“Brain health”—the emergence of a new healthy construct and its role in everyday life

Abstract

Background and Objectives

Emerging public health discourse increasingly frames brain health and dementia prevention as matters of personal responsibility and urge individuals to adopt modifiable behaviors across the life course. This study examines how adults at different life stages perceive dementia risk and engage with brain health practices, with particular attention to how these behaviors are socially structured and culturally mediated.

Research Design and Methods

Using a life course perspective and an abductive critical realist approach, this qualitative study draws on semi-structured interviews with 33 participants (aged 19–81 years) recruited across three generational cohorts: younger adults (n = 11), middle-aged adults (n = 8), and older adults (n = 14). Abductive thematic analysis was employed to examine how participants understand brain health, dementia, and responsibility for the management and prevention of these aspects of late-life health.

Results

Participants articulated diverse and age-contingent understandings of brain health. While younger adults associated prevention with aspirational self-optimization, middle-aged adults emphasized routine, sustainability, and caregiving-informed insight. Older adults, often informed by lived proximity to dementia, described adaptive strategies to preserve brain health amid physical limitations. Across all groups, health practices were framed through an ethos of personal accountability, although often enacted within structurally constrained contexts.

Discussion and Implications

Findings emphasize the need to critically engage with how dementia prevention discourse is differentially internalized across the life course. Public health strategies should balance behavioral interventions with honest acknowledgement of the structural conditions which stratify distributions of brain health risk and opportunities for prevention.

Background

Brain health has emerged as a critical construct within both global and national health initiatives, yet its conceptualization has evolved significantly over time. Historically, brain health has functioned as a broad term encompassing a variety of specific neurological and mental health conditions, such as dementia, Alzheimer’s disease and cognitive decline (Chen et al., 2022). However, recent shifts in the scientific field have led to a more refined definition that expands the term’s scope to include not only specific neurological pathologies but also the broader spectrum of brain functioning across cognitive, sensory, social–emotional and motor domains (World Health Organization [WHO], 2022). The WHO has perhaps provided the most widely cited definition of brain health, describing it as a state of brain functioning that enables individuals to realize their full potential over the life course, irrespective of the presence or absence of specific disorders (WHO, 2022). This framing departs from earlier biomedical models by disentangling the idea of brain health from the mere absence of disease and instead positioning it as a dynamic, potentially optimizable human capacity.

These reconceptualizations have acquired new urgency amid shifting paradigms in dementia science and prevention. Long considered largely intractable and genetically determined (Avramopoulos, 2009; Berchtold & Cotman, 1998), conditions like Alzheimer’s disease and vascular dementia are now increasingly framed as preventable, or at least modifiable, through behavioral and environmental interventions. A 2024 Lancet Commission report suggests that up to 45% of global dementia cases may be attributable to twelve potentially modifiable risk factors, many of which, such as hypertension, low education, obesity, smoking, and social isolation, are unequally distributed across populations and deeply embedded in social determinants of health (Livingston et al., 2020, 2024). This stands in sharp contrast to earlier evidence syntheses which tended to emphasize immutable factors such as age, genetic predisposition and family history (e.g., Jorm, 1997).

While brain health is relevant for individuals across all age groups, suboptimal brain health disproportionately affects older adults (Béjot & Yaffe, 2019; Wasay et al., 2016). This shift from a purely intrinsic understanding of dementias and other forms of cognitive decline in later-life, focused on genetic and age-related factors to a recognition of the modifiable risks associated with brain health, has been transformative. It further suggests that dementia is not an inevitable aspect of ageing but rather a condition that can be delayed, if not prevented, through targeted public and private health efforts (Latimer, 2018). Children and young adults have been identified as high priority groups for forthcoming targeted dementia prevention interventions, given that patterns of behavior correlated with suboptimal brain health (e.g., alcohol consumption, tobacco use, low levels of physical activity, engagement in contact sports) are often established early on in life (Farina et al., 2024). Parallel narratives have emerged in relation to other neurological conditions, including Parkinson’s disease and multiple sclerosis (Ben-Shlomo et al., 2024; Olsson et al., 2017), where the search for upstream, modifiable influences has reoriented both research and public health messaging. Brain health, in this light, functions not only as a scientific category but as a governance tool, one that links present behaviors to future brain states and, in doing so, renders the ageing brain newly amenable to intervention (Chelberg, 2025; Millington, 2012; Pitts-Taylor, 2010). The concept of brain health has been useful for assembling new evidence regarding the extrinsic etiologies of brain diseases and non-pathologic rates of cellular degeneration into a relatively simple relation which links individual behavior in the present with brain outcomes in the future. As a result of this, although the modern meaning of the concept is less than a decade old, most high-income countries have adopted specific “brain health” targets and initiatives. This includes the 2022 Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders endorsed by the World Health Assembly, which articulated improved brain health awareness and literacy as a primary strategic agenda for member nations. The European Academy of Neurology (Bassetti et al., 2022), the World Federation of Neurology (2024), and the AARP (formerly the American Association of Retired Persons) have also played important roles in bringing the concept of brain health to greater governmental and public attention (AARP, 2022) by encouraging national health bodies to prioritize the salience of brain health.

