Dementia is the second leading cause of death for Australians aged over 65. More than 421,000 Australians currently live with dementia and this figure is expected to almost double in the next 30 years.

There is ongoing public discussion about whether dementia should be a qualifying illness under Australian voluntary assisted dying laws. Voluntary assisted dying is now lawful in all six states, but is not available for a person living with dementia.

The Australian Capital Territory has begun debating its voluntary assisted dying bill in parliament but the government has ruled out access for dementia. Its view is that a person should retain decision-making capacity throughout the process. But the bill includes a requirement to revisit the issue in three years.

The Northern Territory is also considering reform and has invited views on access to voluntary assisted dying for dementia.

Several public figures have also entered the debate. Most recently, former Australian Chief Scientist, Ian Chubb, called for the law to be widened to allow access.

Others argue permitting voluntary assisted dying for dementia would present unacceptable risks to this vulnerable group.

Australian laws exclude access for dementia

Current Australian voluntary assisted dying laws exclude access for people who seek to qualify because they have dementia.

In New South Wales, the law specifically states this.

In the other states, this occurs through a combination of the eligibility criteria: a person whose dementia is so advanced that they are likely to die within the 12 month timeframe would be highly unlikely to retain the necessary decision-making capacity to request voluntary assisted dying.

This does not mean people who have dementia cannot access voluntary assisted dying if they also have a terminal illness. For example, a person who retains decision-making capacity in the early stages of Alzheimer’s disease with terminal cancer may access voluntary assisted dying.

What happens internationally?

Voluntary assisted dying laws in some other countries allow access for people living with dementia.

One mechanism, used in the Netherlands, is through advance directives or advance requests. This means a person can specify in advance the conditions under which they would want to have voluntary assisted dying when they no longer have decision-making capacity. This approach depends on the person’s family identifying when those conditions have been satisfied, generally in consultation with the person’s doctor.

Another approach to accessing voluntary assisted dying is to allow a person with dementia to choose to access it while they still have capacity. This involves regularly assessing capacity so that just before the person is predicted to lose the ability to make a decision about voluntary assisted dying, they can seek assistance to die. In Canada, this has been referred to as the “ten minutes to midnight” approach.

But these approaches have challenges

International experience reveals these approaches have limitations. For advance directives, it can be difficult to specify the conditions for activating the advance directive accurately. It also requires a family member to initiate this with the doctor. Evidence also shows doctors are reluctant to act on advance directives.

Particularly challenging are scenarios where a person with dementia who requested voluntary assisted dying in an advance directive later appears happy and content, or no longer expresses a desire to access voluntary assisted dying.

Allowing access for people with dementia who retain decision-making capacity also has practical problems. Despite regular assessments, a person may lose capacity in between them, meaning they miss the window before midnight to choose voluntary assisted dying. These capacity assessments can also be very complex.

Also, under this approach, a person is required to make such a decision at an early stage in their illness and may lose years of otherwise enjoyable life.

Some also argue that regardless of the approach taken, allowing access to voluntary assisted dying would involve unacceptable risks to a vulnerable group.

More thought is needed before changing our laws

There is public demand to allow access to voluntary assisted dying for dementia in Australia. The mandatory reviews of voluntary assisted dying legislation present an opportunity to consider such reform. These reviews generally happen after three to five years, and in some states they will occur regularly.

The scope of these reviews can vary and sometimes governments may not wish to consider changes to the legislation. But the Queensland review “must include a review of the eligibility criteria”. And the ACT bill requires the review to consider “advanced care planning”.

Both reviews would require consideration of who is able to access voluntary assisted dying, which opens the door for people living with dementia. This is particularly so for the ACT review, as advance care planning means allowing people to request voluntary assisted dying in the future when they have lost capacity.

This is a complex issue, and more thinking is needed about whether this public desire for voluntary assisted dying for dementia should be implemented. And, if so, how the practice could occur safely, and in a way that is acceptable to the health professionals who will be asked to provide it.

This will require a careful review of existing international models and their practical implementation as well as what would be feasible and appropriate in Australia.

Any future law reform should be evidence-based and draw on the views of people living with dementia, their family caregivers, and the health professionals who would be relied on to support these decisions.

Ben White, Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, Queensland University of Technology; Casey Haining, Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology; Lindy Willmott, Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology, Queensland University of Technology, and Rachel Feeney, Postdoctoral research fellow, Queensland University of Technology

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

Have you ever tried to bring back fond memories by eating or drinking something unique to that time and place?

