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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How Much Difference Do Probiotic Supplements Make, Really?
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How Much Difference Do Probiotic Supplements Make?
There are three main things that get talked about with regard to gut health:
- Prebiotics (fibrous foods)
- Probiotics (things containing live “good” bacteria)
- Postbiotics (things to help them thrive)
Today we’ll be talking about probiotics, but if you’d like a refresher on general gut health, here’s our previous main feature:
Making Friends With Your Gut (You Can Thank Us Later)
What bacteria are in probiotics?
There are many kinds, but the most common by far are Lactobacillus sp. and Bifidobacteria sp.
Taxonomical note: “sp.” just stands for “species”. The first name is the genus, which contains a plurality of (sometimes, many) species.
Lactobacillus acidophilus, also written L. acidophilus, is a common species of Lactobacillus sp. in probiotics.
Bifidobacterium bifidum, also written B. bifidum, is a common species of Bifidobacterium sp. in probiotics.
What difference do they make?
First, and perhaps counterintuitively, putting more bacteria into your gut has a settling effect on the digestion. In particular, probiotics have been found effective against symptoms of IBS and ulcerative colitis, (but not Crohn’s):
- Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review
- The role of probiotics in the prevention and treatment of IBS and other related diseases: a systematic review of randomized human clinical trials
- Safety and Potential Role of Lactobacillus rhamnosus GG Administration as Monotherapy in Ulcerative Colitis Patients
- Probiotics for induction of remission in Crohn’s disease
Probiotics are also helpful against diarrhea, including that caused by infections and/or antibiotics, as well as to reduce antibiotic resistance:
- Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children
- Probiotic approach to prevent antibiotic resistance
Probiotics also boost the immune system outside of the gut, too, for example reducing the duration of respiratory infections:
You may recallthe link between gut health and brain health, thanks in large part to the vagus nerve connecting the two:
The Brain-Gut Highway: A Two-Way Street
No surprises, then, that probiotics benefit mental health. See:
- The effects of probiotics on mental health and hypothalamic-pituitary-adrenal axis: A randomized, double-blind, placebo-controlled trial
- A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood
- Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial
There are so many kinds; which should I get?
Diversity is good, so more kinds is better. However, if you have specific benefits you’d like to enjoy, you may want to go stronger on particular strains:
Choosing an appropriate probiotic product for your patient: An evidence-based practical guide
Where can I get them?
We don’t sell them, but here’s an example product on Amazon, for your convenience.
Alternatively, you can check out today’s sponsor, who also sell such; we recommend comparing products and deciding which will be best for you
Enjoy!
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Make Your Negativity Work For You
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What’s The Right Balance?
We’ve written before about positivity the pitfalls and perils of toxic positivity:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
…as well as the benefits that can be found from selectively opting out of complaining:
A Bone To Pick… Up And Then Put Back Where We Found It
So… What place, if any, does negativity usefully have in our lives?
Carrot and Stick
We tend to think of “carrot and stick” motivation being extrinsic, i.e. there is some authority figure offering is reward and/or punishment, in response to our reactions.
In those cases when it really is extrinsic, the “stick” can still work for most people, by the way! At least in the short term.
Because in the long term, people are more likely to rebel against a “stick” that they consider unjust, and/or enter a state of learned helplessness, per “I’ll never be good enough to satisfy this person” and give up trying to please them.
But what about when you have your own carrot and stick? What about when it comes to, for example, your own management of your own healthy practices?
Here it becomes a little different—and more effective. We’ll get to that, but first, bear with us for a touch more about extrinsic motivation, because here be science:
We will generally be swayed more easily by negative feelings than positive ones.
For example, a study was conducted as part of a blood donation drive, and:
- Group A was told that their donation could save a life
- Group B was told that their donation could prevent a death
The negative wording given to group B boosted donations severalfold:
Read the paper: Life or Death Decisions: Framing the Call for Help
We have, by the way, noticed a similar trend—when it comes to subject lines in our newsletters. We continually change things up to see if trends change (and also to avoid becoming boring), but as a rule, the response we get from subscribers is typically greater when a subject line is phrased negatively, e.g. “how to avoid this bad thing” rather than “how to have this good thing”.
How we can all apply this as individuals?
When we want to make a health change (or keep up a healthy practice we already have)…
- it’s good to note the benefits of that change/practice!
- it’s even better to note the negative consequences of not doing it
For example, if you want to overcome an addiction, you will do better for your self-reminders to be about the bad consequences of using, more than the good consequences of abstinence.