This growing emphasis on modifiable lifestyle risk factors internationally has shaped national responses to brain health in Australia. Australia’s National Dementia Strategy (2019–2023) and its follow-up initiatives explicitly recognize that many determinants of cognitive decline are behavioral in nature and therefore potentially preventable. The strategy outlines 12 key potentially modifiable risk factors (including smoking, physical inactivity, poor diet, and social isolation) that are targeted through health promotion campaigns and community-based interventions. Initiatives like the “Your Brain Matters” program, originally launched by Dementia Australia, and “Maintain Your Brain,” have sought to increase public awareness of how everyday lifestyle choices impact brain health across the lifespan and have had some success, although to varying degrees (Brodaty et al., 2025; Lawless et al., 2018). While dementia risk reduction and prevention effectiveness remains debated (Sacchetti et al., 2025), research emerging from longitudinal cohorts such as the Australian Longitudinal Study of Ageing (Fowler et al., 2021) and Sydney Memory Ageing Study (Chen et al., 2021) support this approach, linking midlife behavioral patterns with late-life cognitive outcomes. However, despite growing public engagement with brain health messages, persistent inequities remain in who can act on this knowledge (Knaggs & Siette, 2025; Pase et al., 2022).

While the biomedical and epidemiological literature has largely focused on the risk factor evidence base, a growing body of sociological and anthropological work highlights how brain health operates within neoliberal discourses as a sociopolitical project for neoliberal citizens (Lawless et al., 2018; Lock, 2013; Moreira & Palladino, 2009; Pitts-Taylor, 2010). It is a concept that frames aging as a site of vulnerability and possibility, where cognitive decline is no longer inevitable but rather linked to behaviors, decisions, and lifestyles of individuals. Responsibility for brain health is also recognized as an economic (Lock, 2023) and moral (Lawless et al., 2018) problem facing societies at large. In its most recent formulation then, brain health is not simply an individual attribute which can be cultivated; it also a public and economic good which, due to the role of the brain in social and economic systems, should be monitored, worked upon, and secured as a matter of responsible citizenship (Lawless et al., 2018).

Although behavioral framings of brain health dominate much of the recent public discourse, foundational documents on the modern iteration of the concept caution against overly individualistic interpretations (Livingston et al., 2020; WHO, 2023). Such considerations highlight that individual brain health outcomes cannot be disentangled from the structural conditions under which people live and age (Harris & McDade, 2018; Hilal & Brayne, 2022). Researchers have drawn attention to the ways that race, class, gender, education, and geographic location intersect to produce unequal exposure to the conditions that support or undermine brain health (Dodds & Siette, 2022; Patel et al., 2022; Siette et al., 2022). For instance, cumulative disadvantage, whether through reduced access to quality education in early life, occupational precarity in midlife, or inadequate health care in later-life, has a measurable impact on cognitive trajectories (Johnson et al., 2016; Maalouf et al., 2021; Samuel et al., 2020). These insights challenge purely behavioral accounts, suggesting that personal responsibility alone cannot account for patterns of cognitive decline. Instead, brain health must be understood as a product of unequal culminate distributions of health risks and opportunities which are embedded in broader political, economic, and social systems (Krieger, 2020).

Despite increasing recognition of extrinsic determinants of cognitive aging, empirical research has remained disproportionately focused on older adults, particularly those already experiencing cognitive decline (Beard & Bloom, 2015). While this focus is important, it elides the critical role of early and midlife as a window for modifying exposures when intervention efforts and may be most effective (Farina et al., 2024; Livingston et al., 2020). Few studies have explored how younger and middle-aged adults conceptualize brain health, understand dementia risk, or engage in prevention. Studies which do address this period have not adequately considered how early- and mid-life periods are shaped by distinctive and varying social identities, socioeconomic levels, institutional locations, caregiving experiences, and other conditional factors interact with brain health literacy and behavior. Addressing this gap requires a shift away from age-specific research toward a more holistic, sociological, and longitudinal view of brain health across the life course.

Objectives

This study thus contributes to the brain health ongoing conversation by examining how the concept is framed and understood by adults across the lifespan. While policy and public discourse increasingly emphasize brain health as both a site of personal responsibility and economic investment, there is still relatively little empirical research on how adults interpret the meaning of brain health in their own lives. Drawing on qualitative data from different age cohorts, our study uses a critical realist perspective to explore how individuals in early adulthood, midlife, and later-life conceptualize brain health, including how they situate it within broader narratives of health, aging, and responsibility. Through this focus, the researchers aim to expand the conversation around brain health beyond its current biomedical and behavioral parameters, reorienting attention toward the social meanings and lived implications of brain health as a concept in the context of aging. In doing so, this study seeks to deepen interdisciplinary understandings of how brain health is imagined, narrated, and negotiated across the life course, and what this means for future policy, research, and public health practice.

