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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Artichoke vs Broccoli – Which is Healthier?
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Our Verdict
When comparing artichoke to broccoli, we picked the artichoke.
Why?
Both have their strengths, and it was close! But…
In terms of macros, artichoke has about 2x the fiber (which is lots, because broccoli is already good for this) and more protein, for only slightly more carbs, making it the nutrient dense choice in all respects, and especially in the case of fiber.
In the category of vitamins, artichoke has more of vitamins B3, B9, and choline, while broccoli has more of vitamins A, B2, B5, B6, C, E, and K, thus winning this round.
When it comes to minerals, artichoke has more copper, iron, magnesium, manganese, phosphorus, potassium, and zinc, while broccoli has more calcium and selenium, handing artichoke the win again here.
Looking at polyphenols, both have an abundance; artichoke has more by total mass (in terms of mg/100g) and is especially rich in luteolin and phenolic acids, but broccoli has some that artichoke doesn’t have (such as quercetin and kaempferol). We could reasonably call this a tie or a win for artichoke on strength of numbers; either way, it doesn’t change the end result:
Adding up the sections makes for an overall win for artichoke, but of course, by all means enjoy either or both; diversity is good!
Want to learn more?
You might like:
What’s Your Plant Diversity Score?
Enjoy!
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What’s the difference between a heart attack and cardiac arrest? One’s about plumbing, the other wiring
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In July 2023, rising US basketball star Bronny James collapsed on the court during practice and was sent to hospital. The 18-year-old athlete, son of famous LA Lakers’ veteran LeBron James, had experienced a cardiac arrest.
Many media outlets incorrectly referred to the event as a “heart attack” or used the terms interchangeably.
A cardiac arrest and a heart attack are distinct yet overlapping concepts associated with the heart.
With some background in how the heart works, we can see how they differ and how they’re related.
Explode/Shutterstock Understanding the heart
The heart is a muscle that contracts to work as a pump. When it contracts it pushes blood – containing oxygen and nutrients – to all the tissues of our body.
For the heart muscle to work effectively as a pump, it needs to be fed its own blood supply, delivered by the coronary arteries. If these arteries are blocked, the heart muscle doesn’t get the blood it needs.
This can cause the heart muscle to become injured or die, and results in the heart not pumping properly.
Heart attack or cardiac arrest?
Simply put, a heart attack, technically known as a myocardial infarction, describes injury to, or death of, the heart muscle.
A cardiac arrest, sometimes called a sudden cardiac arrest, is when the heart stops beating, or put another way, stops working as an effective pump.
In other words, both relate to the heart not working as it should, but for different reasons. As we’ll see later, one can lead to the other.
Why do they happen? Who’s at risk?
Heart attacks typically result from blockages in the coronary arteries. Sometimes this is called coronary artery disease, but in Australia, we tend to refer to it as ischaemic heart disease.
The underlying cause in about 75% of people is a process called atherosclerosis. This is where fatty and fibrous tissue build up in the walls of the coronary arteries, forming a plaque. The plaque can block the blood vessel or, in some instances, lead to the formation of a blood clot.
Atherosclerosis is a long-term, stealthy process, with a number of risk factors that can sneak up on anyone. High blood pressure, high cholesterol, diet, diabetes, stress, and your genes have all been implicated in this plaque-building process.
Other causes of heart attacks include spasms of the coronary arteries (causing them to constrict), chest trauma, or anything else that reduces blood flow to the heart muscle.
Regardless of the cause, blocking or reducing the flow of blood through these pipes can result in the heart muscle not receiving enough oxygen and nutrients. So cells in the heart muscle can be injured or die.
