause – the chance is not zero.
So, what do we know about the chance of conceiving naturally after age 45? And what are the risks?
IKO-studio/Shutterstock Is there a spike in fertility before menopause?
The hormonal changes that accompany perimenopause cause changes to the menstrual cycle pattern, and some have suggested there can be a “surge” in fertility at perimenopause. But there’s no evidence this exists.
In the years leading up to menopause, a woman’s periods often become irregular, and she might have some of the common symptoms of menopause such as hot flushes and night sweats.
This might lead women to think they have hit menopause and can’t get pregnant anymore. But while pregnancy in a woman in her mid 40s is significantly less likely compared to a woman in her 20s or 30s, it’s still possible.
The stats for natural pregnancies after age 45
Although women in their mid- to late 40s sometimes have “miracle babies”, the chance of pregnancy is minimal in the five to ten years leading up to menopause.
The monthly chance of pregnancy in a woman aged 30 is about 20%. By age 40 it’s less than 5% and by age 45 the chance is negligible.
We don’t know exactly how many women become pregnant in their mid to late 40s, as many pregnancies at this age miscarry. The risk of miscarriage increases from 10% in women in their 20s to more than 50% in women aged 45 years or older. Also, for personal or medical reasons some pregnancies are terminated.
According to a review of demographic data on age when women had their final birth across several countries, the median age was 38.6 years. But the range of ages reported for last birth in the reviewed studies showed a small proportion of women give birth after age 45.
Having had many children before seems to increase the odds of giving birth after age 45. A study of 209 women in Israel who had conceived spontaneously and given birth after age 45 found 81% had already had six or more deliveries and almost half had had 11 or more previous deliveries.
Conceiving naturally at age 45 plus is not unheard of. pixelheadphoto digitalskillet/Shutterstock There’s no reliable data on how common births after age 45 are in Australia. The most recent report on births in Australia show that about 5% of babies are born to women aged 40 years or older.
However, most of those were likely born to women aged between 40 and 45. Also, the data includes women who conceive with assisted reproductive technologies, including with the use of donor eggs. For women in their 40s, using eggs donated by a younger woman significantly increases their chance of having a baby with IVF.
What to be aware of if you experience a late unexpected pregnancy
A surprise pregnancy late in life often comes as a shock and deciding what to do can be difficult.
Depending on their personal circumstances, some women decide to terminate the pregnancy. Contrary to the stereotype that abortions are most common among very young women, women aged 40–44 are more likely to have an abortion than women aged 15–19.
This may in part be explained by the fact older women are up to ten times more likely to have a fetus with chromosomal abnormalities.
There are some extra risks involved in pregnancy when the mother is older. More than half of pregnancies in women aged 45 and older end in miscarriage and some are terminated if prenatal testing shows the fetus has the wrong number of chromosomes.
This is because at that age, most eggs have chromosomal abnormalities. For example, the risk of having a pregnancy affected by Down syndrome is one in 86 at age 40 compared to one in 1,250 at age 20.
There are some added risks associated with pregnancy when the mother is older. Natalia Deriabina/Shutterstock Apart from the increased risk of chromosomal abnormalities, advanced maternal age also increases the risk of stillbirth, fetal growth restriction (when the unborn baby doesn’t grow properly), preterm birth, pre-eclampsia, gestational diabetes and caesarean section.
However, it’s important to remember that since the overall risk of all these things is small, even with an increase, the risk is still small and most babies born to older mothers are born healthy.
Multiple births are also more common in older women than in younger women. This is because older women are more likely to release more than one egg if and when they ovulate.
A study of all births in England and Wales found women aged 45 and over were the most likely to have a multiple birth.
The risks of babies being born prematurely and having health complications are higher in twin than singleton pregnancies, and the risks are highest in women of advanced maternal age.
What if you want to become pregnant in your 40s?
If you’re keen to avoid pregnancy during perimenopause, it’s recommended you use contraception.
But if you want to get pregnant in your 40s, there are some things you can do to boost your chance of conceiving and having a healthy baby.
These include preparing for pregnancy by seeing a GP for a preconception health check, taking folic acid and iodine supplements, not smoking, limiting alcohol consumption, maintaining a healthy weight, exercising regularly and having a nutritious diet.
If you get good news, talking to a doctor about what to expect and how to best manage a pregnancy in your 40s can help you be prepared and will allow you to get personalised advice based on your health and circumstances.
Karin Hammarberg, Adjunct Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Lucid Dreaming – by Stephen LaBerge Ph.D.
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For any unfamiliar: lucid dreaming means being aware that one is dreaming, while dreaming, and exercising a degree of control over the dream. Superficially, this is fun. But if one really wants to go deeper into it, it can be a lot more:
Dr. Stephen LaBerge takes a science-based approach to lucid dreaming, and in this work provides not only step-by-step instructions of several ways of inducing lucid dreaming, but also, opens the reader’s mind to things that can be done there beyond the merely recreational:
In lucid dreams, he argues and illustrates, it’s possible to talk to parts of one’s own subconscious (Inception, anyone? Yes, this book came first) and get quite an amount of self-therapy done. And that hobby you wish you had more time to practice? The possibilities just became limitless. And who wouldn’t want that?
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How Useful Is Hydrotherapy?
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Hyyyyyyydromatic…
Hydrotherapy is a very broad term, and refers to any (external) use of water as part of a physical therapy. Today we’re going to look at some of the top ways this can be beneficial—maybe you’ll know them all already, but maybe there’s something you hadn’t thought about or done decently; let’s find out!
Notwithstanding the vague nature of the umbrella term, some brave researchers have done a lot of work to bring us lots of information about what works and what doesn’t, so we’ll be using this to guide us today. For example:
Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body
Swimming (and similar)
An obvious one, this can for most people be a very good full-body exercise, that’s exactly as strenuous (or not) as you want/need it to be.
It can be cardio, it can be resistance, it can be endurance, it can be high-intensity interval training, it can be mobility work, it can be just support for an aching body that gets to enjoy being in the closest to zero-gravity we can get without being in freefall or in space.
See also: How To Do HIIT (Without Wrecking Your Body)
Depending on what’s available for you locally (pool with a shallow area, for example), it can also be a place to do some exercises normally performed on land, but with your weight being partially supported (and as a counterpoint, a little resistance added to movement), and no meaningful risk of falling.
Tip: check out your local facilities, to see if they offer water aerobics classes; because the water necessitates slow movement, this can look a lot like tai chi to watch, but it’s great for mobility and balance.
Water circuit therapy
This isn’t circuit training! Rather, it’s a mixture of thermo- and cryotherapy, that is to say, alternating warm and cold water immersion. This can also be interspersed with the use of a sauna, of course.
See also:
- Ice Baths: To Dip Or Not To Dip?
- Saunas: Health Benefits (& Caveats)
- The Stress Prescription (Against Aging!)
this last one is about thermal shock-mediated hormesis, which sounds drastic, but it’s what we’re doing here with the hot and cold, and it’s good for most people!
Pain relief
Most of the research for this has to do with childbirth pain rather than, for example, back pain, but the science is promising:
Post-exercise recovery
It can be tempting to sink into a hot bath, or at least enjoy a good hot shower, after strenuous exercise. But does it help recovery too? The answer is probably yes:
Effect of hot water immersion on acute physiological responses following resistance exercise
For more on that (and other means of improving post-exercise recovery), check out our previous main feature:
How To Speed Up Recovery After A Workout (According To Actual Science)
Take care!
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