Research design and methods

Study design

This study adopted a qualitative design grounded in reflexive thematic analysis to explore how adults across the life course conceptualize brain health, dementia risk, and successful ageing. Data were collected via two semi-structured focus group workshops, each approximately two hours in duration. Workshops were held online via Zoom or in person, depending on participant preference, and were designed to encourage open-ended, dialogic engagement among participants. Focus groups were organized by generational cohort (e.g., younger, middle-aged, older adults) where possible, with three to six participants per session to promote intracohort discussion. However, in practice, scheduling constraints and participant availability necessitated flexibility; some sessions included intergenerational groups or were conducted as individual interviews. This pragmatic adaptation aligns with an interpretive methodological stance that foregrounds participant voice and acknowledges the contingencies of fieldwork. The study received ethical clearance from the Western Sydney University Human Research Ethics Committee (H15878).

Participants

This study involved English-speaking participants aged 18 years and older who were residing in Australia during the time of the study and able to provide informed written consent. Individuals with cognitive impairment or neurological conditions were eligible to participate as long as they were able to provide informed consent. Recruitment was conducted through a combination of social media advertisements, research databases, the Western Sydney University research participation system, and community outreach through the Brain Health Hub. All participants provided informed consent prior to participation and received a $30 e-gift card in appreciation of their time. Further eligibility criteria included the ability to speak English, the ability to comprehend the details and ethical risks of the study, and Australian residency. Interested participants completed an enrolment form on the research team’s website to register their interest. Individuals were then emailed a participant information sheet outlining what the study entailed and what it would mean to be involved in the study, alongside with a consent form that had to be signed and emailed back to the study coordinators in order to participate. Upon successful participation, each participant received a $30 e-gift voucher.

Procedure and materials

Participants were invited to take part in the “Brain Health, Your Way” workshop. Each workshop was semi-structured to allow for both consistency across sessions and the emergence of novel insights. The discussion guide explored themes of aging well, perceptions of brain health, and familiarity with the twelve modifiable risk factors for dementia (see Supplementary Material). Sample prompts included: “What does it mean to you to age well?”, “How do you manage social connections?”, and “What does being physically active mean in your daily life?” Questions were designed to elicit rich, contextually grounded reflections on lifestyle, identity, and health.

Sessions were audio-recorded with participant consent and transcribed verbatim. The quality of transcriptions was cross checked by researchers to ensure accuracy. All identifying information was anonymized during transcription to protect confidentiality. Data collection continued until themes reached saturation as per previous protocol (Krueger, 2014).

Analysis

Data were analyzed using reflexive thematic analysis, (Braun & Clarke, 2014, 2023) , which is suited to exploring patterns of meaning within participants’ accounts while recognizing the active role of the researcher in theme development. This method proceeds through six iterative phases of data familiarization, generating initial codes, constructing candidate themes, reviewing themes, defining and naming themes, and producing the report. NVivo 12 was used to store and organize data.

An abductive critical realist approach (Proudfoot, 2023) guided the coding process, which was informed by existing frameworks on dementia risk reduction, life course theory, and sociocultural perspectives on health (Backett & Davison, 1995; Godbee et al., 2020). Data analysis involved what Holstein et al. (2013) refer to as “analytic bracketing,” with researchers iteratively moving between inductive theme generation and deductive comparison of data against pre-ordinate concepts reflective of broader cultural and political contexts pertaining to the “brain health” concept.

Overall, data analysis sought to elucidate dimensional meanings of key concepts raised with participants (aging well, brain health, and dementia prevention) and provide insights about how multidimensional constructs were (or were not) engaged in everyday life (e.g., through healthy behavior). Three researchers (JS, GK, SP) independently reviewed the transcripts and generated initial codes. These codes such as “exercise as discipline,” “sleep disruptions in older age,” and “vaping scepticism” were then iteratively refined into higher order themes within the research team. Four overarching themes were generated: The meaning of aging well—health as the foundation, the concept of “brain health,” dementia as risk, and healthy behaviors and lifestyles across the life-course.

Throughout the analysis, the research team engaged in reflexive dialog to interrogate their own assumptions and positionalities, recognizing that meaning-making is co-constructed between researchers and participants (Holstein & Gubrium, 1995). The credibility of findings was strengthened through peer debriefing and collaborative theme review by multiple members of the research team, including those with disciplinary backgrounds in public health (JS), sociology (GK), psychology (SP, JS), and cognitive aging (JS). This collaborative approach provided a nuanced understanding of the significance of the data in relation to pre-ordinate themes and established disciplinary knowledge bases more broadly.

Results

Participant summary

Participants (N = 33) were predominantly female (75.8%) and the majority (39.4%) aged 65 years and older (Table 1). Participants under 45 years accounted for 33.3%, while those aged 45–64 years represented a smaller segment (24.2%). Educational attainment was varied, although demonstrably skewed toward higher education, with a combined 50% of participants reported holding either a bachelor’s degree (33.3%) or a postgraduate qualification (21.2%). Marital status reflected diverse life course trajectories: the most common status was divorced (36.4%), followed by single (30.3%), married (15.2), and de facto partnerships (9.1%). In terms of employment status, 30.3% were retired and about half were employed full-time (24.2%) or part-time (33.3%).

Table 1.

Participant demographics (N = 33).

