Aging, Medicalization, and the Person Behind the Diagnosis
1. What surprised you the most about Cruikshank’s discussion of the overmedicalization of aging and why? If nothing surprised you, please talk about why not.
What surprised me most was how easily a health concern can become an older adult’s entire social identity. Cruikshank (2013) describes the expectation that older adults will take on a “sick role,” while having fewer other roles recognized by society. I had thought about overmedicalization mainly as receiving too many treatments or medications. Her discussion helped me see its social side: when people expect decline, they may stop seeing an older adult as a parent, friend, worker, neighbor, or person with goals.
That matters to me as a social work student because a medical need can be real without defining someone’s whole life. Supporting an older adult should include asking what they want to do and what relationships and responsibilities matter to them, alongside asking about their health.
2. Aronson uses patient examples to make her point about medication and the dynamic power of physicians. What did you think about her conversation with Irina, Dimitri’s daughter
Aronson’s conversation with Dimitri’s daughter, Irina, made me think about how much power physicians have to shape a family’s understanding of what is happening. When a professional presents a person’s decline as an expected part of aging, it can be difficult for a family member to question that explanation. Dimitri’s case raises the possibility that medications and their effects need closer examination before his condition is accepted as irreversible (Aronson, 2019).
I saw Irina’s perspective as an important part of his care. Families can notice changes in a person’s behavior and abilities over time, and physicians should take those observations seriously. The conversation reminded me that good care requires professionals to listen, reconsider earlier decisions, and include both the patient and family in decisions.
3. Cruikshank discusses Alzheimer’s Disease in her chapter, describing how Alzheimer’s Disease stands for aging in America. What do you think she meant by that? Aronson, in her section “Confusion” takes a different approach to this condition. How would you describe Aronson’s approach to dementia? Do you think we have moved more toward Aronson’s approach, or do we still believe that dementia stands for aging in America?
I understand Cruikshank’s (2013) point to mean that Alzheimer’s disease has become such a powerful image of later life that people may picture memory loss whenever they think about growing older. That image can make aging seem like an inevitable loss of independence and identity, even though older adults’ experiences vary widely.
In “Confusion,” I would describe Aronson’s (2019) approach as more attentive to the individual. Rather than treating confusion as a complete description of a person, she asks what is happening in that person’s life and what kind of care fits their needs. Her approach makes room for dignity, relationships, and quality of life even when someone is living with dementia.
I think care is moving toward that approach, but the fear Cruikshank describes is still present. We may talk more about care centered on the person, yet discussions of aging still often focus on the possibility of losing memory or independence. As a future social worker, I would want to ask how a person wishes to be treated and what still gives their life meaning, rather than assuming a diagnosis answers those questions.
4. What did you learn from the article you chose? How does it compare with what you learned in Cruikshank and Aronson? Are there things you still wonder about, and what do you still like to know regarding this issue?
I chose a 2025 peer-reviewed study by Pickering and colleagues because it examines potentially inappropriate diabetes medications in older adults and does not focus on dementia. The researchers interviewed 15 older adults with diabetes and 10 family caregivers about what might help or hinder a decision to reduce or stop a medication. They found that understanding a prescriber’s reasons could make people more open to that decision, while fear of negative consequences could make it harder (Pickering et al., 2025).
The article helped me understand that addressing overmedication takes more than identifying a drug that may be harmful. A patient or caregiver also needs a clear explanation and a chance to discuss their concerns. This connects with Cruikshank’s (2013) concern about treating older adults mainly through a medical lens and Aronson’s (2019) attention to what can happen when medical decisions are not examined closely enough. It also adds a practical point: changing a medication plan works best when the older adult understands and participates in the decision.
I still wonder how often older adults feel comfortable telling a physician that a medication makes them feel worse. I would also like to know how health care teams can make time for regular medication reviews and include family caregivers without letting the family’s wishes replace the older adult’s own voice.
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.
Pickering, A. N., Richardson, S., Rogal, S., Thorpe, C. T., Brach, J., & Radomski, T. R. (2025). Facilitators of and barriers to deprescribing diabetes medications in older adults: A qualitative study. Journal of the American Geriatrics Society, 73(8), 2447–2456. https://doi.org/10.1111/jgs.19550
I liked your point about how an older adult’s medical condition can sometimes become their entire identity. I agree that we have to remember there is still a person behind the diagnosis with goals, relationships, and a voice in their own care. I also liked your discussion of family involvement because they may notice changes that healthcare professionals miss. Overall, your post shows why it is important to look beyond a diagnosis, treat older adults with dignity, and include them in decisions about their care.
I appreciated how you emphasized the person behind the diagnosis, especially your point that a medical condition can be real without becoming someone’s entire identity.
That stood out to me because my grandfather currently lives in an assisted-living facility due to dementia, and I have seen how easily people can focus on what an older adult can no longer do instead of remembering their relationships, history, preferences, and continued value. I also agree with your interpretation of Irina’s role in Dimitri’s care.
Family members often recognize changes that may not appear during a brief medical appointment, so their observations should be taken seriously when physicians evaluate whether a decline is caused by disease, medication effects, or both. Your discussion of Pickering et al. (2025) also adds an important point: deprescribing should not become another decision imposed on an older adult. Physicians must clearly explain the reasons, risks, and alternatives while allowing the older adult to remain central to the conversation.
As a future social worker, I want to help older adults and their caregivers feel comfortable asking questions while ensuring that neither the physician’s authority nor the family’s preferences silence the older adult’s own voice.
Gerald,
I raised the featured image issue in my feedback on the previous two blog posts, but you are still having trouble. I emailed you in the hope that it would be more helpful. If you still have questions, please let me know.
Cruikshank discusses overmedication much more in this chapter. In her previous discussions, she does talk about the sick role, but this is a different issue, and she raises other, significantly important points that you could have mentioned. (later addition) I understandf that the readings for this post were Ch 3 and 4 – so the discussion of the “sick role” applies. My point was that overmedication was the main thrust of the question.
Regarding Dimitri’s care, Aronson struggled to understand why he had deteriorated so quickly. The gist of the reading was that Aronson asked the right questions to get the information she needed to figure out the problem. While you are correct that physicians need to listen to family, Aronson shows that you also have to ask questions in ways that elicit that information. She was able to see that the problem was the cascade of medications that caused his decline.
Saying dementia is defining aging in America suggests that the fear of dementia is all people think about when they think about aging. Therefore, they don’t want to think about it or talk about it. I do agree with you that Aronson is suggesting something much different. She insists that aging is a social phenomenon and that people can engage in and enjoy life as they age. But she is a gerontologist, after all, right?
The article you chose was very interesting. It was a small qualitative study that suggested ways to enhance deprescribing of diabetes medications. The interviews were in-depth qualitative interviews, and their analysis structure was fascinating (as a qualitative researcher myself, I found it fascinating). The domains they used to organize the interview data, along with examples of comments from the interviews, were really enlightening about this issue. (Of course, you had to go to the actual full PDF of the article to actually get any of this information) I didn’t realize how many older adults are overmedicated for diabetes. It was a really interesting article in view of this and you could have discussed a lot more in the full text.
Dr P