Becoming an active ager: identity, agency, and social connection in APPLE-tree, a cognitive wellbeing intervention

Active ageing is shaped by sociocultural, political, and scientific discourses, with neuro-culture placing emphasis on maintaining cognitive health in later life. Mild Cognitive Impairment (MCI) and Subjective Cognitive Decline (SCD), both associated with elevated dementia risk, may arise from multiple causes beyond neurodegeneration. The APPLE-tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce) programme is a co-designed, multi-modal intervention shown in a randomised controlled trial (ISRCTN17325135) to improve cognition among older adults with mild memory concerns. This ethnographic study examined how participants engaged with active ageing, exploring the paradox of expending cognitive effort to prevent decline. Within the intervention arm of the trial, four online groups were observed between January and April 2021, generating 65 field notes and 16 semi-structured interviews. Data were analysed abductively, integrating inductive insights, theoretical frameworks and reflexive discussion. Three themes were identified. First, adopting the identity of an "active ager" fostered agency despite memory challenges. The intervention supported engagement in cognitive, social, and lifestyle activities, promoting hope and legitimising participants' efforts to sustain brain health. Second, active ageing involved 'responsibilisation': responsibility for cognitive health shifting toward individuals, producing empowerment and pressure. Third, positionality shaped experiences of active ageing, participants negotiated identity through biography and social comparison. Participation affirmed agency and connection within a liminal space between normalised ageing and medicalised understandings of prodromal dementia. Overall, findings highlight opportunities and burdens of active ageing, underscoring the need for policies and interventions attentive to social and contextual influences.