Dear Editor
Jia and colleagues make an interesting discovery that certain lifestyles are associated with better cognitive function over 10 years, even in the presence of the APOE ε4 risk allele (1). But they use the term “unfavourable” to describe lifestyles with zero or one healthy lifestyle factors on their six-point scale, which the Oxford dictionary defines as “not good and likely to cause problems” and “showing that you do not approve of or like somebody/something” (2).
Such language invites a stigmatising view of certain older adults’ way of life (3) and suggests that individuals’ lifestyles are at fault for dementia risk, overlooking structural drivers of unhealthy behaviours and socioeconomic determinants of brain health (4). Since victim blaming in dementia is a real possibility (5), we must use more neutral language to describe lifestyles and behaviour, free of moral judgment and based on neutral association.
References
1 Jia J, Zhao T, Liu Z, Liang Y, Li F, Li Y, Liu W, Li F, Shi S, Zhou C, Yang H, Liao Z, Li Y, Zhao H, Zhang J, Zhang K, Kan M, Yang S, Li H, Liu Z, Ma R, Lv J, Wang Y, Yan X, Liang F, Yuan X, Zhang J, Gauthier S, Cummings J. Association between healthy lifestyle and memory decline in older adults: 10 year, population based, prospective cohort study. BMJ. 2023 Jan 25;380:e072691. doi: 10.1136/bmj-2022-072691.
2 Oxford Learner’s Dictionary. https://www.oxfordlearnersdictionaries.com/definition/english/unfavourab…. Consulted 31st January 2023.
3 Brown RCH. Resisting Moralisation in Health Promotion. Ethical Theory Moral Pract. 2018;21(4):997-1011. doi: 10.1007/s10677-018-9941-3.
4 Daly TP. The need to look beyond lifestyle in preventing dementia. BMJ. 2022 May 10;377:o1167. doi: 10.1136/bmj.o1167.
5 Horstkötter D, Deckers K, Köhler S. Primary Prevention of Dementia: An Ethical Review. J Alzheimers Dis. 2021;79(2):467-476. doi: 10.3233/JAD-201104.
Don’t call older adults’ lifestyles “unfavourable”