The politics of Alzheimer's disease: a case study in apocalyptic demography

La edad molecular: reimaginando la vejez desde laboratorios de experimentación en telómeros

El proceso conocido como “envejecimiento celular” se manifiesta en el acortamiento de los telómeros, que son los extremos de los cromosomas. En las últimas décadas, la posibilidad de la manipulación genética para preservar la longitud de los telómeros ha suscitado formas de pensar el envejecimiento como un proceso maleable y aplazable. Mediante una etnografía de los laboratorios de telómeros y su entorno de divulgación científica, aquí trazamos la emergencia de una “biopolítica molecular” (Rose, 2007) que desestabiliza la idea de una edad lineal y “cronológica”. En su lugar, se plantea una edad “biológica” que, siendo relativa a la longitud y velocidad de acortamiento de los telómeros, puede ser medida y manipulada a nivel micrométrico. Aquí describimos cómo la manipulación molecular de la edad se despliega junto a una intrínseca patologización de la vejez. Como consecuencia, la episteme y práctica biomédica transitan del objetivo de “curar” enfermedades hacia el de la optimización de la fisiología celular para frenar el envejecimiento. La huella del tiempo en el cuerpo deja de ser entendida como un proceso “natural”, y pasa re-imaginarse como un “fallo técnico”, accidental y corregible.

Aggression and Older Adults: News Media Coverage across Care Settings and Relationships

Systematic, in-depth exploration of news media coverage of aggression and older adults remains sparse, with little attention to how and why particular frames manifest in coverage across differing settings and relationships. Frame analysis was used to analyze 141 English-language Canadian news media articles published between 2008 and 2019. Existing coverage tended towards stigmatizing, fear-inducing, and biomedical framings of aggression, yet also reflected and reinforced ambiguity, most notably around key differences between settings and relations of care. Mainstream news coverage reflects tensions in public understandings of aggression and older adults (e.g., as a medical or criminal issue), reinforced in particular ways because of the nature of news reporting. More nuanced coverage would advance understanding of differences among settings, relationships, and types of actions, and of the need for multifaceted prevention and policy responses based on these differences.

Dementia Care Work in Singapore: Embodied Relations and Power Dynamics

Based on research at a dementia day-care center in Singapore, I discuss how embodied care relations proceed amidst cultural expectations on aging, dementia, and care work. Engaging with approaches that conceptualize "care" as either empathy or control, I argue that care between older people with dementia, their families, and care workers can be understood as a reiterative, dialogic process whereby care participants strive to keep pace with each other, however briefly, due to cognitive decline, care workers' own limitations, and particular family difficulties. Care vacillates between practices of control, surveillance, and recognition, and comprises dynamic rather than enduring power relations.

Rethinking the assumptions of intervention research concerned with care at home for people with dementia

Aging populations have been positioned as a challenge to health and social service planning around the world, a situation even more pronounced in the case of persons with a diagnosis of dementia. While policy responses emphasize that care be provided for persons with dementia in home settings for as long as possible and that family carers be supported in the provision of this care, finding good ways to support families as they do the work of ‘delaying institutionalization’ has been challenging despite decades of intervention research intended to develop and evaluate interventions to support families. In this context of limited effectiveness it is useful to examine the assumptions informing research practices. Problematization is a method of literature analysis useful for clarifying and challenging assumptions informing a field of research in order to generate new approaches to research or new research questions. Our analysis suggests that although community-based intervention research has contributed significant knowledge about the kinds of things that might help families, there are limitations related to the dominant assumptions underlying the field. We highlight three areas for re-consideration: the overriding focus on caregiver–care recipient dyads, the under-determination of the object(s) of inquiry and the algorithmic nature of interventions themselves. Issues in these areas, we argue, arise from a commitment to homogeneity characteristic of biomedical models of disease that may need to be rethought in the face of consequential heterogeneity among research populations. That is, there is a mismatch between ‘dementia’ in the intervention research literature and ‘dementia’ in the life that is consequential for families living with these concerns.

