Dementia in Australia

Australia's ageing population has raised public awareness and anxiety about dementia-related health and social challenges. Alongside reports of the increasing proportion of older persons in the population, dementia is often characterised as a ‘disaster’, while the caring and financial ‘burden’ of dementia is a common feature of Australian public talk on ageing (Doyle et al., Reference Doyle, Dunt, Pirkis, Dare, Day and Wijesundara2012; Johnstone, Reference Johnstone2013). In both social and medical terms, the ‘impact’ of dementia has been culturally conceptualised as an ‘unstoppable force’ (Zeilig, Reference Zeilig2014: 260; Hillman and Latimer, Reference Hillman and Latimer2017: 2). Public headlines on the dementia ‘epidemic’, ‘tsunami’ or ‘invasion’ frame the condition as a ‘vast, natural or monstrous force that we must fight’ (Zeilig, Reference Zeilig2014: 261). Yet, although the majority of residents in residential aged care have a diagnosis of dementia,Footnote ² dementia is not well cared for in the aged care system. The recent Royal Commission into Aged Care Quality and Safety made findings of inadequate training in dementia care, overuse of medication and restraints, isolation, and disproportionate effects of COVID-19 (Royal Commission into Aged Care Quality and Safety et al., Reference Pagone and Briggs2021: 100). While the Australian aged care discourse is broadly formed from media, government, commercial and public talk about ageing and aged care, this paper draws on a study of Australian aged care public discourse to explicate the role of aged care stakeholders in constructions of dementia in Australia.

Successful ageing in public discourse

Successful ageing is an enduring theme that has positioned itself at the intersection of contemporary scientific and cultural concerns about ageing (Bülow, Reference Bülow, Eilers, Grüber and Rehmann-Sutter2014: 68). While various models of successful ageing exist in medico-scientific discourses, the biomedical model originally advanced by Rowe and Kahn (Reference Rowe and Kahn1987) has dominated ageing discourses (Bowling and Dieppe, Reference Bowling and Dieppe2005; Kusumastuti et al., Reference Kusumastuti, Derks, Tellier, Di Nucci, Lund, Mortensen and Westendorp2016).Footnote ³ Rowe and Kahn (Reference Rowe and Kahn1997: 439) defined successful ageing to encompass ‘three distinct domains: avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement in social and productive activities’. Challenging the established view that disease and disability were unavoidable in older age, Rowe and Kahn (Reference Rowe and Kahn1997: 434–437) proposed the ageing process could be modified by lifestyle factors such as diet, exercise and social activity. In revealing a distinction between inevitable age-dependent, and malleable age-related, decline, successful ageing theories have powerfully influenced a shift towards ‘optimisation and enhancement’ approaches to older age (Thuesen et al., Reference Thuesen, Feiring, Doh and Westendorpin press). Successful ageing was further developed to include psychological and socio-cultural perspectives (Baltes and Baltes, Reference Baltes, Baltes, Baltes and Baltes1990) and has ongoing application in contemporary fields such as reablement (Thuesen et al., Reference Thuesen, Feiring, Doh and Westendorpin press) and creative ageing (Cho and Chang, Reference Cho and Changin press).

Nevertheless, in focusing on objective criteria, the biomedical model of successful ageing is critiqued for excluding heterogenous lived experiences of ageing and subjective preferences of older persons themselves (Bowling and Dieppe, Reference Bowling and Dieppe2005; Timonen, Reference Timonen2016). Further, reception and translation of biomedical successful ageing into public discourse is reproduced in neoliberal-infused healthy ageing recommendations that allocate responsibility to individuals for their own health and wellbeing in later life (Asquith, Reference Asquith2009; Timonen, Reference Timonen2016). The ideal of an individualised successful age was conceptualised by Rowe and Kahn themselves:

As a result, regimes for successful ageing – advice on how to maintain and enhance physical and mental fitness in older age through exercise, diet, social, self-care and consumer behaviours – have become common in health and ageing discourses. Biomedical successful ageing has been widely received into media and public discourse – e.g. health insurance publications (Van den Bogaert et al., Reference Van den Bogaert, Ceuterick and Bracke2020) and social media ‘tweets’ (Makita et al., Reference Makita, Mas-Bleda, Stuart and Thelwall2021) – and contributed to cultures of ageing where activity, ability and independence are the preferred metrics of a life lived ‘successfully’ in older age (Cardona, Reference Cardona2008; Pack et al., Reference Pack, Hand, Laliberte Rudman and Huot2019).

