Carter, Christine; (2024) How does active ageing policy and practice reconfigure the experience of cognitive impairment? A study of an active ageing intervention. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis explores the interface between active ageing policy, practice and people with memory problems and mild cognitive impairment (MCI), which are not dementia. The complexity of this interface is influenced by an increased medicalisation around memory difficulties. This thesis is set within the context of an active ageing intervention, APPLE-tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce), based upon modifiable risk factors surrounding dementia. I apply a social science lens, drawing upon sociological theory, with three interrelated studies forming the core of the thesis. 1. Scoping review and meta-synthesis: exploring subjective experiences of cognitive impairment and MCI through literature and synthesis. 2. Secondary data analysis: analysis of consultations from the APPLE-tree intervention. 3. Ethnographic study: provides an ethnographic view of APPLE-tree as an example of active ageing practice, using focused ethnography and reflexive thematic analysis to explore experiences of engaging an active ageing aimed at modifying dementia risk. A recurring theme throughout the thesis is one of absence, evident in a number of ways. This includes the lack of acknowledgement of individual subjective experiences of memory difficulties which are not dementia. Ambiguity surrounded cognitive impairment and the uncertain trajectory of an MCI diagnoses created expectations and responsibilities for individuals with memory issues to engage in active ageing interventions. Motivation to participate in APPLE-tree often stemmed from a fear of developing dementia and a desire to prevent cognitive decline. Participation is framed by personal responsibility for health and societal expectations of healthy and successful ageing elevated through public health policy. Engagement in active ageing was complicated by an unclear definition of success with interventions differing from those targeting physical health. Ultimately this led to a tension between participation in an active ageing intervention and achieving desired outcomes, which remains unresolved.

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