A.I. Rajala1
1Tampere University, Politics, Tampere, Finland
Background: Statistical language of the growing global population of people with dementia (PWD) and related costs are frequently used as a rationale for physiotherapy research in dementia. Considering the lack of effective pharmacological treatments, physiotherapy and physical activity offer a promising intervention to help PWD to maintain their physical and cognitive functions. From the perspective of political economy, physiotherapy and physical rehabilitation offer a cost-effective means to manage the effects of aging society.
Purpose: The purpose is to find out how statistical and economic discourse is used in physiotherapy research and who are involved in the discourse.
Methods: A Medline search was performed on dementia/alzheimer's and physiotherapy/physical theorapy/rehabilitation (January 1 2000 and December 31 2019), which yielded 5,048 records. Articles concerning physiotherapy or physical rehabilitation were selected. The remaining 395 articles were read to find mentions of rising numbers of PWD or costs of dementia. The resulting 164 articles constitute the final corpus. The corpus was coded using atlas.ti (version 8) and analysed with reference to the dimensions of Critical Discourse Analysis.
Results: Two strategies to use statistics were identified: 1) impacts and burdens, and 2) mitigation. There were seven subjects/agents: person/patient with dementia, informal carers and family, professionals, healthcare services, society, implicit/unknown subject and the population with dementia. The financial impact, as well as indirect costs of comorbidities, are most often expressed to fall on healthcare. Financial impact for the PWD and family is mentioned less commonly. The burden of care variably falls on healthcare, informal carers, and professionals. Institutionalisation and increased service use are mentioned often, but it is not always clear whether these represent a personal or economic impact. In mitigating the impact of dementia, physical activity is often contrasted with the lack of effective pharmacological treatment. Mitigating increased service use is expressed both as a cost-containment and quality of life measure. Mitigating the functional and cognitive decline focuses on the PWD or the population with dementia; however, there is commonly a depersonalising and passivating tone when the population with dementia is used as the agent in the text. It is more common to express mitigation as 'improving the functioning in/among/of PWD' rather than 'supporting PWD to improve their functioning'.
Conclusion(s): Statistical discourse portrays PWD as a growing mass of dysfunctional bodies that pose a challenge to healthcare. The passivating expressions in which rehabilitation is 'done onto' PWD further accentuates the view of PWD as a burden population. In this context, physiotherapy is translated into an asset that takes the burdens off other caring hands. Physiotherapy contributes to the continuation of the neoliberal healthcare discourse of cost-containment and cost-efficiency, and less room is left for expressing the agency of PWD themselves as active participants in their rehabilitation.
Implications: This research has implications on the social construction of how physiotherapists see PWD and their role in supporting PWD and their families, highlighting the importance of language and discourse in the social construction of reality. It is crucial for the continuing emphasis on person-centred rehabilitation that the values are also reflected in research language.
Funding, acknowledgements: This research is a part of a project funded by Academy of Finland (Dr A Kangas, 325976) and Tampere University.
Keywords: Dementia, Critical Discourse Analysis, Agency
Topic: Older people
Did this work require ethics approval? No
Institution: Tampere University
Committee: Ethics Committee of the Tampere Region
Reason: The data for this research is public, and the research concerns texts and no human participants were recruited.
All authors, affiliations and abstracts have been published as submitted.