Ageing, dementia and the social mind: past, present and future perspectives

Accompanying the ageing of contemporary ageing societies is an increase in age associated morbidity, with dementia having an important impact. Mental frailty in later life is a source of fear for many and a major policy concern to all those concerned with health and welfare services. This introduction to the special issue on 'Ageing, dementia and the social mind' situates the selected papers within the context of debates about dementia and its social relations. In particular it draws attention to the importance of the social imaginary of the fourth age and what this means for the issue of personhood, care, social representations of dementia and its social contextualisation. The papers illuminating these themes draw on a variety of disciplines and approaches; from the social sciences to the humanities and from the theoretical to the empirical in order to help orientate future researchers to the complexities of dementia and the social and cultural matrix in which it exists. This paper provides an introduction to the potential for a more extended sociology of dementia; one which could combine the insights from medical sociology with the concerns of social gerontology.

Elderly people as "apocalyptic demography"? A study of the life stories of older people in Hong Kong born in the 1930s

In Hong Kong, the general view still follows the biomedical discourse to define aging. The government and leading gerontologists follow the prevailing representation of elderly and describe growing old as a process of becoming "frail, infirm, and vulnerable" (Fealy et al., 2012: 91). Discussions of demographic trends often focus on the drastic effects of an aging society on economic development. Our research indicates that Hong Kong's construction of aging is a product of its market-driven economy. Drawing from the life stories of eight participants born in the 1930s, we examine the meaning of aging and the formation of character in a specific historical context, adopting the life-course perspective. We wish to understand how larger movements in the social and political world shaped the experiences of the participants and the strategies they developed to maintain agency and control in life. The participants in our study struggled for survival through unprecedented political disasters and social turmoil in their youth. When they reached maturity in the 1960s and 1970s, they devoted themselves to bettering their lives and contributed to the economic boom of the city. We maintain that the biomedical model offers a reductive and unjust means of viewing the people in this cohort, who are often seen as a problem and a burden. Challenging the prevailing ageist attitude, we set the life stories of the participants against the dominant biomedical model of aging. Our work aims to establish a just description of the life experiences of Hong Kong people.

Anthropology of Aging and Care

In concert with lengthening life spans, emerging forms of care in later life reflect complex and diverse social changes. Embracing a polysemic understanding of care as simultaneously resource and relational practice, this review works across scales of social life and theoretical approaches to care to highlight connections and fissures between global political-economic transformations and the most intimate aspects of daily life. Arguing for analyses of care that account for the kinds of projects, stakes, and obstacles that emerge as people engage in social reproduction in later life, this review traces the circulation of care across aging bodies, everyday practices, families, and nations. Care in later life never exclusively impacts the lives of the old; it is thus a critical site for understanding the diverse ways that increased longevity is shaping the meanings, experiences, and consequences of life itself.

"Senior coolness": living well as an attitude in later life

With demographic change becoming an ever more pressing issue in Germany, old age (80+) is currently talked about above all in terms of being a problem. In mainstream discourse on the situation of the oldest old an interpretive framework has emerged that effectively rules out the possibility of people living positively and well in old age. With regard to both individual (personal) and collective (societal) spheres, negative images of old age dominate public debate. This is the starting point for an interdisciplinary research project designed to look at the ways in which people manage to "live well in old age in the face of vulnerability and finitude"--in express contrast to dominant negative perspectives. Based on the results of this project, the present article addresses an attitudinal and behavioral mode which we have coined "senior coolness". Coolness here is understood as both a socio-cultural resource and an individualized habitus of everyday living. By providing an effective strategy of self-assertion, this ability can, as we show, be just as important for elderly people as for anyone else. "Senior coolness" is discussed, finally, as a phenomenon that testifies to the ways elderly people retain a positive outlook on life--especially in the face of difficult circumstances and powerful socio-cultural pressures.

Medical ideology as a double-edged sword: the politics of cure and care in the making of Alzheimer's disease

This paper builds on our prior work concerning the emergence of Alzheimer's disease (AD) as a major social and health concern. Our study was conducted in two phases (1985-1987 and 2009-2011). We examined the historical evolution of the concept of AD and the emergence of the AD social movement in the U. S. Sources include interviews with movement leaders and scientists, historical documents of the Alzheimer's Association, Congressional records, and published literature. We identified recurrent themes and salient issues motivating those in the movement, its barriers and facilitators, and the roles of government and NGOs in the creation of an organizational structure to maintain it. The characterization of AD as a leading cause of death among the elderly was crucial to sustaining the movement, but also operated as a "double edged sword". By construing "senility" as a treatable, even curable biomedical entity, the movement substantively contributed to the notion of an impending "crisis" of the aging population to be avoided at all costs, compounding the effect of conservative federal policies that emphasized the treatment or cure of AD, and less so the long-term care service needs of sufferers and caregivers that had given rise to the movement. We also discuss how the continuing hegemony of the medical model establishes a race against the demographic clock, pitting advances in biomedical research against the needs of an aging population. We propose that alternative framings and sources of legitimization are critical to address the needs and preserve the humanity of people living with AD and their caregivers.