Variable	N	%
Gender
Male	8	24.2
Female	25	75.8
Age
18–44	11	33.3
45–64	8	24.2
65+	14	51.2
Education
Secondary	5	15.2
Bachelor	11	33.3
Postgraduate	7	21.2
Diploma	4	12.1
Trade qualification	2	6.1
Marital status
Single	10	30.3
Divorced	12	36.4
De Facto	3	9.1
Married	5	15.2
Widowed	3	9.1
Do not want to disclose	3	9.1
Employment status
Employed full-time	8	24.2
Employed part-time	10	30.3
Retired	10	30.3
Semi-retired	1	3.0

Qualitative overview

The analysis resulted in four overarching themes, each containing subthemes that traced conceptual, experiential, and relational dimensions of ageing well, brain health, and dementia, prevention awareness (Figure 1). As described earlier, the interpretive approach employed was abductive in orientation, drawing on established sociological frameworks of health, aging, and life course inequalities, while remaining grounded in participant accounts.

Figure 1.

Summary of themes.

Theme 1: the meaning of aging well—health as the foundation

Across all cohorts, “aging well” was consistently invoked through the language of health, though participants rarely used the term “brain health” unprompted. Rather, they spoke of “cognitive capacity,” “mental health,” and the general functioning of mind and memory.

For younger adults, the notion of aging well was usually framed as an anticipatory project of health maintenance. Participants viewed ageing as something to be prepared for through continued investment in physical fitness and cognitive stimulation. Health was interpreted holistically, with clear links drawn between bodily and psychological well-being:

To age well means to be physically well… your mental state is okay because you’re physically healthy. (Participant 7)

To be healthy and for your brain and memory to be working well as you age. (Participant 11)

By contrast, older participants articulated a more differentiated understanding of health, distinguishing between cognitive, emotional, and physical domains, while asserting that these dimensions were mutually constitutive. Aging well was not only associated with being healthy, but also with having been healthy; that is, a retrospective evaluation of one’s life-long health practices:

I think ageing starts from the time you’re born… I’m thankful for good health, but I feel I’ve got that through the running around; like I did dance and ball sport. (Participant 32)

Among midlife and older participants, health emerged not only as a core component of aging well but as a necessary precondition for pursuing other valued domains of later life, including mobility, participation, and sociability:

Having the health to allow you to be involved in the activities that you’d like to be involved in. (Participant 16)

This framing of health as enabling, rather than merely constitutive, suggests an important distinction. For many participants, health was perceived as both an end in itself and a means to other ends.

Theme 1.1: relational dimensions of aging well: social connection, independence, and usefulness

All participant groups linked aging well to sustained social engagement. Sociality was described both in physical terms, “being able to leave the house,” “mingle in the community,” and in interpersonal terms, such as emotional intimacy and communicative ease:

You just grow with your family and age well. (Participant 12)

To be surrounded by people that I can have conversations with and communicate with. (Participant 7)

Social connectedness was frequently portrayed as contingent on other factors, particularly health and mobility, and influencing the interdependence of domains. For example:

Maintaining your mobility… because if you can get around and do the things you need to, then you can be more involved. (Participant 16)

Independence emerged as an equally salient value, particularly among older and middle-aged adults. Unlike younger participants who emphasized health for its own sake, older individuals framed independence in opposition to dependency and being a “burden”:

To age well means to be able to look after myself… because I don’t want to depend on anyone. (Participant 18)

That’s probably the most difficult part of aging; having to depend on others. (Participant 17)

Social usefulness, particularly through volunteering or continued employment, was also raised as a critical component of aging well. Here, participants resisted cultural narratives of decline by asserting the value of ongoing contribution:

To remain being a useful person. (Participant 27)

This subtle shift from “independence” to “usefulness” reflects a moral dimension of aging in later life and the desire not just to survive or function, but to matter.

Theme 1.2: emotional and psychological dimensions of aging well: the pursuit of happiness

Happiness was a less frequently cited component of aging well, but when raised (primarily by older participants), it was positioned as both a culmination of other factors and an independent domain. For some, happiness was the result of good health, strong relationships, or self-sufficiency. For others, it was a state that could be sustained in spite of age-related limitations:

I have really bad genetics… So yes, I feel very privileged to be at this age and enjoying life. I think happiness comes from within. (Participant 32)

This layered understanding of happiness suggests that, for many participants, emotional well-being is less an outcome than a practice and is an interpretive and affective stance toward aging itself.

Theme 2: concept of brain health

Participants’ interpretations of “brain health” varied widely, both within and across age cohorts, with understandings shaped by personal experiences, educational exposure, and generational framings of the body–mind relationship.

Younger participants often analogized brain health to physical health, either as the absence of disease or as the optimal functioning of cognitive faculties. However, few articulated a technical definition. Only two younger participants referenced brain health in terms of functional domains (e.g., sensory, emotional, motor), suggesting limited familiarity with clinical or public health framings of the term.

Brain health is probably the ability to use your brain to do everyday things, the ability to function and speak to people. (Participant 1)

Middle-aged adults provided more specific, contextually embedded interpretations. Brain health was understood through its functional outputs (e.g., decision-making, communication, problem-solving) and was described as contingent on lifelong habits and behaviors:

Being able to hold conversations… being cognizant, coherent. That only happens when you have a functioning brain. (Participant 13)

It’s that old saying: if you don’t use it, you lose it. (Participant 15)

These participants were also more likely to describe brain health as a continuum and to identify specific maintenance strategies, including mental stimulation, exercise, and stress regulation, which tended to reflect broader health promotion discourses.