See also: How To Reduce Or Quit Alcohol
This goes even just for things like diet and exercise! Things like diet and exercise can seem much more low-stakes than substance abuse, but at the end of the day, they can add healthy years onto our lives, or take them off.
Because of this, it’s good to take time to remember, when you don’t feel like exercising or do feel like ordering that triple cheeseburger with fries, the bad outcomes that you are planning to avoid with good diet and exercise.
Imagine yourself going in for that quadruple bypass surgery, asking yourself whether the unhealthy lifestyle was worth it. Double down on the emotions; imagine your loved ones grieving your premature death.
Oof, that was hard-hitting
It was, but it’s effective—if you choose to do it. We’re not the boss of you! Either way, we’ll continue to send the same good health advice and tips and research and whatnot every day, with the same (usually!) cheery tone.
One last thing…
While it’s good to note the negative, in order to avoid the things that lead to it, it’s not so good to dwell on the negative.
So if you get caught in negative thought spirals or the like, it’s still good to get yourself out of those.
If you need a little help with that sometimes, check out these:
Take care!
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Dried Apricots vs Dried Prunes – Which is Healthier?
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Our Verdict
When comparing dried apricots to dried prunes, we picked the prunes.
Why?
First, let’s talk hydration. We’ve described both of these as “dried”, but prunes are by default dried plums, usually partially rehydrated. So, for fairness, on the other side of things we’re also looking at dried apricots, partially rehydrated. Otherwise, it would look (mass for mass or volume for volume) like one is seriously outstripping the other even if some metric were actually equal, just because of water-weight in one and not the other.
Illustrative example: consider, for example, that the sugar in a bunch of grapes or a handful of raisins can be the same, not because they magically got more sugary, but because the water was dried out, so per mass and per volume, there’s more sugar, proportionally.
Back to dried apricots and dried prunes…
You’ll often see these two next to each other in the heath food store, which is why we’re comparing them here.
Of course, if it is practical, please by all means enjoy fresh apricots and fresh plums. But we know that life is not always convenient, fruits are not in season growing in abundance in our gardens all year round, and sometimes we’re stood in the aisle of a grocery store, weighing up the dried fruit options.
- Apricots are well-known for their zinc, potassium, and vitamin A.
- Prunes are well-known for their fiber.
But that’s not the whole story…
- Apricots outperform prunes for vitamin A, and also vitamins C and E.
- Prunes take first place for vitamins B1, B2, B3, B5, B6, and K, and also for minerals calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc.
- Prunes also have about 3x the fiber, which at the very least offsets the fact that they have 3x the sugar.
Once again, sugar in fruit is healthy (sugar in fruit juices is not*, though, so enjoy prunes rather than just prune juice, if you can) and can take its rightful place as providing a significant portion of our daily energy needs, if we let it.
*It’s the same sugar, just the manner of delivery changes what it does to our liver and our pancreas; see:
Which Sugars Are Healthier, And Which Are Just The Same?
In summary…
Dried apricots are great (fresh are even better), and yet prunes outperform them by most metrics on a like-for-like basis.
Prunes have, on balance, a lot more vitamins and minerals, as well as more fiber and energy.
Want to get some?
Your local supermarket probably has them, and if you prefer having them delivered to your door, then here’s an example product on Amazon
Enjoy!
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What’s Your Plant Diversity Score?
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We speak often about the importance of dietary diversity, and of that, especially diversity of plants in one’s diet, but we’ve never really focused on it as a main feature, so that’s what we’re going to do today.
Specifically, you may have heard the advice to “eat 30 different kinds of plants per week”. But where does that come from, and is it just a number out of a hat?
The magic number?
It is not, in fact, a number out of a hat. It’s from a big (n=11,336) study into what things affect the gut microbiome for better or for worse. It was an observational population study, championing “citizen science” in which volunteers tracked various things and collected and sent in various samples for analysis.
The most significant finding of this study was that those who consumed more than 30 different kinds of plants per week, had a much better gut microbiome than those who consumed fewer than 10 different kinds of plants per week (there is a bell curve at play, and it gets steep around 10 and 30):
American Gut: an Open Platform for Citizen Science Microbiome Research
Why do I care about having a good gut microbiome?
