International Journal of Physical Medicine & Rehabilitation
Open Access

Alzheimer's Disease as Defined by Newspapers using Critical Discourse Analysis: How do major UAE Press Present Alzheimer's to the Public?

Aisha Zayed Al-Ali^{* *}Correspondence: Aisha Zayed Al-Ali, Department of Psychology, Aberystwyth University, Aberystwyth,Wales, United Kingdom, Email:

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Introduction

Critical Discourse Analysis (CDA) starts from social issues and problems, problems which face people in their social lives, issues which are taken up within sociology, political science and/or cultural studies. To study social problems or issues adequately, CDA work is typically inter or multidisciplinary, and especially focuses on the relations between discourse and society, including social cognition, politics and culture [1].

In the UAE, the mortality rate dropped in 2002 to 83.37 per 1000 population, 74.42 in 2005, and reached 67.52 by 2010. Age longevity is linked to a number of reasons, including good access to health care sectors, rising standards of living, better awareness of health issues, and higher incomes. Dementia is an overall term for a particular group of symptoms. The characteristic symptoms of dementia are difficulties with memory, language, problem-solving, and other thinking skills that affect a person’s ability to perform everyday activities. Dementia has many causes Alzheimer’s disease is the most common cause of dementia. Dementia includes a range of neurological disorders characterized by memory loss and cognitive impairment. The most common early symptom is difficulties remembering recent event. Recommend performing a periodical preventive assessment of the health status of elderly people in their place of residence and of the possibility to apply preventive measures to improve their functioning and quality of life or prevent care dependency from progressing. People with a low amount of frailty were better able to tolerate Alzheimer’s disease pathology, whereas those with higher amounts of frailty were more likely both to have more Alzheimer’s disease pathology and for it to be expressed as dementia [2]. Dementia is a growing health concern worldwide with no treatment currently available, but only symptomatic medication. In the Middle East and Africa, the number of dementia cases will be expressive by 2040. In general, low educational background and other socioeconomic factors have been associated with high risk of obesity, sedentarism, diabetes, hypertension, dyslipidaemia, and metabolic syndrome, all of which also raise the risk of vascular dementia and Alzheimer’s disease. Physical activity can promote healthy aging in terms of cognition, independent functioning, and psychological health for individuals experiencing cognitive decline in Mild Cognitive Impairment (MCI). Engagement should be meaningful to, and purposeful for, the individual living with dementia. It should support interests and preferences, allow for choice and success, and recognize that even when the dementia is most severe, the person can experience joy, comfort, and meaning in life [3].

For many laypeople, the mass media constitute one of the most important sources of information about health and medicine. Mass media portrayals contribute to the creation or reproduction of knowledge about illness and disease. They work to portray ill people in certain lights for example, as innocent, victims or deserving of their fate. We find that op-eds were persuasive to both the mass public and elites, but marginally more persuasive among the mass public. In the setting of newspaper op-eds, individuals are capable of considering diverse views and may perhaps even change their minds. If news reports play a part in such major opinion shifts, they may do so mainly as transmitters of more fundamental force. These results suggest that media coverage of the riots influenced attitudes towards welfare recipients; specifically, newspaper coverage of the riots increased the likelihood that readers of the print media expressed negative attitudes towards welfare recipients when compared with the rest of the population. The slant of both news articles had a significant effect on participants' judgments of public opinion on those issues, even when adjusted for the effect of projected personal opinion. Findings supported the hypothesis that people appear to estimate public opinion based on their own reading of press coverage [4].

In this paper we aim to understand how local newspapers present dementia by applying CDA's steps to define this phenomenon and unveil the hidden ideology. Thus, we discuss Alzheimer's consequences that older adults may experience based on the search results and investigate what is being discussed in the newspapers in terms of health, government initiatives, conferences, and dementia-related stories by conducting a review of the discovered articles and present the findings [5].

We acknowledge that newspaper articles participate in raising public awareness and contribute to public knowledge, in spite of that; the CDA methods helped us identify a number of gaps that need to be addressed and shared with the society. Things related to older adults themselves, how do they live with dementia, family understanding of the consequences of dementia, changes in behavior and memory, and older adults’ identity [6].

In this study, quantitative research and qualitative interpretation were combined, in which topics and words related to Alzheimer’s were collected and then interpreted. The research questions were as follows: 1) what is the context that newspapers apply to discuss Alzheimer’s? 2) What are the characteristics of Alzheimer in relation to the real issues? [7]. 