Older participants’ accounts were more heterogeneous. Some defined brain health in relation to memory and recall, while others associated it with mental illness (e.g., depression, anxiety) or dementia. A large proportion expressed uncertainty or unfamiliarity with the term altogether:

I’m not sure what it means… so I couldn’t describe it to someone else. (Participant 31)

Still, a small subset, particularly those with caregiving experience or health sector exposure, expressed more advanced understandings of the concept. Where younger and middle-aged adults emphasized modifiable behaviors, older participants were more likely to frame brain health as both influenced by and limited by aging itself:

Once you pass 90, it’s like that factor overrides. (Participant 25)

Although older adults did discuss broader social and structural influences on aging well, such as ageism or the availability of support, they did not frame brain health in relation to these external determinants. This disconnect may reflect the individualized framing of brain health in public discourse.

Theme 3: awareness and perception of dementia and risk factors

Among younger adults, understandings of dementia were generally nascent and often reductive. Dementia was frequently conceptualized as a genetically predetermined condition, with minimal recognition of the role modifiable lifestyle factors play in shaping cognitive health trajectories. This biomedical framing, attributing cognitive decline solely to heredity, limits the perceived personal agency in adopting preventative behaviors. A participant articulated this ambiguity:

But it is like hereditary or like if you have a family member who’s suffering from dementia, you’re more likely… I don’t really know the difference between Alzheimer’s and dementia. (Participant 5)

Such narratives suggest a partial internalization of public health messaging but also indicates gaps in dementia literacy. When risk factors were mentioned, they were often anecdotal and lacked grounding in broader public health evidence. For example:

My mom scoffs down a lot [of alcohol]… So I think to myself, is she going to get dementia? (Participant 3)

In contrast, middle-aged adults, many of whom had engaged in informal caregiving roles, exhibited a more experiential and relational understanding of dementia. These individuals demonstrated a heightened emotional proximity to the disease, often through family caregiving, which rendered the threat of cognitive decline more tangible. Yet, even with greater experiential exposure, many remained unaware of specific behavioral risk factors, reflecting the persistence of informational gaps:

Dementia is losing your cognitive abilities… I was a carer for my mom when she had dementia. (Participant 16)

Their father had Alzheimer’s, and their mother had frontal lobe dementia… So different. The father’s aggressive behaviour became gentle, and the mother’s behaviour became exaggerated. (Participant 15)

These insights suggest that proximity to the disease fosters empathetic understanding, but not necessarily preventative literacy.

Older adults exhibited the most comprehensive and multidimensional understandings of dementia, likely shaped by both personal and peer-based exposure to cognitive decline. Their narratives often linked awareness of dementia with a proactive orientation toward prevention. Drawing upon the health belief model, this cohort expressed both perceived susceptibility and perceived benefits, which contributed to a heightened willingness to modify behavior:

I have close friends who’ve got dementia… it certainly makes me conscious of what could happen and makes me very aware of the things that I can possibly do to avoid that risk. (Participant 30)

If you do things that you shouldn’t, that’s going to harm your brain, you must stop that kind of behavior; whether it’s drugs, alcohol, cigarettes, dangerous activities. (Participant 23)

For this cohort, motivation toward behavioral change was informed less by public health campaigns and more by lived social realities and embodied witnessing of others’ cognitive decline.

Theme 4: healthy behaviors and lifestyle choices across the life course

This theme examined the structural and cultural factors influencing health-related behaviors, across different stages of adulthood, with a particular focus on how participants conceptualized and practiced health through physical activity, nutrition, shared health knowledge, and cognitive engagement. Adopting a life course lens, the findings illustrate how health behaviors are embedded in everyday routines and reflect not only age but also mediated by social roles, physical capacity, and evolving self-concepts of health and aging.

Theme 4.1: physical activity, diet, and nutrition

Health behaviors were shaped by distinct motivational logics across age groups. Younger adults frequently framed health in aspirational terms, linking nutrition and exercise to ideals of self-optimization and physical performance. There was a tendency to moralize food and fitness, often describing the body as a site of discipline and care:

It’s being aware of what this does to you… what healthy foods benefit you as a person, and seeing the body as something that’s sacred. (Participant 3)

Nevertheless, younger adults also demonstrated a pragmatic orientation to health management and acknowledged the value of balance through practices like “cheat days.” This reflexivity reflects an emerging cultural norm of flexible discipline, an ethos that legitimizes self-care without rigid asceticism.