Here’s a simple way to remember the difference. Author provided But a cardiac arrest is the result of heartbeat irregularities, making it harder for the heart to pump blood effectively around the body. These heartbeat irregularities are generally due to electrical malfunctions in the heart. There are four distinct types:
- ventricular tachycardia: a rapid and abnormal heart rhythm in which the heartbeat is more than 100 beats per minute (normal adult, resting heart rate is generally 60-90 beats per minute). This fast heart rate prevents the heart from filling with blood and thus pumping adequately
- ventricular fibrillation: instead of regular beats, the heart quivers or “fibrillates”, resembling a bag of worms, resulting in an irregular heartbeat greater than 300 beats per minute
- pulseless electrical activity: arises when the heart muscle fails to generate sufficient pumping force after electrical stimulation, resulting in no pulse
- asystole: the classic flat-line heart rhythm you see in movies, indicating no electrical activity in the heart.
Remember this flat-line rhythm from the movies? It’s asystole, when there’s no electrical activity in the heart. Kateryna Kon/Shutterstock Cardiac arrest can arise from numerous underlying conditions, both heart-related and not, such as drowning, trauma, asphyxia, electrical shock and drug overdose. James’ cardiac arrest was attributed to a congenital heart defect, a heart condition he was born with.
But among the many causes of a cardiac arrest, ischaemic heart disease, such as a heart attack, stands out as the most common cause, accounting for 70% of all cases.
So how can a heart attack cause a cardiac arrest? You’ll remember that during a heart attack, heart muscle can be damaged or parts of it may die. This damaged or dead tissue can disrupt the heart’s ability to conduct electrical signals, increasing the risk of developing arrhythmias, possibly causing a cardiac arrest.
So while a heart attack is a common cause of cardiac arrest, a cardiac arrest generally does not cause a heart attack.
What do they look like?
Because a cardiac arrest results in the sudden loss of effective heart pumping, the most common signs and symptoms are a sudden loss of consciousness, absence of pulse or heartbeat, stopping of breathing, and pale or blue-tinged skin.
But the common signs and symptoms of a heart attack include chest pain or discomfort, which can show up in other regions of the body such as the arms, back, neck, jaw, or stomach. Also frequent are shortness of breath, nausea, light-headedness, looking pale, and sweating.
What’s the take-home message?
While both heart attack and cardiac arrest are disorders related to the heart, they differ in their mechanisms and outcomes.
A heart attack is like a blockage in the plumbing supplying water to a house. But a cardiac arrest is like an electrical malfunction in the house’s wiring.
Despite their different nature both conditions can have severe consequences and require immediate medical attention.
Michael Todorovic, Associate Professor of Medicine, Bond University and Matthew Barton, Senior lecturer, School of Nursing and Midwifery, Griffith University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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PFAS Exposure & Cancer: The Numbers Are High
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PFAS & Cancer Risk: The Numbers Are High
Image Credits Mount Sinai This is Dr. Maaike van Gerwen. Is that an MD or a PhD, you wonder? It’s both.
She’s also Director of Research in the Department of Otolaryngology at Mount Sinai Hospital in New York, Scientific Director of the Program of Personalized Management of Thyroid Disease, and Member of the Institute for Translational Epidemiology and the Transdisciplinary Center on Early Environmental Exposures.
What does she want us to know?
She’d love for us to know about her latest research published literally today, about the risks associated with PFAS, such as the kind widely found in non-stick cookware:
Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer risk
Dr. van Gerwen and her team tested this several ways, and the very short and simple version of the findings is that per doubling of exposure, there was a 56% increased rate of thyroid cancer diagnosis.
(The rate of exposure was not just guessed based on self-reports; it was measured directly from PFAS levels in the blood of participants)
- PFAS exposure can come from many sources, not just non-stick cookware, but that’s a “biggie” since it transfers directly into food that we consume.
- Same goes for widely-available microwaveable plastic food containers.
- Relatively less dangerous exposures include waterproofed clothing.
To keep it simple and look at the non-stick pans and microwavable plastic containers, doubling exposure might mean using such things every day vs every second day.
Practical take-away: PFAS may be impossible to avoid completely, but even just cutting down on the use of such products is already reducing your cancer risk.
Isn’t it too late, by this point in life? Aren’t they “forever chemicals”?
They’re not truly “forever”, but they do have long half-lives, yes.
See: Can we take the “forever” out of forever chemicals?
The half-lives of PFOS and PFOA in water are 41 years and 92 years, respectively.