The ambiguous relationships between aging and Alzheimer's disease: A critical literature review

One reason for the rise in the prevalence of Alzheimer's disease (AD) since the 1980s is the new association between the disease and aging. This paper explores the current representations of AD, questioning their relationships to aging, thanks to a literature review of 49 articles published in French and in English between 1995 and June 2010. Aging appears to be a concurrent diagnosis for AD, both for the lay public and for health professionals, but this confusion, which can be interpreted as a lack of medicalization of memory loss on the conceptual level, does not necessarily constitute an obstacle to medical intervention. The transformation of senile dementia into AD can diminish, as well as reinforce, stigmatization of people with AD. Moreover, elderly people with AD are subjected to both the persisting stigmas of aging and of dementia as well as, for most of them, that of feminine cognitive incompetence.

The Ideology of ‘Age/Race Wars’: Deconstructing a Social Problem

Efforts in the United States to encourage divisiveness within the working class have been widely recognised as a key strategy in the war on welfare. This paper examines one aspect of this overall strategy, namely the creation of an ideology based on generational equity and ‘age/race wars’ thinking, which blames the old for poverty and economic hardship in the young. Attempts to frame problem analysis and policy deliberations within such an ideological framework are seen to be based on spurious assumptions concerning the relative financial well-being of the old, the role of elderly entitlements as a cause of poverty in minority children, and growing resentment of programmes for the old among minorities and youth.

This paper examines recent attempts to de-legitimate the claims of the elderly through the advancement of an ideology of age/race wars. The assumptions underlying this approach to policy are critiqued, and a case is made for developing an alternative framework which would stress the interdependence of generations, rather than age/race group competition.

Civic Engagement and Older Adults: A Critical Perspective

The aging of the baby boom generation, together with research that links volunteerism and positive health outcomes in later life, has contributed to a burgeoning of interest in initiatives and programs promoting civic engagement among older adults. Although useful in potentially expanding role options in later life, this growing attention also underscores the importance of stepping back to critically examine frequently overlooked questions concerning the framing and potential consequences of the new emphasis on civic engagement. Following a brief review of semantics and definitional issues in this area, we use a critical gerontology framework, emphasizing both political economy analysis and perspectives from the humanities, to explore underlying questions such as these: What roles are older adults being encouraged to play in civic life? What meanings are implied by these roles? What political and economic forces underlie these roles? What types of civic engagement are left out of the conversation? Our goal is to encourage a broadening of the dialogue to include potentially problematic normative and political economic dimensions of civic engagement, particularly volunteerism, as they pertain to older adults.

Advocating voice: organisational, historical and social milieux of the Alzheimer's disease movement

The Alzheimer's disease movement, despite the stated willingness of the Alzheimer's Association, has yet to comprehensively utilise people with Alzheimer's as spokespersons. This is particularly noteworthy given the increasing availability of those with Alzheimer's who, especially in the early stages, are fully capable of advocating their position. Qualitative interviews and focus groups with people who have been diagnosed with Alzheimer's demonstrate the active role they are beginning to take in informing research, practice and policy. Interviews with affiliates of the national association aiming to advocate for people with memory loss depict an enduring struggle to incorporate these perspectives. Although primary obstacles may involve the structural dynamics within a society that stigmatises those who are old and/or forgetful, there are clear organisational contradictions within the Association itself preventing such mobilisation efforts. The dynamics shaping this health social movement's endeavours portray characteristics that obstruct an ability to embrace as spokespersons the individuals for whom it advocates.

Dementia: sociological and philosophical constructions

This analysis presents a challenge to the biomedical view of dementia as a disease. This view is critiqued from two perspectives: those of sociology and philosophy. Because these domains inform the creation of the medical discourse, their analysis provides an important refinement to the apprehension of the phenomenon of dementia. From the work of Foucault, and in particular his analysis of the historical origins of modern medicine, the sociological construction of dementia is considered. Following this, the philosophical question of Being is discussed, considering particularly the positions of Heidegger and Merleau-Ponty. Lastly aspects of dementia nursing that are damaging to those relatives forced to take on the role of primary carer are isolated, in the context of Kitwood's view that it is possible to maintain personhood at the extremes of this condition. It is suggested that this critique of sociological and philosophical foundations of dementia might offer a way of approaching the dismantling of the self and revise current conceptions of dementia care for the better.

