Frail bodies: geriatric medicine and the constitution of the fourth age

Abstract

Clinical discourses of frailty are central both to the construction of the social category of the fourth age and to the role and identity of hospital geriatric medicine. However, the influence of such clinical discourses is not just from science to the social sphere and nor do these discourses have their source in a putative truth of the old body but emerge from an interplay between physiological facts, discourses of governmentality, productive processes associated with late modern capitalism and the professional ambitions of geriatric medicine. The article explores this interplay in the two key discourses of frailty that have emerged in the clinical literature during the past 15 years, that of the phenotype and the accumulation of deficits, respectively. Outlining the development of the discourse of senescence from its origins to the more recent emergence of a nosological category of frailty the article explores how these key discourses capture the older body according to particular sets of norms. These norms link physiological understanding with broader discourses of governmentality, including the professional project of geriatric medicine. In particular, metaphorical representations in the discourses of frailty convey key cultural and clinical assumptions concerning both older bodies and old age more generally.

Hypervisibility: Toward a Conceptualization of LGBTQ Aging

“…Foucault's work has commonly been cited in theoretical and empirical literature across both LGBTQ studies (Brown and Knopp 2014;Hughes 2008) and within the field of aging (Bjornsdottir 2002;Pickard 2014;Pickard 2010). In both queer and gerontological literature, Foucauldian frameworks have often been used to draw attention to the salience of discourse as a source of power with potential to be both emancipatory and marginalizing (Brown and Knopp 2014;Pickard 2014).…”

“…In both queer and gerontological literature, Foucauldian frameworks have often been used to draw attention to the salience of discourse as a source of power with potential to be both emancipatory and marginalizing (Brown and Knopp 2014;Pickard 2014). Given, specifically, the utility of Foucauldian frameworks in identifying and conceptualizing the role of discursive power in producing particular subject positions that are often subjugated by silence (Pickard 2014), it is not surprising that some have drawn on this lens to understand the hegemonic invisibility that is said to underpin the realities of queer/trans older adults (Brown 2009;Eliason et al 2010). Indeed, Brown (2009), whose work has thus far been discussed at length in this paper, has used Foucault to conceptualize the relative invisibility of theory and empirical literature in the area of LGBTQ aging as a reflection of the marginalized subject positions that older sexual and gender minority adults are said to occupy.…”

Dichotomising dementia: is there another way?

“…Thus autonomy is central to third agers and loss of autonomy defines the fourth age (Higgs et al 2009). Dohmen (2014) argues that 'with impairment and decline considered antonyms of successful ageing, the "fourth age" is automatically deemed "unsuccessful" by means of its proximity to illness and death ' (2014: 66), while Pickard (2013), in an interrogation of clinical literature on the discourses of senescence and frailty, links the meaning derived from the third age as an opposition to frailty, with the intention of avoiding it. The linking of frailty with the fourth age is further developed by Higgs and Gilleard (2014) who suggest that although frailty is synonymous with the fourth age (the 'frailing' of the fourth age), the overwhelming fear is of an imagined future incapacity and the dread of 'going into care' with the isolation, reduction of autonomy and othering this is perceived to bring.…”

Precarity in late life: rethinking dementia as a ‘frailed’ old age

“…This is equally the case for dementia, where the diagnosis provides access to specialized services and community-based programs (Brooker 2007). Where health research tends to focus on dementia as a disease or 'frailty' as an indicator of risk, socio-cultural perspectives lean toward use of a discourse of the 'fourth' age or the discussion of a 'fourth age space' that is grounded in ideas about the 'frailties' and impairments of late life (Pickard 2014, Lloyd 2015.…”

“…It is viewed as a liminal space and an event horizon -a location that holds the negative or less than ideal experiences of aging (Grenier 2012, Gilleard andHiggs 2010). Falling into this space of the 'fourth age' therefore, frailty and dementia occupy sites that are laden with associations of physical and cognitive deficits, dependence and burden, pity or weakness (see Grenier 2007, Pickard 2014). …”