In the body, however, because our body is constantly trying to repair itself and eliminate toxins, it’s more like 3–7 years.
That might seem like a long time, and perhaps it is, but the time will pass anyway, so might as well get started now, rather than in 3–7 years time!
Read more: National Academies Report Calls for Testing People With High Exposure to “Forever Chemicals”
What should we use instead?
In place of non-stick cookware, cast iron is fantastic. It’s not everyone’s preference, though, so you might also like to know that ceramic cookware is a fine option that’s functionally non-stick but without needing a non-stick coating. Check for PFAS-free status; they should advertise this.
In place of plastic microwaveable containers, Pyrex (or equivalent) glass dishes (you can get them with lids) are a top-tier option. Ceramic containers (without metallic bits!) are also safely microwaveable.
See also:
Here’s a List of Products with PFAS (& How to Avoid Them)
Take care!
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Yes, we still need chickenpox vaccines
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For people who grew up before a vaccine was available, chickenpox is largely remembered as an unpleasant experience that almost every child suffered through. The highly contagious disease tore through communities, leaving behind more than a few lasting scars.
For many children, chickenpox was much more than a week or two of itchy discomfort. It was a serious and sometimes life-threatening infection.
Prior to the chickenpox vaccine’s introduction in 1995, 90 percent of children got chickenpox. Those children grew into adults with an increased risk of developing shingles, a disease caused by the same virus—varicella-zoster—as chickenpox, which lies dormant in the body for decades.
The vaccine changed all that, nearly wiping out chickenpox in the U.S. in under three decades. The vaccine has been so successful that some people falsely believe the disease no longer exists and that vaccination is unnecessary. This couldn’t be further from the truth.
Vaccination spares children and adults from the misery of chickenpox and the serious short- and long-term risks associated with the disease. The CDC estimates that 93 percent of children in the U.S. are fully vaccinated against chickenpox. However, outbreaks can still occur among unvaccinated and under-vaccinated populations.
Here are some of the many reasons why we still need chickenpox vaccines.
Chickenpox is more serious than you may remember
For most children, chickenpox lasts around a week. Symptoms vary in severity but typically include a rash of small, itchy blisters that scab over, fever, fatigue, and headache.
However, in one out of every 4,000 chickenpox cases, the virus infects the brain, causing swelling. If the varicella-zoster virus makes it to the part of the brain that controls balance and muscle movements, it can cause a temporary loss of muscle control in the limbs that can last for months. Chickenpox can also cause other serious complications, including skin, lung, and blood infections.
Prior to the U.S.’ approval of the vaccine in 1995, children accounted for most of the country’s chickenpox cases, with over 10,000 U.S. children hospitalized with chickenpox each year.
The chickenpox vaccine is very effective and safe
Chickenpox is an extremely contagious disease. People without immunity have a 90 percent chance of contracting the virus if exposed.
Fortunately, the chickenpox vaccine provides lifetime protection and is around 90 percent effective against infection and nearly 100 percent effective against severe illness. It also reduces the risk of developing shingles later in life.
In addition to being incredibly effective, the chickenpox vaccine is very safe, and serious side effects are extremely rare. Some people may experience mild side effects after vaccination, such as pain at the injection site and a low fever.
Although infection provides immunity against future chickenpox infections, letting children catch chickenpox to build up immunity is never worth the risk, especially when a safe vaccine is available. The purpose of vaccination is to gain immunity without serious risk.
The chickenpox vaccine is one of the greatest vaccine success stories in history
It’s difficult to overstate the impact of the chickenpox vaccine. Within five years of the U.S. beginning universal vaccination against chickenpox, the disease had declined by over 80 percent in some regions.
Nearly 30 years after the introduction of the chickenpox vaccine, the disease is almost completely wiped out. Cases and hospitalizations have plummeted by 97 percent, and chickenpox deaths among people under 20 are essentially nonexistent.
Thanks to the vaccine, in less than a generation, a disease that once swept through schools and affected nearly every child has been nearly eliminated. And, unlike vaccines introduced in the early 20th century, no one can argue that improved hygiene, sanitation, and health helped reduce chickenpox cases beginning in the 1990s.