Middle-aged adults articulated a more measured and routinized approach to physical activity and diet and often emphasized sustainability, integration into daily life, and social accountability. Their health practices were often tailored to accommodate competing demands, such as employment and caregiving responsibilities:

It’s just incremental things. So if you set a little target like ‘I can walk up and down the hallway twice a day.’ (Participant 16)

Talking and walking. Whether it be solo or with friends and siblings… It’s a mix of solo stuff like treadmills or a class activity like a HIIT. (Participant 13)

Their dietary concerns mirrored those of younger adults but placed greater emphasis on portion control and longevity, reflecting a shift toward maintenance rather than optimization:

Eat with serving sizes in mind… avoid things like fast food, not eating too much processed meats. (Participant 13)

Older adults’ practices were shaped by both physical limitations and broader structural constraints, such as mobility issues or weather. Nevertheless, health maintenance remained a priority, with modifications made to sustain engagement. Their approach also embraced pleasure and moderation, integrating occasional indulgences into an overall healthy lifestyle:

You can just even jog inside your house, you don’t have to go out on the street if it’s bad weather. (Participant 25)

Limiting fat and eating a good variety of food… but being able to indulge every so often with a nice piece of chocolate or a glass of red wine is also a healthy thing to do. (Participant 32)

These reflections challenge reductive notions of aging as passive decline and bring to light the adaptive strategies older adults employ to maintain agency over their health.

Theme 4.2: shared health knowledge and understanding

All cohorts exhibited a high level of awareness regarding the health risks associated with smoking and vaping. However, perceptions of vaping as a “cleaner” alternative to smoking emerged predominantly among younger participants, often framed with skepticism:

People are moving onto vapes… acting like it’s a better alternative, but obviously for a lot of vapes it’s not. (Participant 2)

Middle-aged and older participants echoed these concerns, expressing alarm at the popularity of vaping among youth and stressed the importance of public health education:

Vaping has just taken over… people justify it as being healthier.

People like the vapes because they come in cool flavours. (Participant 24)

Attitudes toward sleep were universally positive, with sleep hygiene recognized as a key component of overall health. Younger participants often described sleep in functional and straightforward terms:

I just get eight hours of sleep. Yeah, it’s that simple. (Participant 1)

Middle-aged participants reported more intentional routines involving digital disconnection and calming rituals:

Getting off your devices at least half an hour before you go to bed… maybe having a cup of tea. (Participant 16)

Older adults, in contrast, frequently reported disruptions to sleep related to chronic pain or health conditions, which influenced their expectations around rest:

My idea of a good night’s sleep is getting 4 hours… I suffer chronic pain. (Participant 23)

Theme 4.3: cognitive stimulation and mental engagement

Cognitive engagement was a salient theme across all age groups, though the strategies varied considerably. Younger adults frequently incorporated cognitive stimulation into everyday routines via media consumption, often while multitasking:

I enjoy certain podcasts… they really help me to keep my brain thinking and active. (Participant 2)

Middle-aged adults largely viewed cognitive stimulation through the lens of occupational engagement, with problem-solving and professional development serving as vehicles for mental exercise:

Solving work problems. That’s probably 80% of it, even outside of work. (Participant 13)

Older adults were more likely to pursue structured and intentional forms of cognitive engagement, such as language learning, puzzle solving, or university coursework. These practices were framed as both pleasurable and essential for cognitive longevity:

I do Duolingo on my phone. I do lots of different puzzles… up to 3 hours of different exercise activities a week. (Participant 33)

I study at Uni… not because I want a career, but because I love learning. Sitting in a classroom with 20 other students who are under 25, it really challenges you. (Participant 23)

Theme 4.4: personal strategies for maintaining brain health

Middle-aged participants were more readily able to articulate personal strategies for maintaining brain health compared to younger participants. This cohort frequently associated lifestyle choices, daily habits, and personal decisions with long-term cognitive outcomes. Health behaviors were discussed not only as physical practices but as intentional routines to promote mental well-being.

That’s how I’d look at it, Yeah, doing those activities is [linked to] your own overall health and well-being. If you’re doing the right activities and habits, you’ll have a better outcome. (Participant 16)

People need to kind of look after [their brain] and nurture it, and make sure that they don’t ruin it because it’s so easy to fall into bad habits. And then our physical health and our mental health, our brain health, it all just starts to deteriorate. (Participant 17)

Theme 4.5: social contexts for healthy behaviors

Very younger and middle-aged participants contextualized behaviors linked to brain health within broader social, economic, and political systems. Against this trend, several older participants talked about the influence of cultural and social factors on the ability of individuals engage in identified health behaviors:

The type of cultural group, I think, does have a big bearing, a lot of women in some of those groups, they’re not encouraged to exercise. They’re just, you know, expected to be in the kitchen in the home all the time. They’re not getting opportunities. (Participant 25)

These participants were often critical of individualistic views of late life health, arguing that behaviors which contribute to better brain, such as social engagement, adequate exercise, and healthy diets, are contingent on broader social factors:

[Dementia prevention] is seen as an individual thing. So, you know, if you want to avoid dementia, you have to walk every day, and, you know, keep active and keep socially engaged, you know? I don’t think there’s a whole lot of society, you know, pushing people to do that. (Participant 31)

I think we also need to create more feelings of community and create smaller communities where people help, you know, mutual help and an engagement. And so, as those people age, they, you know, they can… get help from other people. (Participant 29)

Discussion

The findings of this study reflect the ways in which brain health is not strictly a biomedical reality but also a socially constructed one which is shaped by cultural expectations, political problematizations, normative life stages, and structural constraints. Participants across early adulthood, midlife, and later life broadly accepted the idea that cognitive decline could be mitigated through behavioral practices such as physical activity, diet, cognitive stimulation, and social engagement. Yet their engagement with these messages varied not only by life stage but by the extent to which they could integrate such practices into their everyday lives. In line with previous literature, this suggests that while the contemporary framing of brain health carries wide, if often simplistic, public salience, its enactment remains deeply stratified within complex economic, cultural, and social systems (Krieger, 2020; Lock, 2013).

