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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Chetna’s Healthy Indian – by Chetna Makan
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Indian food is wonderful—a subjective opinion perhaps, but a popular view, and one this reviewer certainly shares. And of course, cooking with plenty of vegetables and spices is a great way to get a lot of health benefits.
There are usually downsides though, such as that in a lot of Indian cookbooks, every second thing is deep-fried, and what’s not deep-fried contains an entire day or more’s saturated fat content in ghee, and a lot of sides have more than their fair share of sugar.
This book fixes all that, by offering 80 recipes that prioritize health without sacrificing flavor.
The recipes are, as the title suggests, vegetarian, though many are not vegan (yogurt and cheese featuring in many recipes). That said, even if you are vegan, it’s pretty easy to veganize those with the obvious plant-based substitutions. If you have soy yogurt and can whip up vegan paneer yourself (here’s our own recipe for that), you’re pretty much sorted.
The cookbook strikes a good balance of being neither complicated nor “did we really need a recipe for this?” basic, and delivers value in all of its recipes. The ingredients, often a worry for many Westerners, should be easily found if you have a well-stocked supermarket near you; there’s nothing obscure here.
Bottom line: if you’d like to cook more Indian food and want your food to be exciting without also making your blood pressure exciting, then this is an excellent book for keeping you well-nourished, body and soul.
Click here to check out Chetna’s Healthy Indian, and spice up your culinary repertoire!
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Gooseberries vs Lemon – Which is Healthier?
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Our Verdict
When comparing gooseberries to lemons, we picked the gooseberries.
Why?
Both have their merits, but ultimately, it wasn’t close:
In terms of macros, gooseberries have notably more fiber, for about the same carbs and protein, winning this round.
In the category of vitamins, gooseberries have more of vitamins A, B2, B3, B5, and E, while lemons have more of vitamins B9 and C, yielding a 5:2 win for gooseberries.
Looking at minerals, gooseberries have more copper, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while lemons have more iron, so that’s a clear 7:1 victory for gooseberries here.
In other considerations, gooseberries have more polyphenols, so that’s another point in their favor.
Adding up the sections makes for an overwhelming overall win for gooseberries, but by all means do enjoy either or both, as diversity is best!
Want to learn more?
You might like:
Enjoy!
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The Good, The Bad, & The Vigorously Debated
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This week in health news sees some pretty varied topics:
One more reason to care about the gut-brain axis
Stroke is a top killer in much of the industrialized world, usually making it into the top-few list on a per-country basis. And, it’s rising in prevalence, too. This is partly because our longevity is increasing so age-related things kill us more often, statistically, than age-unrelated things. But that’s only part of the reason; another is that our lifestyle (on the national level) is becoming more conducive to stroke. Diet is a large contributor to that, and gut health has now been identified as a key factor.
What recent research has shown is that minutes after a stroke occurs, normal gut anatomy is disrupted, and cells responsible for gut barrier integrity are eroded, and bugs from the gut get into the blood, and arrive at the (newly damaged) brain vasculature, where the blood-brain barrier is often also compromised on account of the stroke.
Because of this, critical to reducing post-stroke neuroinflammation (something that makes stroke damage more severe and recovery a lot harder) is improving the gut’s ability to heal itself quickly.
This can be helped with a dose of Insulin-like Growth Factor (IGF-1), but there are other things that can help or hinder, and those other things are modifiable by us as individuals in our lifestyle choices (e.g. a gut-healthy diet with plenty of fiber, and avoiding gut-unhealthy things like sugar and alcohol that feed C. albicans growths that will put roots through your intestines and make holes as they do), because the better/worse your gut barrier integrity is to start with, the easier/harder it will be for your gut to repair itself quickly:
Read in full: Healing the gut can reduce long-term impact of stroke
Related: Stop Sabotaging Your Gut
How about that seasonal lead-spiced hot drink?
Lead contamination in ground spices has become a bit of an issue, ground turmeric has had quite some flak in this regard, and now the spotlight is on cinnamon.
These reports, by the way, do not specify what kind of cinnamon (i.e. cassia vs Ceylon), however, clicking through to assorted sources and then doing our own digging finds that all cinnamon products we found listed as contaminated, were cassia cinnamon. This is unsurprising, as a) it’s cheaper b) it’s the kind most readily found on shelves in the US. That said, when it comes to Ceylon (sweet) cinnamon, absence of evidence is not evidence of absence, so that doesn’t mean they got the all-clear on lead contamination, but rather, that they haven’t received the same scrutiny as yet.
It’s worth noting that cinnamon sticks have been found to have less contamination than ground cinnamon, though.
It’s also worth noting that since some adulterated products have had lead added deliberately in increase the weight and darken the color, this is more likely to happen to cassia cinnamon than sweet cinnamon because cassia cinnamon is visibly darker, so adding a darkening agent to sweet cinnamon would just make it look like cassia (which no seller would want to do since cassia is the cheaper of the two).