Gut health affects almost every other kind of health; it’s been called “the second brain” for the various neurotransmitters and other hormones it directly makes or indirectly regulates (which in turn affect every part of your body), and of course there is the vagus nerve connecting it directly to the brain, impacting everything from food cravings to mood swings to sleep habits.
See also:
Any other benefits?
Yes there are! Let’s not forget: as we see often in our “This or That” section, different foods can be strong or weak in different areas of nutrition, so unless we want to whip out a calculator and database every time we make food choices, a good way to cover everything is to simply eat a diverse diet.
And that goes not just for vitamins and minerals (which would be true of animal products also), but in the case of plants, a wide range of health-giving phytochemicals too:
Measuring Dietary Botanical Diversity as a Proxy for Phytochemical Exposure
Ok, I’m sold, but 30 is a lot!
It is, but you don’t have to do all 30 in your first week of focusing on this, if you’re not already accustomed to such diversity. You can add in one or two new ones each time you go shopping, and build it up.
As for “what counts”: we’re counting unprocessed or minimally-processed plants. So for example, an apple is an apple, as are dried apple slices, as is apple sauce. Any or all of those would count as 1 plant type.
Note also that we’re counting types, not totals. If you’re having apple slices with apple sauce, for some reason? That still only counts as 1.
However, while apple sauce still counts as apples (minimally processed), you cannot eat a cake and say “that’s 2 because there was wheat and sugar cane somewhere in its dim and distant history”.
Nor is your morning espresso a fruit (by virtue of coffee beans being the fruit of the plant, botanically speaking). However, it would count as 1 plant type if you eat actual coffee beans—this writer has been known to snack on such; they’re only healthy in very small portions though, because their saturated fat content is a little high.
You, however, count grains in general, as well as nuts and seeds, not just fruits and vegetables. As for herbs and spices, they count for ¼ each, except for salt, which might get lumped in with spices but is of course not a plant.
How to do it
There’s a reason we’re doing this in our Saturday Life Hacks edition. Here are some tips for getting in far more plants than you might think, a lot more easily than you might think:
- Buy things ready-mixed. This means buying the frozen mixed veg, the frozen mixed chopped fruit, the mixed nuts, the mixed salad greens etc. This way, when you’re reaching for one pack of something, you’re getting 3–5 different plants instead of one.
- Buy things individually, and mix them for storage. This is a more customized version of the above, but in the case of things that keep for at least a while, it can make lazy options a lot more plentiful. Suddenly, instead of rice with your salad you’re having sorghum, millet, buckwheat, and quinoa. This trick also works great for dried berries that can just be tipped into one’s morning oatmeal. Or, you know, millet, oats, rye, and barley. Suddenly, instead of 1 or 2 plants for breakfast you have maybe 7 or 8.
- Keep a well-stocked pantry of shelf-stable items. This is good practice anyway, in case of another supply-lines shutdown like at the start of the COVID-19 pandemic. But for plant diversity, it means that if you’re making enchiladas, then instead using kidney beans because that’s what’s in the cupboard, you can raid your pantry for kidney beans, black beans, pinto beans, fava beans, etc etc. Yes, all of them; that’s a list, not a menu.
- Shop in the discount section of the supermarket. You don’t have shop exclusively there, but swing by that area, see what plants are available for next to nothing, and buy at least one of each. Figure out what to do with it later, but the point here is that it’s a good way to get suggestions of plants that you weren’t actively looking for—and novelty is invariably a step into diversity.
- Shop in a different store. You won’t be able to beeline the products you want on autopilot, so you’ll see other things on the way. Also, they may have things your usual store doesn’t.
- Shop in person, not online—at least as often as is practical. This is because when shopping for groceries online, the store will tend to prioritize showing you items you’ve bought before, or similar items to those (i.e. actually the same item, just a different brand). Not good for trying new things!
- Consider a meal kit delivery service. Because unlike online grocery shopping, this kind of delivery service will (usually) provide you with things you wouldn’t normally buy. Our sometimes-sponsor Purple Carrot is a fine option for this, but there are plenty of others too.
- Try new recipes, especially if they have plants you don’t normally use. Make a note of the recipe, and go out of your way to get the ingredients; if it seems like a chore, reframe it as a little adventure instead. Honestly, it’s things like this that keep us young in more ways than just what polyphenols can do!
- Hide the plants. Whether or not you like them; hide them just because it works in culinary terms. By this we mean; blend beans into that meaty sauce; thicken the soup with red lentils, blend cauliflower into the gravy. And so on.