Responsibilisation of the ageing brain

The advocation of successful ageing regimes in public discourse form normative practices for older persons, a ‘moral framework’ on how to deal with the ageing body as an ‘enactment of citizenship obligations’ (Cardona, Reference Cardona2008: 481; Pack et al., Reference Pack, Hand, Laliberte Rudman and Huot2019; Van den Bogaert et al., Reference Van den Bogaert, Ceuterick and Bracke2020). Shifting accountability for ‘achieving’ a successful older age to the individual has culminated in the ‘responsibilisation of ageing’ (Asquith, Reference Asquith2009; Latimer, Reference Latimer2018: 842).

‘Responsibilisation’, as a form of ‘governmentality’ identified by Foucault, is the process whereby individuals and communities are simultaneously liberated, and accountable, to define and achieve their own future and wellbeing (Rose, Reference Rose1996: 328, Reference Rose2000). Termed ‘ethopolitics’ by Rose, this ‘politics of conduct … reconstructs citizens as moral subjects of responsible communities’ (Rose, Reference Rose2000: 1395). Responsibilised citizens must be active in self-governing ‘recipes and routines for the conduct of life’ (Rose, Reference Rose2000: 1402). In the field of public health, individuals are responsibilised to safeguard and improve their own health and capacity (Petersen, Reference Petersen, Bunton and Petersen1997; Brown and Baker, Reference Brown and Baker2013). Against neoliberal approaches to health care, responsibilised individuals are constructed as autonomous and active citizens able to pursue and protect their wellbeing with disciplines of self-care (Brown and Baker, Reference Brown and Baker2013; Liebenberg et al., Reference Liebenberg, Ungar and Ikeda2015). Within these health-care systems, ‘risky’ individuals who fail to self-manage their health risks are marginalised for lacking self-control (Petersen, Reference Petersen, Bunton and Petersen1997: 198) and failing in their citizen obligations (Liebenberg et al., Reference Liebenberg, Ungar and Ikeda2015: 1008).

Neoliberal health policies that responsibilise ‘individual citizen-consumers’ for the self-governance of health and wellbeing (Brookes, Reference Brookes2021: 2213) reimagine older age as subject to management, manipulation and the target of consumer markets of ageing (Cardona, Reference Cardona2008: 479; Asquith, Reference Asquith2009: 256; Brown and Baker, Reference Brown and Baker2013: 13; Timonen, Reference Timonen2016: 27; Latimer, Reference Latimer2018: 842). In the same way as the term ‘lifestyle disease’ denotes ill-health as the outcome of ‘self-inflicted' choices (Brookes, Reference Brookes2021: 2217), responsibilisation of the ageing body (and brain) may contribute to assessments of blame for failing to make proper choices for successful older age (Brown and Baker, Reference Brown and Baker2013: 13; Peel, Reference Peel2014; Latimer, Reference Latimer2018).

Successful ageing frameworks articulated in public discourse promote responsibility for self-care of the ageing brain through brain health advice and discursively construct individual accountability for dementia in older age (Katz and Peters, Reference Katz and Peters2008; Williams et al., Reference Williams, Higgs and Katz2012; Peel, Reference Peel2014; Lawless and Augoustinos, Reference Lawless and Augoustinos2017; Lawless et al., Reference Lawless, Augoustinos and LeCouteur2018; Mitchell et al., Reference Mitchell, Dupuis, Kontos, Jonas-Simpson and Gray2020; Bailey et al., Reference Bailey, Dening and Harvey2021). Framing the ageing brain as a risk to be responsibly self-managed, brain health advice represents normative biomedical recommendations on how individuals may reduce their risk of cognitive decline and prevent dementia in the form of advice on diet, exercise, consumption and ‘brain fitness’ (Mitchell et al., Reference Mitchell, Dupuis, Kontos, Jonas-Simpson and Gray2020: 5). Within health systems that ‘evaluate, manage and track citizens … who are ‘at risk’ or whose behaviour is “risky”’ (Liebenberg et al., Reference Liebenberg, Ungar and Ikeda2015: 1008), brain health advice is promoted to self-manage the (risky) ageing brain. Responsibilisation of ageing in public discourse renders individual brain health a signifier of good citizenship and the target of successful ageing regimes. Growing emphasis on self-care for cognitive health positions the performance of brain health advice to ‘boost’ the ageing brain as the best defence against cognitive decline and dementia.

