Communicative Justice in Later Life: A Critical Discourse Study and Bioethics-of-Vulnerability Analysis of Older Adults' Primary Care in Spain.

Abstract

Older adults' experiences of primary care are shaped not only by service capacity but by the language and routines through which access and care are organised. Using a qualitative Critical Discourse Studies (CDS) approach informed by the bioethics of vulnerability, we analysed interviews and focus groups with 12 community-dwelling older adults living alone in southern Spain. Critical Discourse Analysis (CDA) linked micro-level talk to meso-level scripts and macro-rationales. Participants portrayed appointment systems and digital channels as gatekeeping devices that shifted agency to family 'brokers', with telephone and app-based booking often producing situational-or, after repeated failures, pathogenic-vulnerability. In consultations, haste, technical jargon and the 'doctor-patient-computer' triad curtailed understanding; age-based commonplaces (e.g., 'what do you expect at your age') legitimised truncated responses; discontinuity with physicians contrasted with nurse-led clarity and vigilance. Emotional sequelae included strategic silence and reduced help-seeking. We argue that vulnerability here is produced rather than intrinsic and can be mitigated via human-assisted booking parity, plain-language and teach-back as safety practices, continuity-by-design, and explicit de-ageing of triage and policy scripts. Communicative justice emerges as a core condition for equitable care in later life.