Abstract
Efforts to diagnose Alzheimer's disease (AD) at earlier stages as a means to managing the risks of an ageing population, dominate scientific research and healthcare policy in the UK. It is anticipated that early diagnosis will maximise treatment options and enable patients to 'prepare for their future' in terms of care. Drawing on qualitative data gathered across an out-patient memory service and in-patient hospital in the UK, the purpose of this paper is to examine the ways in which the hopeful promissory claims of early diagnosis as it maintains the dominant biomedical model for managing AD, are negotiated by healthcare practitioners. Developing the analytical standpoint of the sociology of expectations, this paper demonstrates that early diagnosis has the potential to ‘close off’ hopeful promissory visions of the future in two ways. Firstly, it (re)produces the fearful anticipations of AD built around expectations concerning the ageing future ‘self’, and secondly it produces uncertainty in terms of the availability of care as material resource. Whilst practitioners account for the uncertainties and anxieties it produces for patients and their families, they also convey a sense of ambivalence concerning early diagnosis. This article captures the internal conflicts and contradictions inherent to practitioners' perspectives regarding the repercussions of early diagnosis and concludes by arguing that it effaces the uncertainties and anxieties that it produces in practice as it restricts the co-existence of narratives for making sense of memory loss beyond ‘loss of self’, and fails to recognise care as a viable alternative for managing AD.
Highlights
Efforts to improve the detection of Alzheimer’s disease (AD) and increase diagnosis rates at earlier stages to manage the ‘impending burden’ of an ‘ageing population’, drives current UK healthcare policy initiatives and scientific agendas (Lock 2013: 22).According to Golomb et al, (2004), ‘explosion of interest [in Alzheimer's disease (AD)] reflects a shift in dementia research away from established disease and toward early diagnosis’
Developing the analytical standpoint of the sociology of expectations, this paper demonstrates that early diagnosis has the potential to ‘close off’ hopeful promissory visions of the future in two ways
Scientific research is currently dominated by efforts to detect biomarkers, the earliest physical signs of the disease and since age is the greatest risk factor for developing AD, healthcare policy initiatives have emerged in recent years, which seek to improve diagnosis rates in the older population
Summary
Efforts to improve the detection of Alzheimer’s disease (AD) and increase diagnosis rates at earlier stages to manage the ‘impending burden’ of an ‘ageing population’, drives current UK healthcare policy initiatives and scientific agendas (Lock 2013: 22).According to Golomb et al, (2004), ‘explosion of interest [in AD] reflects a shift in dementia research away from established disease and toward early diagnosis’ (pp. 353). Efforts to improve the detection of Alzheimer’s disease (AD) and increase diagnosis rates at earlier stages to manage the ‘impending burden’ of an ‘ageing population’, drives current UK healthcare policy initiatives and scientific agendas (Lock 2013: 22). Scientific research is currently dominated by efforts to detect biomarkers, the earliest physical signs of the disease (see Zetterberg 2011) and since age is the greatest risk factor for developing AD, healthcare policy initiatives have emerged in recent years, which seek to improve diagnosis rates in the older population. Such initiatives implemented in the National Health. Social care in the UK has seen a marked decline in terms of funding with detrimental consequences for adequately meeting the needs of the older population(s)
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