These findings closely align with previous studies indicating that older adults are more likely to perceive themselves at a higher risk of dementia, partly due to their interpersonal connections or increased health awareness associated with aging (Chandler et al., 2024; Jetten et al., 2012; Latham-Staton, 2022). Contrary to this, younger adults reported lower perceived susceptibility and severity, consistent with empirical findings that suggest that younger individuals often do not view long-term health conditions as immediate threats (Millstein & Halpern-Felsher, 2002). However, this perspective often diminishes their motivation to adopt preventative lifestyles and behaviors (Chandler et al., 2024). Despite this finding, younger adults did recognize the importance of physical health, diet and nutrition in maintaining overall health, in line with findings of Stine-Morrow et al. (2008).

The growing emphasis on the links between modifiable behavioral risk factors and brain health can be contextualized with broader inculcations of neurological perspectives within everyday understandings and projects of the self (Fletcher et al., 2022; Pitts-Taylor, 2010; Rose & Abi-Rached, 2014). Participants frequently spoke about health behaviors in terms of responsibility and prevention, which echoes broader ­“neoliberal” public health discourses that locate cognitive outcomes in present-day lifestyle decisions. This resonates with Rose’s (2001) work on the neoliberal production of the self as a flexible entrepreneurial actor and a complex neurological materiality, compelled to anticipate and take on neurobiological risk management and optimization. Thus the brain, once considered opaque and largely inaccessible to individual intervention, is now portrayed as something that can be practically maintained, trained, and improved, through “brain-work” (Chelberg, 2025).

Personal responsibility for the brain was particularly evident among younger and midlife participants, who framed their practices in present as part of long-term strategies to secure optimal brain health in the future. Echoing recent qualitative research on late life responsibilization (Pack et al., 2019; Rudman, 2015), several participants further framed personal responsibility for maintaining health next to broader aspirations to ensures the body’s ongoing social and economic usefulness. As Galvin et al. (2021) warn, such framings typically obscure sociomaterial conditions that unequally distribute opportunities for health “responsible” performances of the body. Excluding several older participants who raised social determinants of health when asked about brain health, relationships between social and economic inequalities and brain health in later-life were not discussed. Put otherwise, appeals to personal responsibility for brain health were largely blind to broader structural factors and inequities (e.g., economic precarity, chronic stress, housing insecurity) that influence dementia risk and shape access to health-promoting resources.

Despite participants generally not discussing brain health in terms social and economic determinants, the findings do show that health literacy and, more broadly, knowledges conditional for health choices and behaviors are profoundly shaped by life course experiences, cumulative advantage, and situational constraints. For example, participants with relatively nuanced understandings of dementia etiology were most able to articulate practical strategies for investing in future brain health. At the same time, these participants often reported difficulties in putting acquired health literacy into meaningful everyday healthy practices. Some older participants described engaging in brain-healthy behaviors such as walking or puzzles, but qualified that physical health, caregiving demands, and the built environment made engaging in such activities difficult. Similarly, midlife adults, who often manage the dual burdens of employment and family care described aspirations for sustained brain health but had to attend to more immediate familial obligations and economic needs.

It was evident that perceived responsibility for brain health was embedded within complex and competing temporal, spatial, economic, and interpersonal situations. This finding gives credence to Beard and Bloom’s (2015) and Marmot’s (2020) call for a shift away from individually focused interventions and toward systemic approaches that attend to the social gradients of health. Brain health, when viewed through a life course lens, becomes not simply the outcome of present-day behaviors but the accumulation of exposures to education, housing, labor, stress, and healthcare access over decades (Elder et al., 2003). This study contributes empirical support to this framework, confirming that the “choice” to act on brain health messages is always mediated by social, cultural, and economic context.

While behavior-focused public health campaigns aim to empower individuals with knowledge, they risk reinforcing reductive distinctions between those who choose to act and those choose not to. This framing, prominent in Australian policy documents and existing public health programs, emphasizes brain health as a domain of personal mastery, downplaying systemic conditions and social inequities which affect the brain’s ability to function (Knaggs & Siette, 2025; Lawless et al., 2018). Moreover, for individuals facing material hardship, the pursuit of health is often not a straightforward issue of motivation or of adequate health literacy; it is one of material and economic feasibility (Stephens et al., 2015).

Critically, framing dementia as something which individuals can mitigate may not only be misleading; this may create harm for individuals who develop dementia. There is emerging evidence that the “responsibilization” of brain health as a individually modifiable domain, although intended to reduce overall burden of dementias in society, may paradoxically increase interpersonal stigma, self-blame, and shame among those unable to meet preventive mandates (Peckham et al., 2024). As the participants themselves noted, recommendations for exercise, social engagement, or dietary change are not universally applicable or affordable. Given that incidences of dementia reflect social, economic, and culturally based inequalities (Bodryzlova et al., 2023; Pase et al., 2022), responsibility and stigma is liable to fall disproportionately on marginalized groups (Fletcher et al., 2022). This tension highlights the need for public health approaches that do not simply broadcast information but also, contribute to structural reform which enable people to put emerging evidences into (Bayer, 2008; Chastin et al., 2016; Siette et al., 2023). Interventions must therefore extend beyond health literacy to include infrastructure investment, housing security, flexible work arrangements, and access to safe public spaces.

