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.

When trying to lose weight, it’s natural to want to see quick results. So when the number on the scales drops rapidly, it seems like we’re on the right track.

But as with many things related to weight loss, there’s a flip side: rapid weight loss can result in a significant loss of muscle mass, as well as fat.

So how you can tell if you’re losing too much muscle and what can you do to prevent it?

Why does muscle mass matter?

Muscle is an important factor in determining our metabolic rate: how much energy we burn at rest. This is determined by how much muscle and fat we have. Muscle is more metabolically active than fat, meaning it burns more calories.

When we diet to lose weight, we create a calorie deficit, where our bodies don’t get enough energy from the food we eat to meet our energy needs. Our bodies start breaking down our fat and muscle tissue for fuel.

A decrease in calorie-burning muscle mass slows our metabolism. This quickly slows the rate at which we lose weight and impacts our ability to maintain our weight long term.

How to tell you’re losing too much muscle

Unfortunately, measuring changes in muscle mass is not easy.

The most accurate tool is an enhanced form of X-ray called a dual-energy X-ray absorptiometry (DXA) scan. The scan is primarily used in medicine and research to capture data on weight, body fat, muscle mass and bone density.

But while DEXA is becoming more readily available at weight-loss clinics and gyms, it’s not cheap.

There are also many “smart” scales available for at home use that promise to provide an accurate reading of muscle mass percentage.

However, the accuracy of these scales is questionable. Researchers found the scales tested massively over- or under-estimated fat and muscle mass.

Fortunately, there are three free but scientifically backed signs you may be losing too much muscle mass when you’re dieting.

1. You’re losing much more weight than expected each week

Losing a lot of weight rapidly is one of the early signs that your diet is too extreme and you’re losing too much muscle.

Rapid weight loss (of more than 1 kilogram per week) results in greater muscle mass loss than slow weight loss.

Slow weight loss better preserves muscle mass and often has the added benefit of greater fat mass loss.

One study compared people in the obese weight category who followed either a very low-calorie diet (500 calories per day) for five weeks or a low-calorie diet (1,250 calories per day) for 12 weeks. While both groups lost similar amounts of weight, participants following the very low-calorie diet (500 calories per day) for five weeks lost significantly more muscle mass.

2. You’re feeling tired and things feel more difficult

It sounds obvious, but feeling tired, sluggish and finding it hard to complete physical activities, such as working out or doing jobs around the house, is another strong signal you’re losing muscle.

Research shows a decrease in muscle mass may negatively impact your body’s physical performance.

3. You’re feeling moody

Mood swings and feeling anxious, stressed or depressed may also be signs you’re losing muscle mass.

Research on muscle loss due to ageing suggests low levels of muscle mass can negatively impact mental health and mood. This seems to stem from the relationship between low muscle mass and proteins called neurotrophins, which help regulate mood and feelings of wellbeing.

So how you can do to maintain muscle during weight loss?

Fortunately, there are also three actions you can take to maintain muscle mass when you’re following a calorie-restricted diet to lose weight.

1. Incorporate strength training into your exercise plan

While a broad exercise program is important to support overall weight loss, strength-building exercises are a surefire way to help prevent the loss of muscle mass. A meta-analysis of studies of older people with obesity found resistance training was able to prevent almost 100% of muscle loss from calorie restriction.

Relying on diet alone to lose weight will reduce muscle along with body fat, slowing your metabolism. So it’s essential to make sure you’ve incorporated sufficient and appropriate exercise into your weight-loss plan to hold onto your muscle mass stores.

But you don’t need to hit the gym. Exercises using body weight – such as push-ups, pull-ups, planks and air squats – are just as effective as lifting weights and using strength-building equipment.

Encouragingly, moderate-volume resistance training (three sets of ten repetitions for eight exercises) can be as effective as high-volume training (five sets of ten repetitions for eight exercises) for maintaining muscle when you’re following a calorie-restricted diet.

2. Eat more protein

Foods high in protein play an essential role in building and maintaining muscle mass, but research also shows these foods help prevent muscle loss when you’re following a calorie-restricted diet.

But this doesn’t mean just eating foods with protein. Meals need to be balanced and include a source of protein, wholegrain carb and healthy fat to meet our dietary needs. For example, eggs on wholegrain toast with avocado.

3. Slow your weight loss plan down

When we change our diet to lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several physiological responses to defend our body weight and “survive” starvation.

Our body’s survival mechanisms want us to regain lost weight to ensure we survive the next period of famine (dieting). Research shows that more than half of the weight lost by participants is regained within two years, and more than 80% of lost weight is regained within five years.

However, a slow and steady, stepped approach to weight loss, prevents our bodies from activating defence mechanisms to defend our weight when we try to lose weight.

Ultimately, losing weight long-term comes down to making gradual changes to your lifestyle to ensure you form habits that last a lifetime.

At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.

Nick Fuller, Charles Perkins Centre Research Program Leader, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.