A prospectus for ethical analysis of ageing individuals' responsibility to prevent cognitive decline

Abstract

As the world's population ages, governments and non-governmental organizations in developed countries are promoting healthy cognitive ageing to reduce the rate of age-related cognitive decline and sustain economic productivity in an ageing workforce. Recommendations from the Productivity Commission (Australia), Dementia Australia, Government Office for Science (UK), Presidential Commission for the Study of Bioethical Issues (USA), Institute of Medicine (USA), among others, are encouraging older adults to engage in mental, physical, and social activities. These lifestyle recommendations for healthy cognitive ageing are timely and well supported by scientific evidence but they make implicit normative judgments about the responsibility of ageing individuals to prevent cognitive decline. Ethical tensions arise when this individual responsibility collides with social and personal realities of ageing populations. First, we contextualize the priority given to healthy cognitive ageing within the current brain-based medical and social discourses. Second, we explore the individual responsibility by examining the economic considerations, medical evidence and individual interests that relate to the priority given to healthy cognitive ageing. Third, we identify three key ethical challenges for policymakers seeking to implement lifestyle recommendations as an effective population-level approach to healthy cognitive ageing. The result is a prospectus for future in-depth analysis of ethical tensions that arise from current policy discussions of healthy cognitive ageing.

The Experts’ Advice: Prevention and Responsibility in German Media and Scientific Discourses on Dementia

“…In German media, aging readers are called on to model their lifestyle along the normative guiding principles of “active aging” and to shape their lives in a healthy and socially responsible manner. The political, economic, and social prerequisites for active aging and dementia prevention tend to be neglected (see also Forlini & Hall, 2017 ). The comparatively large protective influence of education ( Livingston et al, 2017 ) is discussed only occasionally in the examined discourses.…”

“…If healthy aging and dementia prevention appear a question of individual efforts, there is a danger of associating dementia with a negligent lifestyle and blaming the individual for cognitive decline. The responsibility for cognitive health and the blame for cognitive decline in old age might be shifted onto those who do not follow health and prevention recommendations and thus fail or refuse to live their lives in a healthy, active, and socially acceptable manner (Forlini & Hall, 2017). In interaction with degrading and objectifying images of dementia (Harvey & Brookes, 2019;Low & Purwaningrum, 2020), the strong emphasis on individual responsibility might support "victim-blaming of those living with dementia and result in increased stigmatization" (Lawless et al, 2018(Lawless et al, , p. 1548; see also Harris et al, 2016;Mohr et al, 2021;Peel, 2014).…”

“…Current studies on public health communication and media coverage on cognitive aging and dementia have identified a strong emphasis on individual responsibility and lifestyle factors. People are positioned as being at risk for developing dementia and strongly encouraged to adopt a healthy way of life to prevent or delay cognitive decline (Lawless et al, 2018; see also Broer & Pickersgill, 2015;Forlini & Hall, 2017;Harris et al, 2016;Lawless & Augoustinos, 2017;Mohr et al, 2021;Peel, 2014;Robillard & Feng, 2017).…”

Differences in Blame-Like and Forgiveness-Like Judgments between Young People, Healthy Older People, and Older People with Dementia

“…Judgment in everyday situations is an important aspect of cognition and warrants formal evaluation during neuropsychological assessments of older adults. The knowledge gained from this process can be used for diagnostic purposes and to address issues related to functional competence and the level of care required now and in the future [18].…”

Ethical Issues of Primary and Secondary Dementia Prevention

“…This could result in a lack of collective and public efforts to promote healthy lifestyles or in the stigmatization of individuals with dementia by suggesting irresponsible lifestyle choices (Petersen & Schicktanz, 2021). As Schweda and Pfaller (2020) argued, the leading paradigms of "successful aging" and "antiaging" in Western societies lead not only to a shift of responsibility to individual subjects but also to a Prevention campaigns also risk increasing existing health inequalities or social injustices, as socially disadvantaged groups may not be able to benefit from these interventions (Forlini & Hall, 2017). According to Horstkötter et al (2021), such interventions should therefore be accompanied by empirical-ethical research to identify negative side effects and to inform scientific research and policymaking.…”