Read in full: Why lead-tainted cinnamon products have turned up on shelves, and what questions consumers should ask
Related: Sweet Cinnamon vs Regular Cinnamon – Which is Healthier? ← this also covers toxicity issues, by the way
A matter of life and death
Assisted dying is currently legal in 10/40 US states, and Canada. Over in the UK, it’s being debated (and voted on) in Parliament today, at time of writing.
While bodily autonomy discussions are usually quite straightforward arguments between the very separate camps of
- “my body, my choice” vs
- “they shouldn’t be allowed to do that”,
…this one comes with a considerable middleground, because
- “people should have to right to end things without extra suffering and on their own terms”, and
- “many disabled people fear being placed in a position of having justify why they are not exercising their right to die when it might be cheaper and easier for others if they did”
…are positions with a lot of potential overlap.
In any case, we know most of our readers are in the US, but with a 10/40 split in US states (and some recent controversies in Canada), it’s likely a topic that’ll come up for most people at some point, so it’s good to understand it, and this is as good an opportunity as any:
Read in full: How would the assisted dying bill work and what issues might it create?
Related: Managing Your Mortality ← this talks about psychological/social considerations, as well as end-of-life care, palliative care (which is not quite the same thing!) and euthanasia in various forms, including the unofficial kind that you might want to be aware of if you want to avoid that happening.
Take care!
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Does Eating Shellfish Contribute To Gout?
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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 😎
❝I have a question about seafood as healthy, doesn’t eating shellfish contribute to gout?❞
It can do! Gout (a kind of inflammatory arthritis characterized by the depositing of uric acid crystals in joints) has many risk factors, and diet is one component, albeit certainly the most talked-about one.
First, you may be wondering: isn’t all arthritis inflammatory? Since arthritis is by definition the inflammation of joints, this is a reasonable question, but when it comes to classifying the kinds, “inflammatory” arthritis is caused by inflammation, while “non-inflammatory” arthritis (a slightly confusing name) merely has inflammation as one of its symptoms (and is caused by physical wear-and-tear). For more information, see:
- Tips For Avoiding/Managing Rheumatoid Arthritis ←inflammatory
- Tips For Avoiding/Managing Osteoarthritis ← “non-inflammatory”
As for gout specifically, top risk factors include:
- Increasing age: risk increases with age
- Being male: women do get gout, but much less often
- Hypertension: all-cause hypertension is the biggest reasonably controllable factor
There’s not a lot we can do about age (but of course, looking after our general health will tend to slow biological aging, and after all, diseases only care about the state of our body, not what the date on the calendar is).
As for sex, this risk factor is hormones, and specifically has to do with estrogen and testosterone’s very different effects on the immune system (bearing in mind that chronic inflammation is a disorder of the immune system). However, few if any men would take up feminizing hormone therapy just to lower their gout risk!
That leaves hypertension, which happily is something that we can all (barring extreme personal circumstances) do quite a bit about. Here’s a good starting point:
Hypertension: Factors Far More Relevant Than Salt
…and for further pointers:
How To Lower Your Blood Pressure (Cardiologists Explain)
As for diet specifically (and yes, shellfish):
The largest study into this (and thus, one of the top ones cited in a lot of other literature) looked at 47,150 men with no history of gout at the baseline.
So, with the caveat that their findings could have been different for women, they found:
- Eating meat in general increased gout risk
- Narrowing down specific meats: beef, pork, and lamb were the worst offenders
- Eating seafood in general increased gout risk
- Narrowing down specific seafoods: all seafoods increased gout risk within a similar range
- As a specific quirk of seafoods: the risk was increased if the man had a BMI under 25
- Eating dairy in general was not associated with an increased risk of gout
- Narrowing down specific dairy foods: low-fat dairy products such as yogurt were associated with a decreased risk of gout
- Eating purine-rich vegetables in general was not associated with an increased risk of gout
- Narrowing down to specific purine-rich vegetables: no purine-rich vegetable was associated with an increase in the risk of gout
Dairy products were included in the study, as dairy products in general and non-fermented dairy products in particular are often associated with increased inflammation. However, the association was simply not found to exist when it came to gout risk.
Purine-rich vegetables were included in the study, as animal products highest in purines have typically been found to have the worst effect on gout. However, the association was simply not found to exist when it came to plants with purines.
You can read the full study here:
Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men
So, the short answer to your question of “doesn’t eating shellfish contribute to the risk of gout” is:
Yes, it can, but occasional consumption probably won’t result in gout unless you have other risk factors going against you.
If you’re a slim male 80-year-old alcoholic smoker with hypertension, then definitely do consider skipping the lobster, but honestly, there may be bigger issues to tackle there.