Having chickenpox as a child puts you at risk of shingles later
Although most people recover from chickenpox within a week or two, the virus that causes the disease, varicella-zoster, remains dormant in the body. This latent virus can reactivate years after the original infection as shingles, a tingling or burning rash that can cause severe pain and nerve damage.
One in 10 people who have chickenpox will develop shingles later in life. The risk increases as people get older as well as for those with weakened immune systems.
Getting chickenpox as an adult can be deadly
Although chickenpox is generally considered a childhood disease, it can affect unvaccinated people of any age. In fact, adult chickenpox is far deadlier than pediatric cases.
Serious complications like pneumonia and brain swelling are more common in adults than in children with chickenpox. One in 400 adults who get chickenpox develops pneumonia, and one to two out of 1,000 develop brain swelling.
Vaccines have virtually eliminated chickenpox, but outbreaks still happen
Although the chickenpox vaccine has dramatically reduced the impact of a once widespread disease, declining immunity could lead to future outbreaks. A Centers for Disease Control and Prevention analysis found that chickenpox vaccination rates dropped in half of U.S. states in the 2022-2023 school year compared to the previous year. And more than a dozen states have immunization rates below 90 percent.
In 2024, New York City and Florida had chickenpox outbreaks that primarily affected unvaccinated and under-vaccinated children. With declining public confidence in routine vaccines and rising school vaccine exemption rates, these types of outbreaks will likely become more common.
The CDC recommends that children receive two chickenpox vaccine doses before age 6. Older children and adults who are unvaccinated and have never had chickenpox should also receive two doses of the vaccine.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Not all ultra-processed foods are bad for your health, whatever you might have heard
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In recent years, there’s been increasing hype about the potential health risks associated with so-called “ultra-processed” foods.
But new evidence published this week found not all “ultra-processed” foods are linked to poor health. That includes the mass-produced wholegrain bread you buy from the supermarket.
While this newly published research and associated editorial are unlikely to end the wrangling about how best to define unhealthy foods and diets, it’s critical those debates don’t delay the implementation of policies that are likely to actually improve our diets.
What are ultra-processed foods?
Ultra-processed foods are industrially produced using a variety of processing techniques. They typically include ingredients that can’t be found in a home kitchen, such as preservatives, emulsifiers, sweeteners and/or artificial colours.
Common examples of ultra-processed foods include packaged chips, flavoured yoghurts, soft drinks, sausages and mass-produced packaged wholegrain bread.
In many other countries, ultra-processed foods make up a large proportion of what people eat. A recent study estimated they make up an average of 42% of total energy intake in Australia.
How do ultra-processed foods affect our health?
Previous studies have linked increased consumption of ultra-processed food with poorer health. High consumption of ultra-processed food, for example, has been associated with a higher risk of type 2 diabetes, and death from heart disease and stroke.
Ultra-processed foods are typically high in energy, added sugars, salt and/or unhealthy fats. These have long been recognised as risk factors for a range of diseases.
Ultra-processed foods are usually high is energy, salt, fat, or sugar. Olga Dubravina/Shutterstock It has also been suggested that structural changes that happen to ultra-processed foods as part of the manufacturing process may lead you to eat more than you should. Potential explanations are that, due to the way they’re made, the foods are quicker to eat and more palatable.
It’s also possible certain food additives may impair normal body functions, such as the way our cells reproduce.
Is it harmful? It depends on the food’s nutrients
The new paper just published used 30 years of data from two large US cohort studies to evaluate the relationship between ultra-processed food consumption and long-term health. The study tried to disentangle the effects of the manufacturing process itself from the nutrient profile of foods.
The study found a small increase in the risk of early death with higher ultra-processed food consumption.
But importantly, the authors also looked at diet quality. They found that for people who had high quality diets (high in fruit, vegetables, wholegrains, as well as healthy fats, and low in sugary drinks, salt, and red and processed meat), there was no clear association between the amount of ultra-processed food they ate and risk of premature death.