It could be a Pina Colada that recalls an island holiday? Or a steaming bowl of pho just like the one you had in Vietnam? Perhaps eating a favourite dish reminds you of a lost loved one – like the sticky date pudding Nanna used to make?

If you have, you have tapped into food-evoked nostalgia.

As researchers, we are exploring how eating and drinking certain things from your past may be important for your mood and mental health.

Bittersweet longing

First named in 1688 by Swiss medical student, Johannes Hoffer, nostalgia is that bittersweet, sentimental longing for the past. It is experienced universally across different cultures and lifespans from childhood into older age.

But nostalgia does not just involve positive or happy memories – we can also experience nostalgia for sad and unhappy moments in our lives.

In the short and long term, nostalgia can positively impact our health by improving mood and wellbeing, fostering social connection and increasing quality of life. It can also trigger feelings of loneliness or meaninglessness.

We can use nostalgia to turn around a negative mood or enhance our sense of self, meaning and positivity.

Research suggests nostalgia alters activity in the brain regions associated with reward processing – the same areas involved when we seek and receive things we like. This could explain the positive feelings it can bring.

Nostalgia can also increase feelings of loneliness and sadness, particularly if the memories highlight dissatisfaction, grieving, loss, or wistful feelings for the past. This is likely due to activation of brain areas such as the amygdala, responsible for processing emotions and the prefrontal cortex that helps us integrate feelings and memories and regulate emotion.

How to get back there

There are several ways we can trigger or tap into nostalgia.

Conversations with family and friends who have shared experiences, unique objects like photos, and smells can transport us back to old times or places. So can a favourite song or old TV show, reunions with former classmates, even social media posts and anniversaries.

What we eat and drink can trigger food-evoked nostalgia. For instance, when we think of something as “comfort food”, there are likely elements of nostalgia at play.

Foods you found comforting as a child can evoke memories of being cared for and nurtured by loved ones. The form of these foods and the stories we tell about them may have been handed down through generations.

Food-evoked nostalgia can be very powerful because it engages multiple senses: taste, smell, texture, sight and sound. The sense of smell is closely linked to the limbic system in the brain responsible for emotion and memory making food-related memories particularly vivid and emotionally charged.

But, food-evoked nostalgia can also give rise to negative memories, such as of being forced to eat a certain vegetable you disliked as a child, or a food eaten during a sad moment like a loved ones funeral. Understanding why these foods evoke negative memories could help us process and overcome some of our adult food aversions. Encountering these foods in a positive light may help us reframe the memory associated with them.

What people told us about food and nostalgia

Recently we interviewed eight Australians and asked them about their experiences with food-evoked nostalgia and the influence on their mood. We wanted to find out whether they experienced food-evoked nostalgia and if so, what foods triggered pleasant and unpleasant memories and feelings for them.

They reported they could use foods that were linked to times in their past to manipulate and influence their mood. Common foods they described as particularly nostalgia triggering were homemade meals, foods from school camp, cultural and ethnic foods, childhood favourites, comfort foods, special treats and snacks they were allowed as children, and holiday or celebration foods. One participant commented:

I guess part of this nostalgia is maybe […] The healing qualities that food has in mental wellbeing. I think food heals for us.

Another explained

I feel really happy, and I guess fortunate to have these kinds of foods that I can turn to, and they have these memories, and I love the feeling of nostalgia and reminiscing and things that remind me of good times.

Understanding food-evoked nostalgia is valuable because it provides us with an insight into how our sensory experiences and emotions intertwine with our memories and identity. While we know a lot about how food triggers nostalgic memories, there is still much to learn about the specific brain areas involved and the differences in food-evoked nostalgia in different cultures.

In the future we may be able to use the science behind food-evoked nostalgia to help people experiencing dementia to tap into lost memories or in psychological therapy to help people reframe negative experiences.

So, if you are ever feeling a little down and want to improve your mood, consider turning to one of your favourite comfort foods that remind you of home, your loved ones or a holiday long ago. Transporting yourself back to those times could help turn things around.

Megan Lee, Senior Teaching Fellow, Psychology, Bond University; Doug Angus, Assistant Professor of Psychology, Bond University, and Kate Simpson, Sessional academic, Bond University

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