Neuroculture and boosting the ageing brain

The term ‘neuroculture’ has been used to refer to widespread cultural and intellectual adoption of neuroscience into contemporary life and public discourse, and notably its normative influence on societal values and consumer practices (Frazzetto and Anker, Reference Frazzetto and Anker2009: 815; Williams et al., Reference Williams, Higgs and Katz2012; Bülow, Reference Bülow, Eilers, Grüber and Rehmann-Sutter2014; Wade, Reference Wade2018). Situated within shifting notions of health and illness, ability and disability, treatment and enhancement, neuroculture brings neuroscientific knowledge, such as brain imaging, genetics and pharmaceuticals, to influence on popularised cultural and social understandings of the brain and its processes (Williams et al., Reference Williams, Higgs and Katz2012: 64). Neuroculture contributes to consumer markets of brain health in the form of expert advice on how to ‘boost’ or enhance memory and cognition, where ‘everybody must try to remember everything’ (Katz and Peters, Reference Katz and Peters2008: 354).Footnote ⁴ Widespread reception of scientific research on neuroplasticity has shaped neurocultural conceptions of ‘neuro-enhancement’ that promote brain ‘training’ and ‘fitness’ practices to keep the brain in its prime, regardless of age (Wade, Reference Wade2018: 297).

Against biomedical discourses of successful ageing, neurocultural practices have relevance for the ageing brain by shaping conceptual boundaries of ‘normal’ cognition and memory in natural ageing. In neuroculture, any ‘forgetting … is increasingly regarded as an act of "failure"’ (Williams et al., Reference Williams, Higgs and Katz2012: 71). Within neurocultural discourses adopting biomedical definitions of ‘normal’ and ‘deficient’ cognitive function, surveillance of the ageing brain aims to identify persons with early cognitive decline before they ‘slip’ into dementia. In particular, the boundary of mild cognitive impairment as ‘pre-’ or ‘early’ dementia pathologises all memory loss and justifies biomedical inspection and intervention against the threat of dementia (Katz and Peters, Reference Katz and Peters2008: 353; Williams et al., Reference Williams, Higgs and Katz2012: 71). Positioning the ageing brain itself as ‘risky’, neurocultural practices build on negative framing of dementia as disaster and successful ageing discourses to promote brain health advice as valorised labour to prevent, delay or avoid dementia (Wade, Reference Wade2018).

The discursive intersection of successful ageing and neurocultural frameworks positions the ageing brain as both ‘promise and peril’ to be ‘diligently laboured upon’ in order to avoid cognitive decline and dementia (Wade, Reference Wade2018: 297). These ‘brain-boosting’ regimes are found in brain health advice instructing older persons to follow expert biomedical recommendations on how to prevent or delay the risk of mild cognitive decline and dementia. In cultures of responsibilised successful ageing, where the ‘quality’ of older age has been discursively reconceptualised as the outcome of diligence and choice by conscientious citizens, brain health advice carries both promise of enhanced cognition and moral obligation to avoid the personal, economic and social disaster of dementia.

‘Impact’ of dementia

Consistent with prior studies (see e.g. Brookes, Reference Brookes2018; Bailey et al., Reference Bailey, Dening and Harvey2021), the public discourse sample revealed the (re)appearance of the concept of dementia as physical threat. Language of force, such as ‘impact’, ‘fight’, ‘battle’ and ‘halt’, frame dementia as a powerful and destructive agent and legitimise a disciplined ‘regime and industry’ of resistance informed by biomedical and stakeholder interests (Cardona, Reference Cardona2008: 478). One clear instance is ‘impact’, a term frequently used to describe the effects of dementia on persons, families and carers, as well as its social and economic consequences. Across the public discourse sample, the word ‘impact’ (or stemmed words ‘impacts’, ‘impacted’) was repeated over 770 times in 64 documents. Several examples of articulations of the ‘threat of dementia’ are set out as follows:

The third example is from the current strategic plan of Australia's peak dementia advocacy and support group, which repeats the phrase ‘impacted by dementia’ eight times to describe dementia as a powerful negative force. This is reinforced by the phrasing ‘impact of dementia’, which promotes a rhetoric of resistance by individuals in the ‘fight’ against dementia. Similar terms of ‘defence’ were observed in the public discourse sample, such as ‘stop in tracks’, ‘tackle’, ‘wipe-out’, ‘reverse’, ‘alter course’ and ‘fend off’, that conceptualise dementia as an advancing dangerous force to be physically opposed, while terms ‘ward off’ and ‘retard’ frame dementia as a power to be pushed or held back. When dementia is framed in aged care public discourse as a threatening force, individuals are discursively recruited in the ‘fight’ against dementia, such as these examples:

The use of military terms (‘war’, ‘battle’, ‘attack’, ‘fight’) occur throughout the public discourse sample and frame dementia as a violent threat to be repelled. In the rally to ‘fight dementia’, words of opposition – ‘prevent’, ‘delay’, ‘avoid’ or ‘reduce’ appear in more than 1,400 references in 100 documents across the sample – promote the counterforce needed to ‘fight back’ in the ‘battle’ against dementia.

Brain health advice is often accompanied by warnings, consistent with dementia as a feared health and social condition portrayed through a ‘panic-blame framework’ (Peel, Reference Peel2014: 890). Public dread of dementia (re)appears in public discourse of aged care stakeholder documents to promote diligence in managing the ageing brain against cognitive decline. Articulations of dementia warnings, such as ‘top 10 early warning signs’, ‘10 warning signs’ or ‘early indicators something might not be right’, in the sample of stakeholder documents equate dementia with impending threat. Choice of language, such as the phrase ‘warning signs’ (instead of ‘symptoms’), urge watchfulness in older persons to monitor and mitigate their risk of dementia. Other discursive formulations warn vigilance against the threat of any memory loss by emphasising dementia as ‘disaster and danger’ (Behuniak, Reference Behuniak2011; Cuijpers and van Lente, Reference Cuijpers, van Lente, Swinnen and Schweda2015; Brookes, Reference Brookes2018), such as the following extract from an aged care industry group article:

The danger of ignoring any dementia warning sign (such as misplaced keys) is reinforced by the stock photograph of a man who appears unable to read a calendar, inferred to be due to dementia. Allocation in aged care public discourse of the dementia ‘load’ to the individual occurs amid the withdrawal of Australian public health and welfare, particularly in aged care (Asquith, Reference Asquith2009), and directs individuals to self-assess and self-manage the ageing brain.

The concept of dementia as a ‘threat’ in public discourse is underscored by statistics on dementia prevalence and expenditure, expressed in the following example, titled ‘The Dementia Tsunami’:

As Latimer (Reference Latimer2018: 835) notes, the reduction of dementia to its economic costs renders persons with dementia as ‘old, demented and costly’. This extract states ‘pushing back’ the onset of dementia would ‘save billions in costs’, where ‘this goal’ of economic savings is ‘quite achievable’ with ‘concerted’ efforts to change ‘health and lifestyle choices’. Here, ‘save’ carries the dual meaning of ‘to avoid the spending or waste of’ and ‘to rescue from danger’ (Macquarie Dictionary Publishers, 2021), and is reinforced by ‘tsunami’ in the headline. Discursive constructions of dementia as ‘costly’ promote an imperative to ‘save’ Australia from the threat of dementia. A literal formulation of this framing is found in the campaign of Australia's peak dementia advocacy group, expressed in the example below:

The slogan ‘Fight Alzheimer's Save Australia’ advocates resistance, a framing reinforced by an accompanying image of a group of people holding protest signs and a banner with a raised fist graphic, portraying dementia as threatening the existence of the Australian nation. Rhetorical emphasis on the national threat of dementia in public discourse is repeated in the next example by a medical stakeholder:

This extract warns the rising costs of dementia threaten to ‘blow out’ Australia's health budget unless ‘we … proactively look[ing] after our brains’, and uses words of disaster and force (‘tragedy’, ‘blow out’ and ‘trajectory’) to promote ‘more than halv[ing] our rate of developing dementia’ through lifestyle changes. Where dementia is conceptualised in public discourse to have the impact of physical disaster, it advocates a regime of resistance in the form of brain health advice to prevent or delay dementia and reduce cognitive decline.