And similarly, obviously skip it if you have a shellfish allergy, and if you’re vegan or vegetarian or abstain from shellfish for religious reasons, then you can certainly live very healthily without ever having any.
See also: Do We Need Animal Products, To Be Healthy?
For most people most of the time, a moderate consumption of seafood, including shellfish if you so desire, is considered healthy.
As ever, do speak with your own doctor to know for sure, as your individual case may vary.
For reference, this question was surely prompted by the article:
Lobster vs Crab – Which is Healthier?
Take care!
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What Tirzepatide Does To Brown Fat
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Firstly, for any unfamiliar with tirzepatide, it’s a GLP-1 drug, but as well as boosting the action of GLP-1 (glucagon-like peptide 1) receptors, it also acts simultaneously on GIP (glucose-dependent insulinotropic peptide) receptors, thus adding a second mechanism of action.
For this reason, it is more effective than its predecessors, including Ozempic:
❝The first GLP-1 mimicking drug was exenatide (Bayetta). It’s still available for treating type 2 diabetes, but there are currently no generics. Exenatide does provide some weight loss, but this is quite modest, typically around 3-5% of body weight.
For liraglutide, those using the drug to treat obesity will use the stronger one (Saxenda), which typically gives about 10% weight loss.
The newest GLP-1 mimicking drug on the market, tirzepatide (Mounjaro for type 2 diabetes and Zepbound for weight loss), results in weight loss of around 25% of body weight.❞
Read in full: Ozempic’s cousin drug liraglutide is about to get cheaper. But how does it stack up?
You can also read more about tirzepatide in our main feature about it, here: Mounjaro/Zepbound’s Stable Weight Loss Curve
But now, there’s newer news, and today we’re going to talk about…
Burning the BAT
…which may sound like the name of a Meat Loaf album or something, but no, it’s about brown adipose tissue (BAT), which we wrote about here, in the context of when the body slows down / stop producing this particular kind of fatty tissue: The BAT-pause!
You may be wondering: if it’s so good, to the point that you wrote an article about the methods and merits of converting white adipose tissue to brown, why do we want tirzepatide to affect the brown?
And the answer lies in the thermogenesis prompted by BAT activation.
Researchers (Dr. Marion Peyrou et al.) found that tirzepatide directly activates brown adipose tissue, increasing thermogenic activity and upregulating genes linked to thermogenesis and substrate oxidation independent of calorie reduction.
Translating that from sciencese: it made the fat work better for energy metabolism
So, what of white adipose tissue in all of this? In the study, white adipose tissue showed distinct changes mainly in lipid metabolism, with a trend toward greater visceral and subcutaneous fat reduction in the tirzepatide group.
In other words, a healthy reduction of fat in the places people are usually trying to lose it from, in large part as a knock-on effect of the BAT-activation, and (importantly!) independent of reduction in food intake (so, not dependent on the main mechanism of action of GLP-1 drugs).
As a special bonus, unlike previous attempts to pharmacologically activate brown fat, which often caused cardiac side effects, tirzepatide appears to activate brown adipose tissue while showing cardiovascular benefits.
You can read the paper in full, here: Differential effects of the anti-obesity drug tirzepatide on adipose tissues: Brown fat as a key target
Want to learn more?
You might like this book that we reviewed a little while back:
Enjoy!
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5 Hip Mobility Exercises That Change Everything
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Marina Sarenac, mobility coach, shows what works better than just stretching:
Seat of power
Biomechanically speaking, your hips are pretty much central to everything else you do, so it’s no surprise that they need to be strong as well as supple.
Here’s how to go about getting both halves of that at once:
- Pigeon pose loaded stretch: with your front leg on a step or bench at 90°, hips square, and your back leg straight, hold a dumbbell below your shoulders, hinge forwards with your chest upright, pause at the bottom, and then return with good form.
- Horse stance good mornings: with a wide stance and your toes slightly out, your weight between your legs, hinge at your hips without rounding your back, and then return slowly (with good form) to an upright position.
- Lateral hinge T spine opener: with one foot elevated on box or bench, feet wide, dumbbells in hands, and your arms in T, hinge sideways towards your elevated leg, lower your opposite hand in front of your foot while your top arm reaches up, and follow your hand with your eyes (and thus, as necessary, with your face).
- Spinal wave squat: start in a deep squat on a box, with your spine neutral and your chest open. Tuck your chin, round your spine, roll up segment by segment to standing, then reverse the process to return into a squat.
- Goblet squat with pause: hold a kettlebell or dumbbell close to your chest, with your feet wide and toes slightly out. Squat down slowly with your elbows inside your knees, hold at the bottom, then push back up through your heels to return to the starting position.
For more on all of this plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
The Most Underrated Hip Mobility Exercise (Not Stretching) ← if you only want to do one thing, not five, then make this it 😎
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