Data And Methods

In this article, I argue that there are three types of Alzheimer discourses presented in the UAE newspapers. Representative informative articles from international journals, media coverage of locally-held events in gerontology diseases, and interviews with social specialists, and physicians; which was deduced from the content of the articles in five Emirati newspapers published in the English language. The CDA method was applied to understand the ideology [8].

It is exactly the connection between discourses and social contexts, processes, and situations that makes discourse analysis a valuable and powerful tool for studying social phenomena. The critical discourse analysis provides a well-established framework to show how discourses acquire dominant and taken for granted meanings. Roughly speaking, discourse analysis would only describe discourse practices, whereas critical approaches to texts and talks would show how these hide power relations, prejudices, discrimination, and so on. Eclecticismin CDA is to mean that a critical discourse analysis is required to explore and select relevant analytical categories based on a number of factors in place such as the nature of social problem(s) and social groups under investigation. Among the descriptive, explanatory and practical aims of CDA-studies is the attempt to uncover, reveal or disclose what is implicit, hidden or otherwise not immediately obvious in relations of discursively enacted dominance or their underlying ideologies. It is clear in media studies, for instance [8]. For a long time, the media were regularly apprehended as a reflection of dominant ideologies. We know now that the media have their own ideology, that their vision of ‘reality is tightly connected to the functioning of specific communities. The expression and reinforcement of negative aging discourse are informed by the master cultural narrative normalizing the devaluing of age and aging although simultaneously contributing further to the cultural narrative. Our semiotic analysis revealed how across all sections of the press red tops, midmarket tabloids, and broadsheets people with dementia were variously constructed through discourses of loss and victimhood [9,10].

The Critical Discourse Analysis (CDA) serves the requirements of the PhD program in Psychology of Older adults. It was found that the topic of Alzheimer's disease is closely related to older adults and was chosen as one of the societal phenomena experienced by a number of senior people and their families in the United Arab Emirates. One of the study limitations is that articles published in Arabic were not part of the study scope and English text is widely used. The Newspapers published in Arabic were not searched due to time constraints and the content will require translation, which will require more time, in addition to translating some scientific terminologies that require searching for what suits them in English.

To limit the scope of this study, the focus was on those articles that have been published during the past three years, from January 31, 2018, to January 31, 2021, in the United Arab Emirates [11].

Daily five widest distributions newspapers in English were surveyed over a period of one month between January 2018 and January 2021. The chosen newspapers are popular tabloids in the United Arab Emirates The-National, Khaleej Times, Gulf News, Gulf Today, and Emirate 24/7 [12].

Newspaper articles were obtained from the newspapers library websites, by using the provided search engines, and the articles were manually screened by headlines related to Alzheimer in the UAE. All articles were selected and all entities were included that have published information about Alzheimer's [13].

Inclusion and exclusion criteria

The entire journal articles were surveyed and sections related to technology, economy, film industry, philanthropy, sport, conferences, and biographies were included in the data collection. The excluded articles are content related to advertisements; opinions were not found in the searched items that is why it was not included. The next Table 1 shows the coding of newspaper articles [14].

Table 1: Coding of Newspapers Articles.

To cover all aspects of Alzheimer's, all articles related to welfare, services, and people's stories were included regardless of their negative or positive impact. 95 articles were collected from five newspapers, published over a three years. The search has indicated that the topics of Alzheimer's were not sufficiently discussed. More than half of the articles were copied from the international newspapers, as well as not related to the UAE or Dubai community [15].

Results

In sum, 95 Alzheimer-related articles were collected during February 2021. Of these, 45% were medical research, biotechnology and biopharmaceuticals firm studies, 24% were Alzheimer’s specialists’ interviews and service provision, 11% were biographies of people with Alzheimer and personal stories of people caring for family members with Alzheimer’s complications, 5% were on technology deployment for awareness, and training purposes, 5% were on local held conferences and workshops on Alzheimer, 3% were sports tests introduced to improve memories, but they are not directly linked to Alzheimer people, 3% philanthropy on donations and aids to help Alzheimer patients mostly related to international organizations [16].

In Addition, 1% was related to the film industry where the main character played a role of Alzheimer patient, 1% was related to expense and investment in health sector pharma research one of them was related to Alzheimer, and last one was 1% Millennials were one article discusses legal issues between children and parents suffering from Alzheimer over paramount planning. As seen in Figure 1.

Figure 1: Newspapers findings categorization.

When it comes to newspapers, the number of published articles as shown in Table 2 was 37 by The National, 26 published by Khaleej Times, 19 published by Gulf Today, 10 published by Gulf News, and 3 published by Emirates 24/7 [17,18].

Table 2: Number of published articles per newspaper.

