• What surprised me the most about Cruikshank’s discussion was how much American culture can contribute to the overmedication of older adults. I was especially interested in the “more is better” mentality and how that can carry over into health care. In American culture, we often associate having more with something being better, but I had never really thought about how that same mindset could influence the amount of medication and medical treatment a person receives. One statistic that really stood out to me was Cruikshank’s discussion of nursing home residents receiving an average of eight medications a day (Cruikshank, 2013). This number jumps out to me and made me question whether more medication means better care. Before reading this chapter, I assumed medications were prescribed because they were medically necessary. Cruikshank made me think more about how our culture views aging itself. We tend to associate getting older with sickness, which can lead to normal changes in aging being treated as medical problems that need to be fixed. What was especially concerning to me was her point that medication can cause slowing down, confusion, or falls, and those effects can then be mistaken for normal aging. 42.pdf To me, this shows how easily a cycle can develop where an older person is given more medication, experiences side effects, and then those effects are blamed on their age instead of the medication. Overall, I was surprised by how much overmedication can be connected not only to medical decisions, but also to our American belief that more treatment must mean better treatment.
• What stood out to me about Aronson’s conversation with Svetlana was how easily Dimitri’s decline could have been accepted as an inevitable result of Parkinson’s and aging. Svetlana initially described his condition, but Aronson kept asking what Dimitri had been like before and how quickly he had changed. That led Svetlana to explain that he had been walking, talking, and reading the newspaper only six months earlier. Aronson reviewed Dimitri’s prescriptions and considered whether they might be contributing to his condition. I appreciated that Aronson did not assume the existing diagnoses explained everything and asked the additional questions. The case shows how much power physicians have. One prescription led to side effects that were treated with more prescriptions, while Dimitri’s overall decline went unquestioned. It also shows why families should be heard as partners in care. Svetlana knew her father’s history in a way his medical chart may not capture (Aronson, 2019)
• I think Cruikshank means that Alzheimer’s has become the image many Americans associate with growing old. She acknowledges how devastating the disease is, but argues that media has made people fear it as though it happens to most older adults. That fear can cause us to see an older person through the possibility of decline rather than as an individual (Cruikshank, 2013, pp. 39–40). Aronson takes a different approach by separating dementia from normal aging and looking at the whole person. She points out that most older adults do not have dementia and that a sudden decline may have another maybe treatable cause. For people who do have dementia, she emphasizes communication, support for caregivers, and quality of life alongside medical care (Aronson, 2019, pp. 51, 54). I think we have moved somewhat toward her approach, but fear still shapes how people talk about dementia. When someone is described as if they are already “gone” it’s harder to recognize the person who is still there.
• Mikkelsen, T. H., Søndergaard, J., Kjaer, N. K., Nielsen, J. B., Ryg, J., Kjeldsen, L. J., & Mogensen, C. B. (2023). Handling polypharmacy – a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatrics, 23, Article 477.
  • This article helped me see that taking multiple medications affects more than a person’s physical health. The older adults interviewed were concerned about side effects and interactions, and some felt confused when medication names or instructions changed. A lot of patients wanted a thorough review and a clearer explanation of what they were taking (Mikkelsen et al., 2023). This connects with Cruikshank’s concerns about overmedication and with Dimitri’s story in Aronson: medications can accumulate while no one steps back to look at the full picture (Aronson, 2019; Cruikshank, 2013). What the article added for me was the patient’s point of view. Even when each prescription has a reason behind it, managing all of them can become overwhelming. I still wonder how often medication reviews lead to meaningful changes, rather than simply reassuring patients that their current list is correct. I’m also curious about what helps older adults feel comfortable questioning a medication their doctor prescribed.

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 Publishers.

Mikkelsen, T. H., Søndergaard, J., Kjaer, N. K., Nielsen, J. B., Ryg, J., Kjeldsen, L. J., & Mogensen, C. B. (2023). Handling polypharmacy – a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatrics, 23, Article 477.