Importantly, this also requires rethinking how brain health is represented in public discourse. If, as the findings suggest, individuals are already engaging with the concept of brain health as a moral and practical concern, then the task for researchers and policymakers is not merely to increase awareness but to reflect on the frameworks deployed. Emphasizing lifelong responsibility without recognizing structural constraints risks deepening disparities. A truly equitable and effective brain health agenda must foreground not just what individuals should do. It must also consider, from a health justice perspective, who gets to act on brain health and who does not.

Implications and future directions

These findings have multiple implications for research, policy, and practice. First, they call for a critical sociological lens on brain health that moves beyond individual responsibility to account for social, economic, and structural determinants. Rather than positioning lifestyle change as a panacea, future policies and public messaging should embrace a dual focus; on the one hand, supporting individual agency while addressing the broader social determinants that shape health behavior. This includes attending to inequalities in early childhood education, midlife working conditions, and later-life care, all of which leave durable imprints on cognitive health (Lu et al., 2023). Indeed, recent brain health messaging describing how access resources, education, and supportive environments can shape an individuals’ capacity to act has appeared, even in early life stages such as preschool (Siette et al., 2024) and at shopping malls, to reach a wider demographic (Siette et al., 2024).

Health systems can operationalize this by embedding equity-oriented brain health promotion into primary care and community health services, and ensuring culturally and socioeconomically tailored prevention programs, as well as tracking equity metrics to ensure marginalized populations benefit. Practitioners could develop community-based initiatives, such as peer support networks, dementia-friendly environments, or accessible cognitive health programs, to reduce barriers to engagement.

From a policy perspective, this entails aligning brain health initiatives with broader health justice goals, including investment in community-level supports and policies that reduce structural inequalities (Dodds & Siette, 2022; Siette et al., 2022). This includes safe public spaces, educational opportunities, and affordable access to healthy nutrition and physical activity. Policy levers could also include funding for caregiver support, incentives for cross-sector collaboration, and regulatory frameworks that reduce health inequities. By situating individual engagement within a framework of collective responsibility and structural opportunity, researchers, practitioners, and policymakers can design more equitable, effective strategies to promote brain health across the life course.

Limitations

As with all qualitative research, this study is contextually situated and analytically bounded. The sample, while diverse in age, was limited in its geographic and socioeconomic scope, potentially shaping the types of brain health narratives elicited. Participants were also recruited from relatively health-literate, highly educated populations, which may have elevated the salience of prevention discourses and reduced the visibility of counter-narratives, such as fatalism, medical distrust, or cultural divergence in conceptualizations of cognitive decline, as well as limiting discussions to nonstructural determinants. While culturally tailored health messaging is desirable, the possibility for dementia prevention and other brain health campaigns to clash with and undermine cultural beliefs, practices, and identities should also be acknowledged by forthcoming interventions. Historically, problematizing behaviors, habits, and diets, which are “risky” from biomedical perspective have inadvertently devalued the cultural practices and beliefs of nondominant cultural groups (Ranzijn, 2010). A longitudinal, ethnographic approach with more diverse samples could more fully capture the dynamics between responsibility, health practices, structural constraint, and cultural identity across the life course. While the researchers employed a life course framework analytically, the method did not allow them to trace the full biographical arc of participants’ experiences; future work could benefit from more explicitly temporal or narrative methodologies to examine the cumulative shaping of health beliefs and behaviors.

Conclusion

This study contributes to sociological understandings of health governance by illustrating how individuals across the life course engage with emerging brain health discourses. The findings suggest that the cultural framing of dementia prevention and other facets of later-life brain health as a matter of personal responsibility are widely internalized, yet experienced through the differentiated lenses of age, capacity, and social positioning. While individuals expressed agency in adopting health behaviors, their ability to act was fundamentally structured by material, temporal, and relational constraints.

The current brain health agenda further exemplifies a broader shift toward responsibilized models of aging, in which individuals are expected to manage their biological futures through continuous self-surveillance and self-optimization. Such models, while empowering in intent, also risk creating harms by exacerbating health inequalities, masking the structural conditions under which choices are made. A more just and socially attuned approach to brain health would move beyond individualistic prevention paradigms to address the cumulative and unequal life course exposures that shape cognitive outcomes. As societies age and dementia becomes an increasingly prominent public concern, the challenge lies not only in educating individuals on what they can do to promote brain health, but also ensuring equitable conditions for engaging in this kind of action. In this task, public health initiatives remain indispensable.

Supplementary material

Supplementary data are available at The Gerontologist online.

Funding

This work was supported by the National Health and Medical Research Council (TCR 2024768 to J.S.).

Conflict of interest

None declared.

Data Availability

Data are available upon reasonable request to the corresponding author.