Text tone

Text analysis revealed that articles on Alzheimer's disease are generally positive in tone and used a range of sources, and 52% of which are conveyed from international articles. Also, there are local articles represent by Federal, Abu Dhabi, and Dubai Governments, thus the content was easy to be grouped based on the place of issuance, 1) International 2) Federal, 3) Abu Dhabi, and 4) Dubai. However, there was no strong voice from the community, which suggests that the journalists’ articles were not based on fieldwork when it comes to this topic. There have been few national and local articles related to Alzheimer’s in the past three years, the three identified articles were about family members caring for relatives with Alzheimer's, describing the families' experiences and adding the participants' reflections; although the articles were less positive but were very expressive in presenting the people’s experience. Table 3 shows examples of positive, negative, and neutral content on Alzheimer's disease from the UAE Newspapers [19].

Table 3: Examples of positive, negative, and neutral content on Alzheimer's disease from UAE Newspapers for the two highest repetitive categories.

Table 3 explanation:

1) Medical research and Biotech/Biopharmaceuticals

“Reading delays cognitive decline in the elderly and has protective benefits against Alzheimer's disease”.

There is a tone of hope in the above sentence when saying ‘delays cognitive decline'. Thus, we can notate how reading can change the lives of older adults by bringing hope of protection. A senior person who practices reading will be protected from Alzheimer’s disease when stated that there are benefits against Alzheimer’s disease. Which is a positive tone [20].

“A number of studies in recent times have suggested the use of music for the benefit of patients in long-term care. Especially in people with conditions like Dementia and Alzheimer’s disease, music has been found to reduce agitation and unhappiness”.

The text tone in the above phrase is neutral as it is attributed to a number of other sources. It is conceivable that we are not far from the truth if we realize here, that referring to a number of published researches on the role of music through the text ‘a number of studies’ makes them common. The effective role of music ‘use of music for the benefits of patients’ specifically helping dementia and Alzheimer’s patients when mentioned ‘with conditions like Dementia and Alzheimer’s disease’.

“Where did Covid-19 begin and who contracted it first? The so-called Patient Zero. After talking to doctors involved in the case, the possible first patient was identified as a man in his seventies, already suffering from Alzheimer's disease and "in very bad condition" when he was admitted to hospital” [21-24].

The text tone in the above phrase is negative and stereotypical. The first case of COVID-19 had Alzheimer’s disease; this would create a negative persuasive effect on older men's presentation in the minds of the readers. There is a direct contribution to the assertion that an old man was the first case of COVID-19 'Patient Zero' and the sentence provided more details about the man's age 'man in his seventies, at the same time, noting that the man is in bad condition ‘in very bad condition’.

2) Alzheimer's specialists’ interview and services

“DHA’s seniors’ Happiness Centre is encouraging families of patients with Alzheimer’s and other related dementias to join the support group”.

There is a tone of caring in the above sentence when saying ‘join the support group’. Thus, it is positive to see the supporting role of the Dubai Health Authority (DHA) through their happiness center by encouraging families and patients to join the support group when mentioned ‘encouraging families of patients with Alzheimer’s’. This will create a sense of support that they are not alone and that they can seek help from other members in the group when mentioned ‘join the support group’.

“Alzheimer’s is related to memory, whereas depression is linked to mood so we can usually determine from a few simple tests”.

The text tone in the above phrase is neutral as it shows that the specialist can diagnose Alzheimer’s and depression by conducting simple tests when mentioned ‘a few simple tests’. Referring to a simple test makes the procedure sound easy through the text ‘simple’ which makes it neutral. The Symptoms can be distinguished between Alzheimer's disease and depression when stated in the text ‘Alzheimer’s is related to memory, whereas depression is linked to mood’ [25-27].

“My mum forgets who I am; my mum was diagnosed with Alzheimer’s. Every day, she’s losing memory and sometimes even forgets who I am. It’s like losing your loved one every single day”.

The text tone in the above phrase conveys feelings of sadness and despair, which makes it negative. The person says that her mother is suffering from Alzheimer’s disease and she cannot remember her when mentioned ‘My mum forgets who I am'. The text also conveys feelings of dissatisfaction and that the person cannot handle the situation by repeating ‘Every day’ and ‘every single day’. The person misses her mother when mentioned ‘losing your loved one’.

In general, the content analysis of the 95 articles revealed a strong positive tone of 52% across the categories mentioned in Figure 1. The distribution seen in Figure 2 shows the positive distribution among the four groups as follows; the international (23.16%), Dubai (21.05%), Abu Dhabi (4.21%), and federal (3.16%). The negative distribution among the four groups is the international (18.95%), Dubai (9.47%), Abu Dhabi (1.05%), and federal zero. The neutral distribution among the four groups is the international (11.58%), Dubai (5.26%), Abu Dhabi (2.11), and federal zero.