One more “magic 30”, while we’re at it…
30g fiber per day makes a big (positive) difference to many aspects of health. Obviously, plants are where that comes from, so there’s a big degree of overlap here, but most of the tips we gave are different, so for double the effectiveness, check out:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Enjoy!
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Beyond “Make Your Bed”—life lessons from experience
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Beyond “Make Your Bed”—life lessons from experience
This is Admiral William H. McRaven, a former United States Navy four-star admiral who served as the ninth commander of the United States Special Operations Command.
So, for those of us whose day-to-day lives don’t involve coordinating military operations, what does he have to offer?
Quick note: 10almonds’ mission statement is “to make health and productivity crazy simple”.
We tend to focus on the health side of this, and in the category of productivity, it’s often what most benefits our mental health.
We’re writing less for career-driven technopreneurs in the 25–35 age bracket and more for people with a more holistic view of productivity and “a good life well-lived”.
So today’s main feature is more in that vein!
Start each day with an accomplishment
McRaven famously gave a speech (and wrote a book) that began with the advice, “make your bed”. The idea here doesn’t have to be literal (if you’ll pardon the pun). Indeed, if you’re partnered, then depending on schedules and habits, it could be you can’t (sensibly) make your bed first thing because your partner is still in it. But! What you can do is start the day with an accomplishment—however small. A short exercise routine is a great example!
Success in life requires teamwork
We’re none of us an island (except in the bathtub). The point is… Nobody can do everything alone. Self-sufficiency is an illusion. You can make your own coffee, but could you have made the coffee machine, or even the cup? How about, grown the coffee? Transported it? So don’t be afraid to reach out for (and acknowledge!) help from others. Teamwork really does make the dream work.
It’s what’s inside that counts
It’s a common trap to fall into, getting caught up the outside appearance of success, rather than what actually matters the most. We need to remember this when it comes to our own choices, as well as assessing what others might bring to the table!
A setback is only permanent if you let it be
No, a positive attitude won’t reverse a lifelong degenerative illness, for example. But what we can do, is take life as comes, and press on with the reality, rather than getting caught up in the “should be”.
Use failure to your advantage
Learn. That’s all. Learn, and improve.
Be daring in life
To borrow from another military force, the SAS has the motto “Who dares, wins”. Caution has it place, but if we’ve made reasonable preparations*, sometimes being bold is the best (or only!) way forward.
*Meanwhile the Parachute Regiment, from which come 80% of all SAS soldiers, has the motto “Utrinque paratus”, “prepared on all sides”.
Keep courage close
This is about not backing down when we know what’s right and we know what we need to do. Life can be scary! But if we don’t overcome our fears, they can become self-realizing.
Writer’s note: a good example of this is an advice I sometimes gave during my much more exciting (military) life of some decades ago, and it pertains to getting into a knife-fight (top advice for civilians: don’t).
But, if you’re in one, you need to not be afraid of getting cut.
Because if you’re not afraid of getting cut, you will probably get cut.
But if you are afraid of getting cut, you will definitely get cut.
Hopefully your life doesn’t involve knives outside of the kitchen (mine doesn’t, these days, and I like it), but the lesson applies to other things too.
Sometimes the only way out is through.
Be your best at your worst
Sometimes life is really, really hard. But if we allow those moments to drive us forwards, they’re also a place we can find more strength than we ever knew we had.
Keep on swimming
It’s said that the majority in life is about showing up—and often it is. But you have to keep showing up, day after day. So make what you’re doing sustainable for you, and keep on keeping on.
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Four Thousand Weeks – by Oliver Burkeman
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This is not, strictly speaking, a time management book. It’s more a “contemplating mortality and making things count while still doing the necessaries”.
Burkeman’s premise is that we get around 4,000 weeks of life, on average. If we live to 120, it’s more like 6,200. Unlucky souls may have to do the best they can with 1,000 or so.
The book is thought-provoking; consider:
- how was your last week?
- how will your next week be?
- what if it were your last?
Of course, we cannot necessarily liquidate all our assets and spend next week burning out in style, because then the following week comes. So, what’s the solution?
That’s something Burkeman lays out over the course of the book, with key ideas including passion projects and figuring out what can be safely neglected, but there’s far more there than we could sum up here.
Bottom line: if you ever find yourself struggling to balance what is expected of you with what is of value to you, this book can help you get the most out of your choices.
Click here to check out Four Thousand Weeks, and make yours count!
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