Fake bus stops for persons with dementia? On truth and benevolent lies in public health

Abstract

Fake bus stops are one strategy to keep persons with dementia (PwD) from wandering. By setting up authentic looking shelters and benches in hallways or gardens, nursing homes create the illusion of bus stops, for the purpose of preventing wandering PwD from leaving the facility and getting lost. By attracting wandering PwD to sit down and wait for the bus, they can be supervised more easily by caregivers. However, concerns are expressed that the use of fake bus stops could cause more harm than good for PwD, due to their deceptive nature and the potential stigmatisation of individuals seated at a fake bus stop. This article discusses the ethical aspects of using fake bus stops and outlines considerations prior to setting up fake bus stops in nursing homes in keeping with good clinical practice in dementia care. Moreover, the article assesses whether or not fake bus stops can be ethically justifiable, and if so, how they can be ethically justified and implemented in Israeli and other facilities for PwD.

Was wissen wir über Demenz?

“…Lorey et al untersuchten in ihrer Übersichtsarbeit Scheinbushaltestellen als Form der "wohlmeinenden Lüge" [19]. Scheinbushaltestellen z.…”

“…Andererseits erscheint eine Täuschung dann vertretbar, wenn sie mit guter Absicht durchgeführt wurde und ihr therapeutischer Vorteil anderweitig nicht erreicht werden kann. Eine medizinisch ethische Empfehlung ist es, Scheinbushaltestellen zu erweitern, und zwar hin zu offenen, kommunikativen Treffpunkten für Menschen mit Demenz, deren Angehörige und für professionell Betreuende, um so Sozialkontakte zu fördern [19].…”

Reflections on the IJHPR’s article collection on dementia

“…The article collection “Dementia- an Interdisciplinary Approach,” in the Israeli Journal of Health Policy and Research (IJHPR) [ 7 ] highlights the need for multi-dimensional, interprofessional, and internationally collaborative approaches to improve dementia care. The illuminating seven-article series highlights important issues in dementia care including the use of home hospice in cases of advanced dementia [ 8 ], ethical, regulatory and legal challenges to conducting clinical research in dementia [ 9 , 10 ], and the ways in which depictions of dementia in contemporary movies influences the social valuation of the disease [ 11 ]. Taken together, these articles emphasize the need for national and global action to improve dementia care.…”

The securitisation of dementia: socialities of securitisation on secure dementia care units

“…The literature has questioned the use of environmental interventions ( e.g. sensory cues, fake bus stops and disguised exits) that aim to reduce ‘wandering’ and ‘exit-seeking’ behaviour (Lorey, 2019; Casey et al ., in press). For example, Biggs and Carr (2017: 6) documented environmental cues and sensory prompts at nursing homes, noting ‘Visual cues, smells, and sounds were used to attract residents to certain areas at certain times or reduce interest in thoroughfares and specialist equipment’.…”

“…For example, Biggs and Carr (2017: 6) documented environmental cues and sensory prompts at nursing homes, noting 'Visual cues, smells, and sounds were used to attract residents to certain areas at certain times or reduce interest in thoroughfares and specialist equipment'. Lorey (2019) observed that even the dementia-friendly care village 'De Hogeweyk' in the Netherlands applied a 'confining solution' that has been both praised for its innovation and condemned for its specious ethics. These innovative securitised approaches to care construct people living with dementia in a way that impinges on their dignity as cognisant older adults.…”