Alzheimer's disease: insights from epidemiology

While a complete understanding of the pathogenesis of Alzheimer's disease (AD) remains elusive, many conclusions can be drawn from the numerous epidemiological studies undertaken to date. Prevalence and incidence estimates show consistency, following a roughly exponential pattern with a doubling of both parameters roughly every five years after age 65. Roughly 7% of the population aged 65 and over has AD. The clinical course of the disease is reasonably well established and mortality rates rise with increasing levels of cognitive deficit. Four risk factors for AD are firmly established: increasing age, the presence of the apolipoproteinE-epsilon4 allele, familial aggregation of cases, and Down's syndrome. Numerous other associations have been shown in some studies, but not in others. For example, women generally appear at higher risk than men, as do people with lower levels of education; depression is probably prodromal; head injury is an established risk factor, and may interact with the apoE gene; several occupational exposures appear hazardous, and exposure to aluminum in the water supply confers excess risk. Hypertension and other vascular symptoms appear to predispose to AD, which is now seen as nosologically closer to vascular dementia than was previously believed. Several apparently protective factors have been identified, although preventive trials based on these have so far shown minimal effectiveness. The use of non-steroidal anti-inflammatory drugs to treat arthritis is associated with a reduced risk of AD, as is estrogen use by post-menopausal women. Physical activity appears beneficial, as does a diet with high levels of vitamins B6, B12 and folate. while red wine in moderate quantities appears protective. This review concludes with a discussion of the strengths and limitations of current epidemiological methods for studying Alzheimer's disease.

The discursive construction of dementia care: implications for mental health nursing

This paper sets out a new approach to dementia that may be used to underpin mental health nursing practice. The paper begins by examining the development of community care. Various models of service provision to people with dementia are then critically examined. As an alternative to these approaches a new model of dementia is developed which highlights the position of various family members in the provision of dementia care including the person with dementia and also the importance of linguistic devices such as narrative and discourse. Finally the implications of this approach upon the mental health nursing practice are examined together with various suggestions for the development of research.

Measuring the quality of life of older persons: a model with implications for community and public health nursing

Measuring the quality of life (QOL) of older persons can assist health professionals in achieving a number of important objectives. These include assessing the effects of illness and treatment, identifying need for support services, and developing health enhancing environments. Most QOL models focus unduly on illness and disability, define QOL too narrowly, and do not consider aspects of personal control and potential opportunities for change. A new model of QOL with associated instrumentation, the Quality of Life Profile: Seniors Version (QOLPSV), is described. Administration of the QOLPSV to 205 older persons in Ontario, Canada found it to be reliable and valid. Limitations of the instrument are presented and potential uses explored.

From states of confusion to a national action plan for dementia care: the development of policies for dementia care in Australia

The release of Australia's National Action Plan for Dementia Care in 1992 was the culmination of more than a decade of policy development over which the federal government assumed an increasing role, and the participatory approach fostered under its Social Justice Strategy promoted collectivist and political attempts to address the issues of dementia care. This article begins with an account of four phases of policy development, with the transition from one to the next marked by changes in thinking about dementia care being incorporated into policy and then expressed in programmes and in care practices. In the second part of the article, the goals and structure of the National Action Plan are outlined and its implementation and outcomes discussed. Continuation of the policy climate in which the National Action Plan was formulated is a crucial, but uncertain, factor for future development.

Dementia in old age: an anthropological perspective

This paper examines the assumption that dementia in old age is a universal phenomenon that will vary in its prevalence and manifestation because of social and cultural factors. It finds that while researchers have been successful in demonstrating the commonality of dementia, they have been less successful in showing whether or not it varies across cultures and between social and ethnic groupings. The inconclusiveness of findings may, in part, be a function of diagnostic differences and the research methodologies employed. New instruments and measures are being devised to overcome these problems. However, the sociocultural context in which dementia occurs and the meaning of the disorder to those involved (as sufferers and caregivers) are often missing dimensions. In particular, there is little knowledge about how the disorders of old age in non-Western settings are experienced and understood. In this respect anthropology has a special contribution to make to research on dementia.