Figure 2: Alzheimer Article ton in the UAE newspapers.

Discussion

We found that local reports on Alzheimer's disease constitute 46% of all articles on Alzheimer's disease in the five Emirati newspapers, The-National, Khaleej Times, Gulf News, Gulf Today, and Emirate 24/7 in the past three years. This indicates that the information conveyed on Alzheimer's disease from the international newspapers is greater than local news. Though the UAE community is considered young as youth are higher than older adults as mentioned in the UAE Population Statistics for the year 2021; the majority of the UAE population falls in the age group of 25 to 54 years and the median age for Dubai is 33.5 years. An electronic system will be needed to screen and monitor people in the community by both Federal and Local primary healthcare systems. As mentioned in one of the studies from Spain; the development of algorithms integrating diagnoses and treatment of dementia improved the Alzheimer Disease (AD). Positive Predictive Value (PPV) and sensitivity estimates were high and indicated that AD codes recorded in a large primary care database were sufficiently accurate for research purposes.

45% of the articles on Alzheimer's disease in this research belong to medical research, biotechnology and biopharmaceuticals studies and are generally positive in tone. Most of the information is from international newspapers, with the exception of two studies on Alzheimer representing 5% found from UAE. In general, the articles were not representative of the UAE community, but they carry positive messages about improving memory and preventing dementia and discoveries that in the future will contribute to the early detection of the Alzheimer’s disease. The gaps in knowledge that were observed in our study require more attention to raise awareness about Alzheimer’s Disease (AD) and dementia overall. These results confirm the importance of local media to disseminate the basic knowledge about AD to Saudi citizens.

24% of the Alzheimer's disease articles were interviews with social specialists, and physicians; the majority was positive in tone. Most of the information was gathered by interviewing experts, with the exception of three articles, where the interviewees were older adults’ relatives with Alzheimer's disease representing 13% out of 24%. There were no interviews with guardians who look directly after older adults with memory disorders, and in three articles the families' experiences were described and participants' reflections added. Apart from that, the concept was to promote services, new clinics that provide care to Alzheimer's patients, and the announcement of new government services. There is no evidence of an integrated national campaign to raise awareness on government health services for Alzheimer's and dementia, as it is sporadic and not at the national level. There is a need for local and federal concerted efforts to educate the public and families about issues related to Alzheimer's disease and to create a national slogan of support for all. Campaigns should be located within the framework of public health promotion and the synergy between short national mass media campaigns and longer-term local community action initiatives carefully considered.

Conclusion

We compiled newspaper articles and analyzing them selecting the topic of Alzheimer's for its importance to the UAE families and primary healthcare systems. The research indicated that the topic of Alzheimer's disease was not sufficiently addressed and discussed in the published newspapers. This prompted a search for more articles by increasing the search period to three years instead of the planned 12 months in order to have more articles for review. To this end, all the articles that included the Alzheimer's text in their content were selected for review.

Based on the cited references more than half of the articles were copied from the international newspapers, as well as not related to the UAE or Dubai community. This concludes that an integrated national campaign to raise awareness of government health services for Alzheimer's and dementia is seen needed. Efforts can be gathered to guild long-term care planning that is viewed from the perspective of health care provision, settings, and social services. The long-term planning will assist in studying and planning services related to the welfare of older adults with Alzheimer's, integration back into the community, understanding their needs, and supporting families who care for Alzheimer's patients.

References

1. Ainsworth S, Hardy C. Critical discourse analysis and identity: Why bother? Critical discourse studies 2004;1(2):225-259.

   [Crossref][Googlescholar]

2. Al Ali A. Aging in the UAE and services available for the elderly: Structured interviews with experts in the field", Dubai School of Government Policy Brief 34, 2013.
3. Alhazzani AA, Alqahtani AM, Alqahtani MS. Public awareness, knowledge, and attitude toward Alzheimer's disease in Aseer region, Saudi Arabia. Egypt J Neurol Psychiatry Neurosurg. 2020;56(1).

   [Crossref][Googlescholar][Indexed]

4. Alzheimer's A. 2021 Alzheimer's disease facts and figures. Alzheimer's and Dementia. 2012;8(2): 131-168.

   [Crossref][Googlescholar]

5. Brookes G, Harvey K, Chadborn N. "Our biggest killer": multimodal discourse representations of dementia in the British press. Social Semiotic. 2018;28(3): 371-395.