This suggests overall diet quality has a stronger influence on long-term health than ultra-processed food consumption.
People who consume a healthy diet overall but still eat ultra-processed foods aren’t at greater risk of early death. Grusho Anna/Shutterstock When the researchers analysed ultra-processed foods by sub-category, mass-produced wholegrain products, such as supermarket wholegrain breads and wholegrain breakfast cereals, were not associated with poorer health.
This finding matches another recent study that suggests ultra-processed wholegrain foods are not a driver of poor health.
The authors concluded, while there was some support for limiting consumption of certain types of ultra-processed food for long-term health, not all ultra-processed food products should be universally restricted.
Should dietary guidelines advise against ultra-processed foods?
Existing national dietary guidelines have been developed and refined based on decades of nutrition evidence.
Much of the recent evidence related to ultra-processed foods tells us what we already knew: that products like soft drinks, alcohol and processed meats are bad for health.
Dietary guidelines generally already advise to eat mostly whole foods and to limit consumption of highly processed foods that are high in refined grains, saturated fat, sugar and salt.
But some nutrition researchers have called for dietary guidelines to be amended to recommend avoiding ultra-processed foods.
Based on the available evidence, it would be difficult to justify adding a sweeping statement about avoiding all ultra-processed foods.
Advice to avoid all ultra-processed foods would likely unfairly impact people on low-incomes, as many ultra-processed foods, such as supermarket breads, are relatively affordable and convenient.
Wholegrain breads also provide important nutrients, such as fibre. In many countries, bread is the biggest contributor to fibre intake. So it would be problematic to recommend avoiding supermarket wholegrain bread just because it’s ultra-processed.
So how can we improve our diets?
There is strong consensus on the need to implement evidence-based policies to improve population diets. This includes legislation to restrict children’s exposure to the marketing of unhealthy foods and brands, mandatory Health Star Rating nutrition labelling and taxes on sugary drinks.
Taxes on sugary drinks would reduce their consumption. MDV Edwards/Shutterstock These policies are underpinned by well-established systems for classifying the healthiness of foods. If new evidence unfolds about mechanisms by which ultra-processed foods drive health harms, these classification systems can be updated to reflect such evidence. If specific additives are found to be harmful to health, for example, this evidence can be incorporated into existing nutrient profiling systems, such as the Health Star Rating food labelling scheme.
Accordingly, policymakers can confidently progress food policy implementation using the tools for classifying the healthiness of foods that we already have.
Unhealthy diets and obesity are among the largest contributors to poor health. We can’t let the hype and academic debate around “ultra-processed” foods delay implementation of globally recommended policies for improving population diets.
Gary Sacks, Professor of Public Health Policy, Deakin University; Kathryn Backholer, Co-Director, Global Centre for Preventive Health and Nutrition, Deakin University; Kathryn Bradbury, Senior Research Fellow in the School of Population Health, University of Auckland, Waipapa Taumata Rau, and Sally Mackay, Senior Lecturer Epidemiology and Biostatistics, University of Auckland, Waipapa Taumata Rau
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Hazelnuts vs Pecans – Which is Healthier?
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Our Verdict
When comparing hazelnuts to pecans, we picked the hazelnuts.
Why?
In terms of macros, hazelnuts have more protein, carbs, and fiber, though the difference is not big in the latter two cases, and the glycemic indices are resultantly about the same. Meanwhile, pecans have a little more fat, but the fat is healthy in both cases. Everything taken into account, we’re calling it a tie on macros.
When it comes to vitamins, hazelnuts have more of vitamins B3, B5, B6, B7, B9, C, E, K, and choline, while pecans have more of vitamins A, B1, and B2. An easy win for hazelnuts here.
In the category of minerals, hazelnuts have more calcium, copper, iron, magnesium, manganese, phosphorus, and potassium, while pecans have more selenium and zinc. Another clear win for hazelnuts.
In short, enjoy either or both (unless you’re allergic, in which case, don’t), but hazelnuts are ultimately the more nutritionally dense of the two.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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