Metrifonate and dichlorvos: effects of a single oral administration on cholinesterase activity in rat brain and blood

Cholinesterase activities in rat forebrain, erythrocytes, and plasma were assessed after a single oral administration of metrifonate or dichlorvos. In 3-month-old rats, the dichlorvos (10 mg/kg p.o.)induced inhibition of cholinesterase reached its peak in brain after l5-45 min and after 10-30 min in erythrocytes and plasma. Cholinesterase activity recovered rapidly after the peak of inhibition, but did not reach control values in brain and erythrocytes within 24 h after drug administration. The recovery of plasma cholinesterase activity, in contrast, was already complete 12 h after dichlorvos treatment. Metrifonate (100 mg/kg p.o.) had qualitatively similar inhibition kinetics as dichlorvos, albeit with a slightly delayed onset. Peak values were attained 45-60 min (brain) and 20-45 min (blood), after drug administration. Apparently complete recovery of cholinesterase activity was noted in both tissues 24 h after treatment. The dose-dependence of drug-induced inhibition of cholinesterase in rat blood and brain was determined at the time of maximal inhibition, i.e., 30 min after dichlorvos treatment and 45 min after metrifonate treatment. The oral ED(50) values obtained for dichlorvos were 8 mg/kg for brain and 6 mg/kg for both erythrocyte and plasma cholinesterase. The corresponding oral ED(50) values for metrifonate were 10 to 15 times higher, i.e., 90 mg/kg in brain and 80 mg/kg in erythrocytes and plasma. In rats deprived of food for 18 h before drug treatment, the corresponding ED(50) values for metrifonate were 60 and 45 mg/kg, respectively, indicating an about two-fold higher sensitivity of fasted rats to metrifonate-induced cholinesterase inhibition compared to non-fasted rats. Compared to 3-month-old rats, 19-month-old rats showed a higher sensitivity towards metrifonate and dichlorvos. At the time of maximal inhibition, there was a strong correlation between the degree of cholinesterase inhibition in brain and blood. These results demonstrate that single oral administration of metrifonate and dichlorvos induces an inhibition of blood and brain cholinesterase in the conscious rat in a dose-dependent and apparently fully reversible manner. While the efficiency of a given dose of inhibitor may vary with the satiety status or age of the animal, the extent of brain ChE inhibition can be estimated from the level of blood ChE activity.

Voluntarism and health education in nursing

The concept of voluntarism, as it applies to models of health education, underpins the nursing care of people who are chronically confused and their relatives. This article argues that voluntarism needs to be balanced by the notion of collectivism which takes full account of the contribution made by sociopolitical determinants of health. The central concepts of voluntarism and health education are defined and then the article proceeds to examine the extent to which voluntarism has underpinned various models of health education which can be used to support nursing practice. A critique of the concept of voluntarism, as used in health education, is provided. It is argued that models of health education which are polarized towards either voluntarism or collectivism are based on an inadequate understanding of human social action and that this polarization undermines the usefulness of these models of health education.

Culture, meaning and disability: injury prevention campaigns and the production of stigma

The potential production of stigma through health promotion campaigns is a problem that has not received attention in the current literature on the sociology of health promotion. Cultural production studies can shed light onto the ways in which injury prevention campaigns, and public health campaigns more generally, may call for life-saving interventions at the social expense of people with disabilities or other stigmatized conditions. Questioned here are not only the presumed benefits of health promotion campaigns, but also our conventional understandings of 'health' and 'disability'. This paper examines the way in which cultural production studies can contribute to a theory of the production of stigma by public health professionals. One view of cultural production views culture as a reflection of economic relationships between the dominant and the dominated. A second approach emphasizes the 'reception' of cultural works, or how audiences experience culture. Third, cultural production is sometimes analyzed in terms of texts, or the content of cultural artifacts. Insight into the dilemmas of health promotion can be provided by analyzing health promotion strategies in terms of their production, reception, and content as cultural works. Focusing on the case study of injury control and disability rights, health promotion campaigns are seen as potentially contributing to the production of stigma for people who already possess the attributes targeted for prevention. This analysis moves toward a broader theoretical foundation with which to grasp the unintended, even harmful consequences of prevention strategies, and the shared and oppositional interests of people with stigmatized conditions, targeted audiences of prevention, and public health advocates.