Dementia is capable of prevention or delay

Consistent with findings by other researchers (Lawless and Augoustinos, Reference Lawless and Augoustinos2017; Lawless et al., Reference Lawless, Augoustinos and LeCouteur2018; Petersen and Schicktanz, Reference Petersen and Schicktanz2021), the sample revealed a concept of dementia as able to be prevented or delayed by following expert brain health advice. Set against a shift in biomedical dementia research towards early detection and prevention, brain health advice translates medical and scientific debates on dementia risk reduction and prevention and articulates them in the form of lifestyle and consumptive practices. Brain health advice delivered by a medico-scientific expert promotes a rational and normative discursive construction of dementia as preventable (Lawless and Augoustinos, Reference Lawless and Augoustinos2017: 75). Formulations of this concept are found throughout the sample of aged care public discourse in phrasing such as ‘according to Professor…’, ‘Dr says…’ or ‘Dr has some simple advice…’. Expression of biomedical authority over the ageing brain (‘skulls’) is asserted in the following extract by a digital ‘midlife and retirement’ publisher, titled ‘How to Prevent Dementia – According to a Brain Surgeon’:

This example highlights the role played by biomedical authority to ‘propagate risk knowledge’ (Brown and Baker, Reference Brown and Baker2013: 20) in the responsibilisation of dementia prevention through brain health advice in public discourse. The brain surgeon's clinical experience is used to construct the ageing brain as the outcome of lifestyle choices, ‘the way a person lives their life’, and promote the ‘best ways to help boost memory … and reduce Alzheimer's risk’. The extract continues:

Here, the brain surgeon's recommendations for ‘manageable changes’ to diet and exercise that ‘add up’ to reduce risk are communicated with a warning there is ‘no treatment if you get dementia’. This formulation leverages a warning narrative and tends to discount the possibility of living well with dementia.

In a similar example of medico-scientific dementia research re-articulated as responsibilised brain health advice, a hospital charity stakeholder gives the following guidance under the heading ‘So what can you do?’:

This example positions expert recommendations to ‘treat[ing] your brain well’ about exercise, sleep, social activities, smoking, diet and alcohol as responsibilising brain health advice. The discursive imperative to do something to get a ‘good start’ against dementia is communicated with the verbs ‘getting’, ‘having’, ‘quitting’, ‘eating’ and ‘cutting down’. Further, the headline ‘So what can you do?’ directly addresses individuals to emphasise personal responsibility for dementia risk reduction. Similar examples of this rhetorical strategy are seen in the phrases ‘treating your brain well’, ‘to reduce your risk, you can’ and ‘your brain health’. Use of the pronoun ‘you’ in public discourse constructs cognitive decline and dementia as the responsibilised outcome of individual lifestyle and consumer choices. This is consistent with construction of individuals as ‘responsible choice-makers’ as in other ‘modifiable’ health conditions, such as obesity (Brookes, Reference Brookes2021: 2223).

Brain health advice in aged care public discourse promotes active participation by individuals responsible for self-management of the ageing brain. This discursive ‘injunction to activity’ (Rose, Reference Rose1996: 348) is articulated in emphasis on (literal) ‘staying active’ in the aged care public discourse. Reception and translation of biomedical recommendations into bodywork practices can be seen in aged care public discourse in this example from a health and fitness stakeholder:

The stakeholder advocates exercise as ‘crucial’ for ‘brain health’ to ‘protect against dementia and Alzheimer's disease’, stressed with exclamation marks. Moreover, the brain health advice makes a direct link between biomedical research on associations between exercise (‘time to head to the gym’) and reduction in dementia symptoms (‘keep forgetting where you put your keys?’).

Another example of brain health advice discursively promoting exercise occurs in a news piece by an academic/research institution stakeholder under the heading ‘Exercise Good for Alzheimer's Delay’:

The piece translates medico-scientific research on dementia prevention ‘lifestyle factors’, such as exercise, as ‘very important’ on the basis there is ‘no effective cure or treatment for Alzheimer's disease’, highlighting the potential threat for individuals with an ‘ageing brain’. A direct link between health choices, obesity and dementia is articulated in the following extract in a podcast transcript of a medical health professional:

The stakeholder's statement that dementia rates are ‘driven’ by a ‘big, fat group of older people’ is used to discursively problematise both the number (‘a lot’) and lifestyle habits (‘waistlines’) of older people in general.