   [Crossref][Googlescholar][Indexed]

6. Coppock A, Ekins E, Kirby D. The long-lasting effects of newspaper op-eds on public opinion. Q J Political Sci. 2018;13(1):59-87.

   [Crossref][Googlescholar][Indexed]

7. Doroszkiewicz H, Sierakowska M. Factors associated with risk of care dependency in disabled geriatric patients. Scand J Caring Sci. 2021;35(1):134-142.

   [Crossref][Googlescholar][Indexed]

8. Fairclough N. Critical discourse analysis. How to analyse talk in institutional settings: A casebook of methods. 2001;25-38.

   [Googlescholar]

9. Fazio S, Pace D, Maslow K. Alzheimer's Association Dementia Care Practice Recommendations. The Gerontologist. 2018;58(1):S1-S9.

   [Crossref][Googlescholar][Indexed]

10. Gendron TL, Inker J, Welleford EA. A Theory of Relational Ageism: A Discourse Analysis of the 2015 White House Conference on Aging. The Gerontologist. 2018;58(2): 242-250.

    [Crossref][Googlescholar][Indexed]

11. Gunther AC. The persuasive press inference: Effects of mass media on perceived public opinion. Commun Res. 1998;25(5):486-504.

    [Crossref][Googlescholar][Indexed]

12. Khosravinik M. Actor descriptions, action attributions, and argumentation: towards a systematization of CDA analytical categories in the representation of social groups 1. Critical Discourse Studies. 2010;7(1):55-72.

    [Crossref][Googlescholar][Indexed]

13. Maingueneau D, O'Regan JP. Is discourse analysis critical? And This risky order of discourse. Critical Discourse Stud. 2006;3(2): 229-235.

    [Crossref][Googlescholar][Indexed]

14. Nuzum H, Stickel A, Corona M, Zeller M, Melrose RJ, Wilkins SS. Potential benefits of physical activity in MCI and dementia. Behav Neurol. 2020.

    [Crossref][Googlescholar][Indexed]

15. Page BI, Shapiro RY, Dempsey GR. What Moves Public Opinion?. American Political Science Review. 1987;81(1):23-43.

    [Crossref][Googlescholar][Indexed]

16. Peel E. 'The living death of Alzheimer's' versus 'Take a walk to keep dementia at bay': representations of dementia in print media and carer discourse. Sociol Health Illn. 2014;36(6):885-901.

    [Crossref][Googlescholar][Indexed]

17. Ponjoan A, Garre-Olmo J, Blanch J. How well can electronic health records from primary care identify Alzheimer's disease cases?. Clin Epidemiol. 2019;11:509-518.

    [Crossref][Googlescholar][Indexed]

18. Qiu C, De Ronchi D, Fratiglioni L. The epidemiology of the dementias: an update. Curr Opin Psychiatry. 2007;20(4):380-385.

    [Crossref][Googlescholar][Indexed]

19. Reeves A, De Vries R. Does media coverage influence public attitudes towards welfare recipients? The impact of the 2011 English riots. Br J Sociol. 2006;67(2): 281-306.

    [Crossref][Googlescholar][Indexed]

20. Ricci G. Social aspects of dementia prevention from a worldwide to national perspective: A review on the international situation and the example of Italy. Behav Neurol. 2019.

    [Crossref][Googlescholar][Indexed]

21. Rizzi L, Rosset I, Roriz-Cruz M. Global epidemiology of dementia: Alzheimer's and vascular types. Biomed Res Int. 2014.

    [Crossref][Googlescholar][Indexed]

22. Seymour J. The Impact of Public Health Awareness Campaigns on the Awareness and Quality of Palliative Care. J Palliat Med. 2018;21(S1): S-30-S-36.

    [Crossref][Googlescholar][Indexed]

23. Van Der Wardt V, Hancox J, Pollock K. Physical activity engagement strategies in people with mild cognitive impairment or dementia - a focus group study. Aging Ment Health. 2020;24(8):1326-1333.

    [Crossref][Googlescholar][Indexed]

24. Van Dijk TA. Aims of critical discourse analysis. Japanese discourse. 1995;1(1):17-27.

    [Googlescholar][Indexed]

25. Wallace LM, Theou O, Godin J, Andrew MK, Bennett DA, Rockwood K. Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer's disease: a cross-sectional analysis of data from the Rush Memory and Aging Project. Lancet Neurol. 2019;18(2):177-184.

    [Crossref][Googlescholar][Indexed]

26. Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, et al. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neuro. 2016;15(5):455-532.

    [Crossref][Googlescholar][Indexed]

27. Wood LA, Kroger RO. Doing discourse analysis: Methods for studying action in talk and text. SAGE Publications, Incorporated. 2000.