Academic journal article Health Sociology Review

'Ageing Well': Competing Discourses and Tensions in the Management of Knee Pain

Academic journal article Health Sociology Review

'Ageing Well': Competing Discourses and Tensions in the Management of Knee Pain

Article excerpt

In this paper we seek to explore the competing discourses that surround the maintenance of health among older people who are living with potentially debilitating symptoms. Age and ill-health have long been identified as being intrinsically intertwined, however in contemporary affluent societies like the UK, USA and Australia the inevitability of the relationship is now challenged. In part this is a result of people living longer without a limiting condition or chronic illness but it is arguably also influenced by the development of strategies of health maintenance for chronic conditions which suggest other ways of responding to these issues rather than necessarily seeing them as an indicator of decline and incapacity. The boundary between the discourses of ageing and chronic illness is not easy to demarcate given that most conditions vary between individuals as well as differ in intensity. It is possible, however, to shed some light on the interplay between the ageing body and chronic illness by considering how differing cultures of ageing play a key role in articulating a dichotomy between seeing chronic illness as an aspect of health or of ill-health and age-related decline. We suggest that in order to understand how this might be played out in practice it is necessary to consider individual experiences of living with a chronic condition at older ages. We use knee pain as an example of the kind of condition that traverses the boundary between important cultural discourses. We argue that to understand how the interplay between ageing and chronic illness influences the interpretation of knee pain as 'ageing well' or as a sign of impending decline and physical dependency we need to employ a discursive methodological approach. As part of a discursive methodological approach talk is explored as a form of action designed for its local interactional context and the focus is on what statements mean for speakers in the context in which they occur. Thus we present an argument in support of discourse analysis to look beyond the literal meaning of language and taken for granted ideas and examine the multiplicity of relevant ideas and perspectives.

LIVING LONGER AND THE CULTURE OF THE THIRD AGE

Concerns about the increasing longevity of the population and the likely impact on both health services and on the economy in general have been a regular refrain in discussions about the 'greying of the population' (Gee, 2000). While there are constant debates about the persistence of long term trends (Crimmins & Beltran- Sanchez, 2011) this pessimistic view needs to be seen in the context of increases in disability free life expectancy results across the most affluent nations (Hyde, Higgs, & Newman, 2009). Not only have these trends allowed for increases in the eligibility age for the payment of state pensions but it has coincided with the emergence of the idea of the third age (Laslett, 1996) as a sustained period of relatively good health and independence allowing many older people the option to actively enjoy their retirement rather than be placed in a category of aged dependency. Within this new set of circumstances new cultures of ageing have sprung up which focus on independence and vitality as keystones of a new later life (Gilleard & Higgs, 2000). While health has always been valued by people of all ages, participation in the third age has extended this valorisation into being one of the ways that stave off the ever present threat of being cast into old age. It is not surprising then that the third age promotes a 'will to health' (Higgs, Leontowitsch, Stevenson, & Jones, 2009) that meshes with the individualisation of health identified by writers such as Lupton (1995) and as such becomes a marker of 'successful' third age identities. As has been noted (Polivka, 2011) such an emphasis on the third age as a demarcation of health and agency separates those able to participate in it from those affected more deeply by the physical limitations often accompanying old age. …

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