Brain health advice in aged care public discourse may also be formulated as specific recommendations based on associations with other health conditions, such as hearing loss, as seen in this example from a medical-aid supplier:

In this extract, responsibilising brain health advice leverages fear of dementia to promote services and products. While the research association between hearing loss and dementia is described as ‘depressing’, a ‘silver lining’ is advocated as possible if the individual ‘take[s] immediate action’ for their ‘mental health’.

In a similar example, research correlating dementia and gut health is the focus of brain health advice under the heading ‘Your Gut Bacteria Could Influence Whether You Develop Alzheimer's Disease’ and accompanied by the following image:

In this brain health advice, the aged care provider stakeholder draws on biomedical research linking intestinal bacteria and risk of dementia for ‘new strategies’ of ‘diet and probiotics’. The image of a pill labelled ‘Alzheimer's’ promotes discursive construction of dementia as potentially preventable with probiotic supplements or medication.

Biomedicalised discourses on successful ageing have been received and articulated into the aged care public discourse to promote responsibilisation of older persons to ‘age well’. Applied to the ageing brain, this has been adopted in public discourse to advocate individualised self-care to avoid cognitive decline and dementia. Consistent with the responsibilisation of ageing, the sample of Australian aged care public discourse showed brain health advice messages promotes a biomedical concept of dementia as capable of delay, or even prevention, through articulation of regimes for successful ageing lifestyle and consumer practices.

‘Brain boosting’ against dementia

Consistent with the ‘neuro-turn’ observed by other researchers (Williams et al., Reference Williams, Higgs and Katz2012; Wade, Reference Wade2018), a neurocultural concept of good cognitive health as the outcome of ‘brain-boosting’ enhancement was observed in the sample of aged care public discourse. Reflected from neurocultural discourses that pathologise any cognitive decline, brain health advice in public discourse promotes ‘neuro-enhancement’ in the pursuit of what Wade (Reference Wade2018: 303) calls ‘aspirational biocitizenship’ and advocates ‘perfect’ memory as a shield against cognitive decline and dementia. Practices of ‘neurological self-fashioning’ of the (risky) ageing brain are articulated in public discourse as a rational responsibilised response to protect against the threat of cognitive decline and dementia (Wade, Reference Wade2018: 315).

Analysis of brain health advice formulations in the sample of aged care public discourse reflects adoption of self-fashioning, neurocultural terms – ‘reclaim’, ‘maximise’, ‘enhance’ and ‘boost’ – to promote practices for enhancing memory and cognitive function. Indeed, such neurocultural terms appear more than 220 times across the public discourse sample and discursively construct ‘valorised neuro-enhancement’ as the best prevention against cognitive decline (Williams et al., Reference Williams, Higgs and Katz2012; Wade, Reference Wade2018). Wade (Reference Wade2018: 300) described brain games as ‘virtuous play’, where ‘fears [of dementia] are eased by reassurances that we are dedicating our best minds to save our lost brains’. The following further extracts from two earlier examples illustrate this concept:*

Expression of neurocultural phrases, such as ‘boost your brain’, ‘boost memory’, ‘enhance brain function’, ‘build a better brain’ and ‘stay sharp at age 90’’, discursively promote practices of industrious neuro-enhancement. Neurocultural brain health advice in the public discourse sample interprets research linking mental activity and cognitive function to promote ‘brain games’. The following example is from a government health information website, under the heading ‘Improve Your Mental Fitness’:

This extract presents ‘brain boosting’, in the form of a ‘30 to 50 per cent’ improvement in ‘memory loss’, as possible ‘simply by doing mental exercises’, while failure to perform ‘regular workouts’ is said to result in a ‘weaker’ brain. The brain health advice also advocates individualised participation in ‘a social life’ and ‘play thinking games’. Adopting the ‘responsibilising rhetoric’ for so-called ‘lifestyle diseases’ (Brookes, Reference Brookes2021: 2213), the extract discursively assigns personal accountability for brain health with phrases such as ‘if you do not’ and ‘you may want to try’.

