Each of the chapters in Aronson and Cruikshank’s texts was incredibly enlightening. However, I found the statistics in Learning to Be Old: Gender, Culture, and Aging to be the most informative about the systemic issues regarding older adults and overmedication. It is alarming to see the significant influence drug companies have over the flow of information to physicians and consumers. The use of the term “polypharmacy” is an excellent example of how the human being who is impacted by overmedication is easily separated from the scientific and enterprise aspects of pharmacology (Cruikshank, 2013). The fact that there is an awareness of how the human body changes over time, how common doses and side effects can impact older people, and that all drugs that are prescribed for long-term use undergo short-term studies is appalling. Suppose patients and their families were informed of these facts rather than being pushed to take prescriptions to correct issues caused by overmedication. In that case, there may be increased pressure on the system to incorporate alternative therapies and better practices in treatment.

I found Cruikshank’s section on drug reactions most informative. Her analysis was thorough and raised concerns for me as a potential social worker. The natural changes that occur during the aging process affect the way drugs are metabolized. This understanding should be at the forefront of the minds of physicians who are prescribing to older adults. Dosing adjustments and more frequent evaluation of patients’ overall health progress should be included in their care plan. Prolonged drug exposure is more detrimental to a person’s well-being. Just because someone is aging or has a specific diagnosis does not mean that the symptoms they present with are an acceptable part of the disease. Improving one’s life should be centered on patient care rather than making things more manageable for the care team. We are caring for people, not a monolithic breed of unintelligent beings.

As an aging person, I imagine that the information Cruikshank shares about aging and overmedication may be daunting, but I found the knowledge empowering. Knowing what the standards are offers a certain amount of ownership over one’s care. The deference that many have to doctors does not serve the patient. We must remember that we all have the right to quality care and should demand it for ourselves and our loved ones. Physicians should be dedicated to serving their patients. The system does not always allow this, but that does not mean we shouldn’t pursue the best care possible.

I really enjoyed seeing Aronson’s growth as a physician, as exemplified in the conversation with Dmitri’s daughter. Her line of questioning took into account their family culture and shifted when needed to gather more information. It was helpful that she had a nurse who was attentive and prepared to assist at a moment’s notice. Svetlana was able to communicate the timeline of her father’s decline accurately, and luckily, that was enough to prove, alongside the pharmacy’s input, that this was a case of a “prescribing cascade.” (Aronson, 2019) Aronson prioritized caring for the whole person, which harkens back to the core of what brought her into medicine. It was also lovely to see that alternative therapies were implemented to improve Dmitri’s quality of life and his ability to be present in his life, even if it did cause waves in his marriage.

Aronson’s statement about how geriatricians attend to dementia reminded me of the Memory Loss Tapes because it not only concerns the patient’s well-being but also that of the caregivers. We saw a vast spectrum of patients in the Tapes, and if this spectrum were more readily understood, then the options for care might be more varied and creative. By remembering that these are people with lived experiences and rich personal histories, not just an unfortunate diagnosis that requires sedation, we can combat the subpar standard of American healthcare.

It was interesting that Aronson received resistance from the course director regarding the topic of her talk. I’m curious about the credentials this person has that would lead them to assume these two professionals would have the same content in their presentations. It shows how little people know about dementia despite the numerous papers written on the topic just that year. All aspects of research, clinical experience, and alternative interventions are essential to the conversation and inform the forward momentum of dementia care.

I was absolutely blown away by Patricia Gabow’s intervention in her mother’s care. While she had made strides in improving the overall standard of care for many patients in the Denver Health system, it was her own experience as a patient’s advocate that helped inform her professional work. Without a dementia diagnosis, Gabow’s mother may have benefited from the course of care suggested by the physicians. Still, her diagnosis would likely have initiated a rapid decline in her mother’s health. If she was going to experience greater distress with an extended hospital stay because she could not understand what was happening, then she was better off with unconventional care. Because Gabow understood her mother’s needs, she was able to facilitate care that actually benefitted her and afforded her dignity in her healing process. The financial factor in this decision-making process would greatly benefit many patients if the knowledge were available. In gatekeeping care options, insurance companies generate revenue, and hospitals are not required to create individualized care plans for patients. The fact that her mother was walking with PT so soon after fracturing her hip was remarkable.

The value of alternative therapies is undeniable, and when given the chance to work in conjunction with medical interventions, the whole person is allowed to thrive. Unfortunately, these options are either reserved for those who can pay out of pocket or are invalidated by the healthcare system because they originate from cultural traditions that do not align with the medical standards dominated by pharmaceutical companies.

References :

Aronson, L. (2019). Elderhood: Redefining aging, transforming medicine, reimagining life. Bloomsbury Publishing.

Cruikshank, M. (2013). Learning to be old: Gender, culture, and aging (3rd ed.). Rowman & Littlefield.