Reflecting preoccupation in neurocultural discourse with ‘boosted’ cognition, the aged care public discourse catastrophises any memory loss and conceptualises the ageing brain itself as symbolic of cognitive decline. This is demonstrated in the following extract:

Articulated in the phrases ‘losing your memory’ and ‘memory is failing’, the extract advocates individualised scrutiny of the ageing brain on the grounds of ‘a little forgetful[ness] or … getting older’. The health education charity stakeholder goes on to promote a fee-based programme, ‘Reclaiming Your Brain’, where, notwithstanding the ‘state of your brain’, it will be possible to ‘improve its functioning’. Reflecting neuroscientific discourses that ‘molecularize’ brain processes (Katz and Peters, Reference Katz and Peters2008: 350), public discourse labels older brains as inherently ‘risky’, as expressed in the following examples:

In these examples, the ‘healthy elderly brain’ and ‘healthy ageing’ are discursively contrasted against risky ‘elevated proteins’ and ‘mild cognitive impairment’ to promote ‘tackl[ing]’ the ‘terrible cost’ of neurodegenerative disease. Framed in this way, the aged care public discourse reflects biomedical debates about ‘normal’ and ‘deficient’ memory to legitimise individualised monitoring and inspection of the ageing brain (Katz and Peters, Reference Katz and Peters2008; Williams et al., Reference Williams, Higgs and Katz2012).

Matrix of brainwork practices

The primary finding of this study emerges from synthesis of three key concepts of dementia identified in public discourse by aged care stakeholders. Together, these concepts advocate a responsibilising framework of ‘brainwork practices’ on how to self-manage the ageing brain which, in turn, has consequences for constructions of dementia as failed or unsuccessful ageing. Building on Pack et al.'s (Reference Pack, Hand, Laliberte Rudman and Huot2019) terminology of ‘bodywork practices’ for self-management of the ageing body, the phrase ‘brainwork practices’ is adopted here to represent self-management of the ageing brain.

In their role as ‘dutiful biocitizens’ (Wade, Reference Wade2018: 314), older persons are responsibilised to decode a range of broad and specific brain health advice into individual brainwork practices to ‘boost’ the brain and protect against cognitive decline and dementia (Mitchell et al., Reference Mitchell, Dupuis, Kontos, Jonas-Simpson and Gray2020: 5). Across the sample of aged care public discourse, brain health advice takes the form of expert recommendations on diet, exercise, social activity, leisure, substance use, hearing, intestinal bacteria and mental training. In addition to advice on single factors for brain health, extensive ‘shopping lists’ of brain health advice are found across the sample. Examples that articulate formulations such as ‘Tips for keeping your memory sharp’, ‘The 7 hidden causes of memory problems’ and ‘6 things you can do to reduce your risk of dementia’ discursively construct ‘recipes and routines’ (Rose, Reference Rose2000: 1402) for optimal cognitive health. In this way, responsibilising brain health advice in aged care public discourse represents the reception and translation of biomedical successful ageing and neurocultural discourses expressed as a matrix of ‘brainwork practices’ that promote individualised cognitive health.

The imperative of brainwork practices for ageing brains is illustrated in the following example from an aged care lobbyist, which uses the phrase ‘cognitive footprint’ to describe ‘whole of life’ events that determine propensity to cognitive decline:

Bringing together key themes in the public discourse sample, this extract frames dementia as a dangerous force (‘prey’, ‘epidemic’, ‘impact’) to advocate brainwork practices (‘cognitive health efforts’) to protect and enhance cognitive capacity (‘cognitive footprint’, ‘shape’). Portrayed in the illustration of a brain lifting weights, the message frames the cognitive health of the ‘nation’ as the sum of individualised brainwork practices of a ‘whole society’.

Brainwork practices are discursively framed as acts of responsibilised citizens for the benefit of both individual and society, where ‘proper care of the [cognitive] self’ is an ‘obligation’ to society to minimise the personal and public dangers of dementia in Australia (Cardona, Reference Cardona2008: 480; Pack et al., Reference Pack, Hand, Laliberte Rudman and Huot2019). This framing of brain health as a personal accountability constructs notions of fault or self-infliction for cognitive decline and dementia. As a final example, the following extract is from a medical aid supplier on the association between hearing loss and dementia:

The example goes on to repeat the phrase ‘done absolutely nothing about’ eight times in relation to hearing loss leading to ‘acceleration’, ‘decline’ and ‘premature ageing’, framing this failure to act as ‘failure to govern themselves’ (Rose, Reference Rose1996: 349). These examples reveal explicit stakeholder discourse about the responsibility of older persons to self-manage the ageing brain.